Canada’s crisis of primary care access: Is expanding residency training to 3 years a solution?

The crisis and manpower free-fall of comprehensive community family physicians is well covered by the article. Both challenges in comprehensive care and increased interest in time/financial protected niche care have contributed to this....ignored multifactorial societal and personal evolutions. There are critical problems and missed opportunities of the current CFPC proposal.

As a very longstanding CCFP/FCFP member, I recall my residency choices for 'general practice' were either the FM specialty certification route of CFPC, or the minimal competency route of the 1-year rotating internship. The former was the comprehensive family systems program that I chose. The latter was for many either undecided, or just didn't want to bother with the extra training time in order to get out into the real world to start serving our communities. Since that time, rotating internships have been fully retired, and those who were licensed under that schema have largely been cajoled into practice-eligible CCFPs. The result is that while I have appreciated and supported CFPC's aspirations of excellence and comprehensive training, the fact is that society (and residents) have no minimum path to licensure and service. I am near full spectrum FM (no obs/ER) with many expanded areas of practice that will not be emphasized in any CFPC program. Most of my newer colleagues, and certainly most current students, don't want this, and as pointed out in the article, many of our practices will have very limited team-organized opportunities. So, aspirational, but not much of a fit for actual needs. CFPC is trying to move up Maslow's hierarchy triangle, even as the foundation security level is crumbling. And this is done without offering society and residents the opportunities to not be leaders, not be team-based, not be more sensitive than those of us already in practice, and not all the extras. Sometimes we just need to be out there in service. Since CFPC was essentially complicit in removing the rotating internship equivalent, they have assumed that mantle, and I would propose, therefore has an obligation to provide some equivalency to adequate minimal training instead of moving further along aspirations of excellence.

In fact, I would propose that CFPC remap their demands to a 2-year core skills/experience CCFP. They can move all the aspirational, leadership, societal items to a 3rd year fellowship, and replace the current not-useful FCFP designation. This is much better alignment with the concept of medical fellowships anyway. And the +1 can remain as either a CCFP+1 or an FCFP+1. I would happily give up my FCFP designation, which really has never had meaning or value for the 2+ decades I've had it.

To my young proteges, it's been a wonderful career with many opportunities. With innovative approaches, wider societal involvement, and support from our august bodies, you will have decades of satisfaction and service ahead.