Do Canadian FM Residencies adequately prepare you?

[blueskyguy]

Hello all,

I am a Canadian citizen currently in my 3rd year at a U.S. med school. I am interested in pursuing a career in FM, and I would ultimately like to live and work in Canada. I am at the point where I have to start to think about whether I should start aiming for a U.S. FM residency or a Canadian FM residency. I understand that the Canadian FM residency is 2 years and the U.S. FM residency is 3 years. 

Does the 2 year FM residency in Canada adequately prepare you to practice right out of residency? I am mostly interested in working in an outpatient setting, including a clinic/walk-in clinic setting in Ontario.

I recently spoke to a Canadian FM doc working in Ontario who completed his FM residency in the U.S., and he said something like "it takes 5 years for Canadian-trained FM docs to match U.S.-trained docs", but he also said he was biased.

Is this true? How competent are Canadian-trained FM docs? Would they be adequately prepared to start working in a clinic/walk-in clinic setting right out of residency? Do they have to be "coached" or "groomed" after residency?

Thanks for the advice and help!

[bearded frog]

Considering the 100s? of FM programs in the US, there's going to be a way bigger difference in performance following residency between the best and worst US program compared to the average US and Canadian program. Canadian programs vary heavily too, ie a rural program vs an urban program with rotations at tertiary hospitals (each will have advantages in certain areas). All else being equal, especially with FM vs other residency programs, my opinion is you should try to do your residency where you want to work, or at least in the same province. Each province has their own nuanced system/billings/practices etc. that would be very useful to not have to relearn when you finish residency. Also learning the Canadian system is important vs US system. Certainly I hear no great clamoring for FM to be longer from the recent grads or senior docs, so its basically one more year of staff salary vs residency salary.

[Baljinderthecrow]

Is there a particular reason why you want to match back into Canada? Do Family docs have a better lifestyle in Canada? I am asking from the perspective of a Canadian who will be begin med school in the US next year. 

[medigeek]

Huge variance. The best FM programs in USA will be better since they essentially prepare you to take care of ICU patients, Ob, etc. The very good FM programs in Canada are also excellent. 

Also programs can have weaknesses and strengths and you have to see if those fit your personal goals. I will admit there are some FM programs in Canada/USA that are all-around weak. Residents don't do anything beyond bread and butter stuff/constantly refer things out, inpatient training is weak, peds exposure isn't good, not much high acuity exposure in ED, Ob experience is poor etc. Those can be true for any residency but when you combine them all together.....

[yup]

2 hours ago, medigeek said:

Huge variance. The best FM programs in USA will be better since they essentially prepare you to take care of ICU patients, Ob, etc. The very good FM programs in Canada are also excellent. 

Also programs can have weaknesses and strengths and you have to see if those fit your personal goals. I will admit there are some FM programs in Canada/USA that are all-around weak. Residents don't do anything beyond bread and butter stuff/constantly refer things out, inpatient training is weak, peds exposure isn't good, not much high acuity exposure in ED, Ob experience is poor etc. Those can be true for any residency but when you combine them all together.....

Can you elaborate on the "very good" FM programs in Canada vs. some of the weaker ones if your goal is to practice rural?

[Edict]

12 hours ago, blueskyguy said:

Hello all,

I am a Canadian citizen currently in my 3rd year at a U.S. med school. I am interested in pursuing a career in FM, and I would ultimately like to live and work in Canada. I am at the point where I have to start to think about whether I should start aiming for a U.S. FM residency or a Canadian FM residency. I understand that the Canadian FM residency is 2 years and the U.S. FM residency is 3 years. 

Does the 2 year FM residency in Canada adequately prepare you to practice right out of residency? I am mostly interested in working in an outpatient setting, including a clinic/walk-in clinic setting in Ontario.

I recently spoke to a Canadian FM doc working in Ontario who completed his FM residency in the U.S., and he said something like "it takes 5 years for Canadian-trained FM docs to match U.S.-trained docs", but he also said he was biased.

Is this true? How competent are Canadian-trained FM docs? Would they be adequately prepared to start working in a clinic/walk-in clinic setting right out of residency? Do they have to be "coached" or "groomed" after residency?

Thanks for the advice and help!

Just pick the shorter one. You'll find that there are always ways to extend your training, but you'll also find that in most cases, by the end, you don't want to. I personally don't think Fam Med should be just 2 years for the reasons you are talking about, but I mean it more in terms of the lowest common denominator, i don't know if someone who does the minimum amount necessary for lets say a 3 yr med school and then a 2 yr residency is going to be good enough to be independent at least for the first few years.. If you are keen and willing to work hard, as i'm sure you are, you'll do fine in Canada's FM residency. 

[medigeek]

5 hours ago, yup said:

Can you elaborate on the "very good" FM programs in Canada vs. some of the weaker ones if your goal is to practice rural?

If your goal is rural then pick a more rural (not necessarily remote rural btw...) program. Not sure where you are but most provinces have good ones. Urban residencies tend to be more outpatient focused, but that's not always the case either. I would also ensure the elective time is there so you get more a more urban/suburban inpatient/ICU experience and get exposed to high acuity and complexity patients. 

USA programs are more inpatient heavy and a majority prepare you to do what is essentially GIM work in Canada. Some of the exceptionally good ones (ex. ventura county) train you for managing day to day high-acuity ICU patients etc. 

[magneto]

On 3/4/2020 at 4:50 AM, blueskyguy said:

Hello all,

I am a Canadian citizen currently in my 3rd year at a U.S. med school. I am interested in pursuing a career in FM, and I would ultimately like to live and work in Canada. I am at the point where I have to start to think about whether I should start aiming for a U.S. FM residency or a Canadian FM residency. I understand that the Canadian FM residency is 2 years and the U.S. FM residency is 3 years. 

Does the 2 year FM residency in Canada adequately prepare you to practice right out of residency? I am mostly interested in working in an outpatient setting, including a clinic/walk-in clinic setting in Ontario.

I recently spoke to a Canadian FM doc working in Ontario who completed his FM residency in the U.S., and he said something like "it takes 5 years for Canadian-trained FM docs to match U.S.-trained docs", but he also said he was biased.

Is this true? How competent are Canadian-trained FM docs? Would they be adequately prepared to start working in a clinic/walk-in clinic setting right out of residency? Do they have to be "coached" or "groomed" after residency?

Thanks for the advice and help!

I feel that 2 year FM residence was adequate in preparing me to independently practice right out of residency.

The thing about Canadian-trained FM vs U.S.-trained is NOT  true.

Canadian-trained FM docs are competent. College gives them a license to practice. And if the program or college feels that resident is not competent then he/she does not get the license.

FM residents will be adequately prepared to start working in a clinic/walk-in-setting right out of residency.

I don't think they need to be "coached" or "groomed". Of course, they will keep improving just like any other specialty. Medicine is a life-long learning.

There are always residents who do not put in the work or do not have the enthusiasm. But a few bad apples do not make the whole batch bad.