A new medical school coming to Ontario! (in addition to TMU Medical School scheduled to open in Sept. 2025)

[Bambi]

https://www.yorku.ca/news/2024/03/26/york-university-welcomes-transformative-investment-in-next-phase-to-create-a-new-school-of-medicine/

https://toronto.citynews.ca/2024/03/26/ontario-budget-2024-york-university-medical-school/#:~:text=As more than a million,dedicated to training family doctors.

York University medical school

The Progressive Conservatives are partnering with York University in Vaughan, Ont. to build a new medical school specifically for family physicians.

Few details have been provided on this new initiative, with officials saying that about $900 million has been put aside for planning.

The government says this will be the first medical school in Canada primarily focused on training family doctors.

It’s unclear why York University was chosen as the partner institution for this new endeavour, as a December auditor general report(opens in a new tab) found that an overreliance on international students and steadily decreasing domestic enrolment was putting the institution at risk.

Working with our Partners

York is working closely with community, government and health sector partners as we plan for a new School of Medicine. On March 26, 2024 the provincial government announced its support for further development and planning for a new school. York’s formal collegial governance processes will work to establish the School and Medical Doctor degree program.

 

The above is in addition to TMU Medical School:

 https://www.torontomu.ca/news-events/news/2023/03/senate-approves-establishment-of-new-school-of-medicine/

[robclem21]

What an absolute disaster....

[Bambi]

Why?

See https://www.oma.org/siteassets/oma/media/public/hcp-factsheet-doctor-shortage.pdf

https://ottawa.citynews.ca/2024/01/29/ottawa-short-171-family-doctors-oma-warns-the-province-needs-to-act-now/

https://www.newswire.ca/news-releases/ontario-s-doctors-say-primary-care-is-in-crisis-burnout-at-record-levels-806211567.html

https://toronto.citynews.ca/2024/02/14/paperwork-burden-driving-ontario-family-doctor-to-quit-amid-critical-gp-shortage/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10186392/

 

[shikimate]

I thought York med school was supposed to open like in 2017 or something?

[Aetherus]

This is going to lead to a disaster in CaRMS if they don't add residency positions to match all these new seats they are creating. It's always the same thing, it's much more appealing politically to build a new medical school instead of investing in residency positions. In addition, if they don't address the factors that are making medical students shy away from primary care in the first place, this will just lead to greater competition for speciality positions and exacerbate an already broken system. 

[Bambi]

I understand why thoughts of disaster. I would assume that acceptance into the new medical school would be subject to the equivalent of a ROS Agreement whereby the student agrees to do FM in Ontario for x number of years, perhaps in an under serviced community or in a specific geographical area AND there would need to be a corresponding increase in the numbers of FM residency positions in CaRMS. Otherwise, the province is not achieving its goals.   

The intended date for med school opening for York is now September 2025.

[MedicineLCS]

Even if there is a ROS that forces people to do comprehensive family I'm not sure how effective that is since there's nothing to stop someone from immediately ceasing comprehensive family practice the minute it's over OR doing hospitalist/EM/surgical assist/anesthetics/some other non-comprehensive FM thing. 

[Bambi]

The devil will be in the details and who knows how far along they are with these highly important points. It has the capacity to be a marvelous success or as robclem21 suggests, an absolute disaster.

[indefatigable]

I think the pretext for both medical schools in TO is the primary care shortage, but more medical schools will not address the root causes of the shortage.  In fact, there are actually more FM doctors than ever - but they're not doing comprehensive primary care.  

TMU is adding residency spots in excess of UGME spots, however I agree that the same matching trends will likely continue in terms of specialty preference (>)> FM.  

The Ontario Government announced on March 15, 2022 that TMU will receive the following ministry-funded spaces as of 2025: 

• 94 Undergraduate Medical Education (UGME) seats for medical students
• 105 Postgraduate Medical Education (PGME) seats for residents

If York builds a medical school like Queen's FM stream, at best it will create more FM docs, not necessarily comprehensive physicians for which there are many articles highlighting a poor practice environment:

https://www.ctvnews.ca/canada/sinking-ship-doctors-say-unfair-salaries-driving-them-away-from-family-medicine-in-canada-1.6821795

https://www.thestar.com/opinion/contributors/as-family-doctors-our-prescription-for-residents-is-to-not-set-up-a-practice-in/article_92430004-d015-11ee-9408-d711cf0d1b55.html

 

[robclem21]

16 hours ago, Bambi said:

The devil will be in the details and who knows how far along they are with these highly important points. It has the capacity to be a marvelous success or as robclem21 suggests, an absolute disaster.

It has nothing to do with the need. I am 100% confident that this province needs more family physicians and that both access and the availability of family physicians are at critically low levels. Who is going to train these doctors?

Even family medicine programs need access to sites with dedicated CTUs, OB, pediatrics, emergency medicine and family med clinics with faculty willing to teach. They need people to teach and create lectures, seminars, tutorials, academic day and simulation for residents, etc. Physicians in community settings aren't always interested in providing this and getting buy-in from those who just want to practice and are already burnt out is miserable. Not wanting to be involved in academics is why many went to the community in the first place. Finding the capacity in hospitals/clinics for an additional several hundred people (per year) is nearly impossible. Even TMU right now is in the process of not being able to obtain RC accreditation for many of their residency programs because they don't have the appropriate infrastructure in hospitals to provide rotations or teaching for residents. They are relying on other schools to accept and teach their trainees that also don't have capacity to support their current learners.

The idea up front is excellent, but the downstream infrastructure doesn't exist to actually feasibly train this many new doctors. They can't just show up to a clinic and be a functional member of the healthcare team. The money is there, but it's a publicity stunt with poorly explored consequences.

[GH0ST]

On 3/26/2024 at 6:45 PM, Bambi said:

 

York University medical school

..........................

The government says this will be the first medical school in Canada primarily focused on training family doctors.

Rofl I guess NOSM doesn't count as a medical school, you know, the first one with an actually integrated and practiced mandate for social accountability. 

Even Ontario government can't remember their medical schools

- G 

[shikimate]

Well a lot of hospital based physicians don't really have a choice. When the hospital starts getting students you either take it or go to another hospital. More and more community places are supposedly becoming affiliated with medical schools.

Just look at UPEI/MUN, supposedly they need to hire 70 additional doctors in PEI to reach the capacity for teaching. They'd be lucky if they don't lose any in the first place!

Personally I've never got a single dime for all these medical students I've supervised lol.

[Findanus]

5 hours ago, shikimate said:

Well a lot of hospital based physicians don't really have a choice. When the hospital starts getting students you either take it or go to another hospital. More and more community places are supposedly becoming affiliated with medical schools.

Just look at UPEI/MUN, supposedly they need to hire 70 additional doctors in PEI to reach the capacity for teaching. They'd be lucky if they don't lose any in the first place!

Personally I've never got a single dime for all these medical students I've supervised lol.

Why are you working for free?

[anonymouspls]

This new trend of opening medical schools left and right without addressing the core chronic deficiencies of the healthcare system will surely create an awesome experience for Canadian medical trainees in the next decade! Just like unrelenting uncontrolled mass immigration and braindead economic policies have been such a boon to every facet of our society, Canada is only on the up and up!

I would strongly encourage every single CMG and resident in Canada to write the USMLEs. This country is quickly heading off a cliff. 

[DrOtter]

Honestly - this is what premeds and the public don't seem to fully appreciate. All these headlines of "Canadians left the country to study medicine" etc.

Even the US and UK are facing ever-worsening problem with getting enough training spots for their medical graduates because of the unscrupulous ballooning of medical school admissions.

People love to complain about how hard it is to get into medical school. Just wait until they see how much worse it is gonna be to go unmatched with $100k+ in student debt having graduated from a Canadian med school in a few years.

[Bobthebuilder]

10 hours ago, DrOtter said:

Honestly - this is what premeds and the public don't seem to fully appreciate. All these headlines of "Canadians left the country to study medicine" etc.

Even the US and UK are facing ever-worsening problem with getting enough training spots for their medical graduates because of the unscrupulous ballooning of medical school admissions.

People love to complain about how hard it is to get into medical school. Just wait until they see how much worse it is gonna be to go unmatched with $100k+ in student debt having graduated from a Canadian med school in a few years.

wym ? there were like 50 + residency spots left after second iteration last year but everybody wants ROAD > FM. That's the issue. Also, since 2014 unmatched rate after 1st round is gradually increasing from 0.6% to around 2%. My interpretation is not lack of residency spots but a discrepency between spots available and what people actually want to do. Perhaps more of a FM attractivity problem than a residency spots availability problem ?

just my 2 cents

Bob

[DrOtter]

54 minutes ago, Bobthebuilder said:

wym ? there were like 50 + residency spots left after second iteration last year but everybody wants ROAD > FM. That's the issue. Also, since 2014 unmatched rate after 1st round is gradually increasing from 0.6% to around 2%. My interpretation is not lack of residency spots but a discrepency between spots available and what people actually want to do. Perhaps more of a FM attractivity problem than a residency spots availability problem ?

just my 2 cents

Bob

The increasing unattractiveness of family medicine is definitely a factor, but even then, people who shift away from FM aren't necessarily gunning for ROAD either - lots are going for IM and EM as well.

And that's really part of the problem here right? simply increasing the number of medical school seats while doing nothing to address the systemic issues with primary care or increasing residency spots guided by MD grad trends will lead to higher risk of going unmatched (yes, even if there are tonnes of FM spots left to fill).

And tbf, even IMGs who are desperate to enter Canadian residencies don't want or are able to match to many of these unfilled spots - I can't imagine the higher number of CMGs are going to magically fill these. 

[Pakoon]

I think this entire discussion lacks insight into what the real problem in Ontario is at the moment; a lack of primary care in the form of family practices.

By the numbers of nearly any match year, you'll have ~50% of a graduating class match into FM regardless of how many wanted to be a ocular neuro-cutaneousplastic cosmetic interventional cardio surgeon. 

The real issue lies in the fact that family physicians are not incentivized to open a family practice. So no matter how many FM positions you open, if people would rather do LTC, locums, OB, ED, hospitalist or any other number of flexible roles at their disposal, the shortage will remain.

They can go ahead and pump the numbers up, but until they make it appealing for new grads to open practices, this problem will only get worse.

The best new medical schools will do is marginally increase supply and at worst seriously damage our collective bargaining power down the line. 

[shikimate]

I heard the situation in UK and Australia isn't much better either. Was reading some articles earlier this year about a lot of "GP Surgeries" (aka FM clinics) closing due to lack of doctors in UK. Maybe Canada can poach some GPs from NHS lol, at least we are marginally a bit more affordable than UK and our inflation # isn't as bad as there.

[MedicineLCS]

I think part of this is recognizing that different groups have different, not necessarily identical, goals. The province no doubt wants more Ontarians to have FMs, but they also want to say they "did something" and considering how little the average Ontarian understands about the medical training pipeline they love opening medical schools as it says "look we did something". It's also a popular move with the local University and MPP as well. "Think of the new jobs!". Now if they churn out 300 more Ontario grads in 4 years and the crisis is still there they can say "well look at all we did it's obviously a problem for the OMA to solve". The reality is the universities/cities are big lobbyists because they'd love more shiny new things than adding 10 spots to an existing school (already done anyway). Think of the ED backlog problem, it's not very flashy to say you'll help it by paying for allied health support on weekends to speed up dispo processes, or to admit the real problem is inadequate hospital resources combined with inadequate dispo options combined with unattached patients. 

Arguably, if the province was somehow able to open the floodgates of FMs they would be able to point the finger back and say it's really an allocation problem (what a lot of people have been saying all along) and that generalism isn't popular for a number of system reasons. Of the let's say 5-10 friends I have doing FM I'd say maybe 1 has indicated a desire in generalist practice. 

[Edict]

I'm going to play devil's advocate and be in favour of this proposal. This is just an early announcement and everyone is pouncing on it with worst case scenarios. First, we know that the GTA has plenty of community hospitals that could serve as teaching hospitals. Second, we know that the GTA is growing rapidly and these medical schools are long term plays, they are being built for the next 100-200 years. Toronto is the largest city in North America with just 1 medical school. It is a simple fact that we have needed a 2nd or even a 3rd medical school for a long time now. 

Naturally, with medical schools there will be residency programs. Naturally, York will start off as mainly designed to train family doctors, but with time this will change. McMaster was founded mainly for similar reasons too but now has grown rapidly into a full service medical school. 

We need more medical schools and we can't just keep gatekeeping our profession or else the government will do it for us. 

[Aspirin 81mg]

^Agree with above, Province taking action better than no action. 

Interested to see where TMU places its medical students. Every major academic hospital in Toronto is already affiliated with the University of Toronto (UHN, Unity Health, SB, NYG).  Would it be easier opening a FM stream at UofT rather setting up another faculty of medicine....

[indefatigable]

I can't think of any other profession where experienced practitioners are quitting and the solution is somehow to try to coax more graduates into comprehensive FM in part by building more med schools.  Yet another "I am quitting FM in Ontario" article.. in this case a 20 year seasoned primary care practitioner.  

https://torontolife.com/city/family-doctor-clinic-closing-burnout-inflation/

Granted she was working in a HCOL location (Mississauga), although it's close to where these new med schools are being built, but some of the highlights are "When I was first building my practice, I made about $90,000 per year, after all our office expenses were accounted for. In 2022, that figure was about $142,000".   When the average medical student debt is somewhere around 150-200K, Ontario FM in HCOL locations is becoming unsustainable.  Like MedicineLCS noted, this is all about show and not about substance - it sounds good for other universities to have med schools but does almost nothing to fix the underlying issues.  What's the point in building more med schools if you're facing accelerating losses?  Any rational strategy would involved both retention as well as recruitment.  

This makes me think of health care in Ontario

.

[rmorelan]

On 3/27/2024 at 12:48 PM, MedicineLCS said:

Even if there is a ROS that forces people to do comprehensive family I'm not sure how effective that is since there's nothing to stop someone from immediately ceasing comprehensive family practice the minute it's over OR doing hospitalist/EM/surgical assist/anesthetics/some other non-comprehensive FM thing. 

Other than I suppose the market will be flooded at some point, making it extremely difficult for anyone to actually get into those positions. Depending on the timeline involved you could be in full practise for awhile prior, and physically not be in an area where you can easily network into those positions. 

This seems to be a part of the strategy here overall - They cannot force people to go into particular fields easily, even if those fields are exactly where they think people can go. Instead they can control the ratio of students to CARMS spots - effectively a larger portion of people into less popular fields ultimately or doing things like ROS etc (or both). 

 

 

 

[zoxy]

On 4/20/2024 at 6:26 AM, rmorelan said:

This seems to be a part of the strategy here overall - They cannot force people to go into particular fields easily, even if those fields are exactly where they think people can go. Instead they can control the ratio of students to CARMS spots - effectively a larger portion of people into less popular fields ultimately or doing things like ROS etc (or both). 

Why would the government make practicing family medicine desirable when you can force desperate medical students with 200K of debt to do it? The capital gains tax changes with no exemption for incorporated physicians in the setting of rising inflation and static fee codes show how much contempt both the federal government and provinces have for doctors.