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- Page navigation anchor for RE: Transforming training for todayRE: Transforming training for today
My thanks to the members who took the time to share their thoughts on my column outlining the current work of the CFPC to strengthen family medicine residency training in Canada.
Among the various responses, I note the well-placed focus on rural medicine. Current discussions around what a strengthened residency program will look like has supporting primary care needs in underserved areas, particularly rural and remote communities, as a priority. As stated in the original column, however, any redesign will consider how best to incorporate opportunities for further exposure and transition supports in such settings that might comprehensively equip learners while providing critical resourcing for these communities.
I agree with many of the challenges presented by the well considered and passionate viewpoints expressed by Dr. Jay and other commentators. It's important to note that the current proposal to strengthen residency training is being overseen by CFPC in its mandate as a standard-setting organization for the purposes of certification. That said, the decision to do so arose from a wide-ranging, multi-year consultation with many key individuals drawn from family medicine who have expertise on postgraduate family medicine training. Materials from this consultation are available on our website. (1)
Also notable is that many of the present concerns raised as arguments against the proposal to redesign residency curriculum are, in fact, broader chal...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: 3rd year residencyRE: 3rd year residency
The aims are good. The timing is disastrous.
With a shortage of doctors now, with population further growing by 1.5 million from immigration in the next 3 years, with more doctors retiring in the next 5 years than graduating, your plan should be postponed in favour of offering CME to licensed physicians to fill the gaps you see and accelerate licensing of foreign trained physicians.
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I am concerned the College of Family Physicians of Canada’s plan to have family medicine residency be three years rather than two will harm the specialty.
Family medicine is increasingly being done by NPs and PAs, both groups who have magnitudes of order less training than family doctors. And now we can add pharmacists to the list, who do not get any formal training on differential diagnoses. These groups have done an excellent job advocating for themselves vis a vis that less training is not a problem, and in response, many patients feel comfortable receiving primary care from them. This is in spite of the fact that data from other jurisdictions shows that non-physician providers cost the system more in the long run.
Family medicine already has a PR problem. The hidden curriculum at med school is that family medicine is the lowest status specialty, and one of the lowest paid. Adding in an extra year of training, when evidence shows that patients who have a family doctor have a mortality benefit, and at a time when the role of family doctors is being eroded through government-sanctioned increases in the number non-physician providers seems detrimental to the future of family medicine in Canada.
The justifications raised in this article do not explain how on the one hand it is safe for non-physicians to have expanded, independent, medical scopes, but that physicians need more training to occupy the same jobs. Before such a drastic, far-reaching change...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: three-year residencyRE: three-year residency
I am a family doctor who practises both in the city and in rural/remote locations. I fully support the shift to three years. The shift away from acute care since 1993 is largely appropriate. However, the lack of ICU, in Calgary anyway, increases the fear that newer family doctors have of working in the periphery. That is where I learned to get an airway reliably and use vasopressors. There are other ways to do this I’m sure. The competencies required in Obstetrics have also steadily declined, while the distances a rural person in labour has to travel are ever greater as communities close their OB programs. With all due respect to the “soft” skills we also desperately need, there are some hard skills that are being lost. Working rurally will never give a resident the volume of hands on airway management or OB skills they need to safely work out there. In fact, it would be wonderful if rural docs could also rotate through as a resident in the city sometimes for a week here or there.
Regards,
Dr Janet Northcott
Competing Interests: None declared. - Page navigation anchor for RE: residency trainingRE: residency training
We have seen over the last thirty years the effect of lengthier training on primary care access - primary care access is diminished and patients flock to emergency rooms for primary care. In the past, doctors who completed a one-year internship would go on to perform locums or brief positions in communities to hone their skills and many would settle down in primary care and not go on to a Royal College specialty. The two year program aimed to better prepare doctors for practice but inadvertently reduced the number of people locuming in rural areas - rural medicine is now a dying profession. With an additional year of training, rural medicine will be annihilated.
Competing Interests: None declared. - Page navigation anchor for RE: Transforming Training for TodayRE: Transforming Training for Today
The idea of a year of quasi-independent rural practice to obtain a wide base of abilities is a good idea. Rural practice is exactly what I did in 1972-73 after a one-year rotating internship. I was far ahead of my classmates who stayed for a two-year FM residency, and I stayed for 5 years of service.
Competing Interests: None declared. - Page navigation anchor for RE: residency trainingRE: residency training
Have you considered the importance of practice management training in the residency. Currently very few , if any, receive this training and consequently either have no interest nor ideas on how to do so.
Competing Interests: None declared.