Chillest FM Programs in Canada (Schools and specific sites)

[8fuewbf]

Hey everyone,

I'm going into my 4th year of med school and I'm starting to think about which FM residency program might best suit me. I am at UofT now and I will be honest; clerkship really kicked my ass. I like the idea of Family Med, but I am not looking to kill myself in residency. I would like to have more of a life than I have had this past year in clerkship. I have been having trouble finding a current thread on this topic: I am looking for any insights on the "chillest" FM residency programs in Canada. This would include both schools, and specific sites at those schools (Mississauga site at UofT, or Coastal Health at UBC, for example). 

Anecdotally, I have heard that community sites are more relaxed than downtown centres at UofT, but am looking for more information than is offered on the program websites...

Things that I am interested in hearing about are average number of work hours, call shifts per month, work-life balance, amount of elective time, and importance of wellness to the faculty, among any other things you find relevant!

Thanks!

[JohnGrisham]

3 hours ago, 8fuewbf said:

Hey everyone,

I'm going into my 4th year of med school and I'm starting to think about which FM residency program might best suit me. I am at UofT now and I will be honest; clerkship really kicked my ass. I like the idea of Family Med, but I am not looking to kill myself in residency. I would like to have more of a life than I have had this past year in clerkship. I have been having trouble finding a current thread on this topic: I am looking for any insights on the "chillest" FM residency programs in Canada. This would include both schools, and specific sites at those schools (Mississauga site at UofT, or Coastal Health at UBC, for example). 

Anecdotally, I have heard that community sites are more relaxed than downtown centres at UofT, but am looking for more information than is offered on the program websites...

Things that I am interested in hearing about are average number of work hours, call shifts per month, work-life balance, amount of elective time, and importance of wellness to the faculty, among any other things you find relevant!

Thanks!

My colleagues who did their FM training in Toronto, especially community peripheral sites, as well as core McMaster, found their programs were quite chill.  If you know you want to do mostly outpatient FM, then you are prepared well by avoiding wasting time doing overnight calls for surgical fields, excessive obstetrics(some canadian FM residencies make you do 2 months of Obstetrics, which is a waste if you never intend to do OB. Dont be fooled thinking youl'l get to do a bunch of gyne either, most often dont have much incorporation of this, aside from speculum exams and swabs etc). Many Toronto/Mcmaster programs dont make FM residents do traditional MTU/CTU rotations with overnight call either.  McMaster actively promoted minimal overnight call, and no CTU at all for some programs. 

Alberta and UBC programs are generally not "chill". Calgary can be to an extent but apparently has gone under revisions.

Just make sure you know what you want. If you want to be a competent hospitalist or emerg doc after FM, then you need to work alot harder and get more experience i.e. overnight call,  to be competent.

[frenchpress]

Disagree about UofA FM not being chill. I am in this residency right now, and have found it to be pretty well balanced between chill and busy, with the busy stuff mostly being worth my time. Wellness seems very important over all to the faculty. 

Work hours and call vary a lot by rotation. We spend ~11-12 blocks (4 weeks each) over two years in office-based family practice, 2-5 months of which is rural (your choice). In my home family practice I work 6 hour days 2-3 days per week, and 8 hour days the rest. There’s quite a bit of flexibility for horizontal ‘electives’/activities during FM in first year, and options to integrate in hospitalist, psych, palliative to gain extra elective time. Call can be minimal to almost non-existent during these blocks, depending on what you choose to do. Obs is also integrated into family blocks, and while it varies a bit between sites, overall can be quite minimal - at my site we schedule our own Obs call, and you can do as much or as little as you want really. There’s also 3 blocks of Emerg, which I personally find quite chill, since you only end up with about 4 shifts a week. 

There are some heavier blocks. You have to do a block each at least of CTU, CCU, and surgery, which do have heavier call, but as @JohnGrisham mentioned, these are the things that will help you become more competent if you think you might want to do any hospitalist/Emerg. It’s easy enough to just do outpatient family once you finish a tougher residency, but it’s hard to go the other direction and pick up those skills if your residency is ‘too’ chill or outpatient focused.

Happy to talk more about specifics of the program and my experiences if you want to DM me. 

[medigeek]

Even if you're 100% set on outpatient only for the rest of your life (people have done 180 degree changes on this btw), at least make sure the program provides very strong training in that. If you're just going to be referring everything out and doing refills/diabetes/hypertension in residency; you won't be a very competent doctor. Poor inpatient training also makes you not as strong outpatient, as an fyi. I do agree that Ob isn't that necessary if it isn't something you'll be doing.

[jb24]

I would really want to go to a rigorous family medicine program tbh. Family medicine is a short residency. It should be fairly intense to be competent, IMO. 

[8fuewbf]

8 hours ago, jb24 said:

I would really want to go to a rigorous family medicine program tbh. Family medicine is a short residency. It should be fairly intense to be competent, IMO. 

I respectfully disagree! I do not think there is a correlation between intensity and competence in future practice. In fact, I have heard the opposite. Many Toronto academic sites (e.g. SBH, UHN) are notorious for having very intense family med programs, with 1 in 4 27 hour call, and a focus on service (scut work) rather than teaching. I have heard that you are often behind many other learners, including residents from other specialties (since so much of the program is off service) and fellows for learning opportunities. Contrastingly, I know many excellent family residents from the Mississauga, Scarborough, and NYGH programs, who typically have night call only, and are admittedly "less intense". I have had plenty of 26 hour call this year, and I do not find it beneficial at all. I have similarly heard from my colleagues that the intensity of call at academic teaching sites during residency leads to burnout and disenchantment with medicine as a whole. One of my favourite staff on CTU this year had to take a year off from his residency program, as it was "too intense" and it was deteriorating his mental health (and he was the chief resident!). 

All that said, I would love more insight on call shifts per month, work-life balance, focus on teaching/learning, amount of elective time, and importance of wellness to the faculty, as I mentioned before, since I don't have much insight into other schools. 

Thanks to those who have replied! 

[Snowmen]

On 8/24/2021 at 7:26 AM, 8fuewbf said:

I respectfully disagree! I do not think there is a correlation between intensity and competence in future practice. In fact, I have heard the opposite. Many Toronto academic sites (e.g. SBH, UHN) are notorious for having very intense family med programs, with 1 in 4 27 hour call, and a focus on service (scut work) rather than teaching. I have heard that you are often behind many other learners, including residents from other specialties (since so much of the program is off service) and fellows for learning opportunities. Contrastingly, I know many excellent family residents from the Mississauga, Scarborough, and NYGH programs, who typically have night call only, and are admittedly "less intense". I have had plenty of 26 hour call this year, and I do not find it beneficial at all. I have similarly heard from my colleagues that the intensity of call at academic teaching sites during residency leads to burnout and disenchantment with medicine as a whole. One of my favourite staff on CTU this year had to take a year off from his residency program, as it was "too intense" and it was deteriorating his mental health (and he was the chief resident!). 

All that said, I would love more insight on call shifts per month, work-life balance, focus on teaching/learning, amount of elective time, and importance of wellness to the faculty, as I mentioned before, since I don't have much insight into other schools. 

Thanks to those who have replied! 

That has nothing to do with the hours worked, though. As you mentioned, the problem with urban family medicine programs is the pyramid. What you want is a rural program where you're gonna work a lot to get maximal exposure.

As mentioned by jb24, your residency is only 2 years in family medicine and even with the most rigorous program, you won't learn everything. What you're looking for is a program that's the gonna make the proportion of things you don't know as small as possible and chill programs won't give you that. Once you're an attending, there's no one to catch the things you miss (and that's not a consultant's job).

Edit: Just realised I wrote "you won't learn anything" while I meant to write "you won't learn everything"

[blah1234]

39 minutes ago, Snowmen said:

That has nothing to do with the hours worked, though. As you mentioned, the problem with urban family medicine programs is the pyramid. What you want is a rural program where you're gonna work a lot to get maximal exposure.

As mentioned by jb24, your residency is only 2 years in family medicine and even with the most rigorous program, you won't learn anything. What you're looking for is a program that's the gonna make the proportion of things you don't know as small as possible and chill programs won't give you that. Once you're an attending, there's no one to catch the things you miss (and that's not a consultant's job).

Yea, poor consults are a great way to destroy a relationship with your local consultants.

[JohnGrisham]

6 minutes ago, blah1234 said:

Yea, poor consults are a great way to destroy a relationship with your local consultants.

On the flip side, I have seen many local consultants thrive financially off of easy consults - i.e. FM docs sends super easy peds/endo/resp/etc consult, consultant doesn't decline it because its a trivial consult, sees the patient for 5-15 minutes and bills 100-200$ consult fee and discharges back to FM with short note. 

With virtual only telehealth companies like TELUS, these "please see patient for x and physical" consults are ubiquitous in our area right now, and consultants  are eating them up for easy/quick visits.

[Snowmen]

25 minutes ago, JohnGrisham said:

On the flip side, I have seen many local consultants thrive financially off of easy consults - i.e. FM docs sends super easy peds/endo/resp/etc consult, consultant doesn't decline it because its a trivial consult, sees the patient for 5-15 minutes and bills 100-200$ consult fee and discharges back to FM with short note. 

With virtual only telehealth companies like TELUS, these "please see patient for x and physical" consults are ubiquitous in our area right now, and consultants  are eating them up for easy/quick visits.

Which is an awful use of limited financial ressources and a bad thing for us in the long term because "physicians billing 200$ to see a patient for 10 minutes" is a catchy headline to promote paycuts.

Also, some of them are just awful and still eat up a ton of time. For instance, during rheumatology clinic, I had 3 referrals from the same FP in the same day and none of them were even close to being rheumatological (ankylosing spondylitis at 74, PMR with a normal CRP/ESR and suspected rheumatoid arthritis for distal interphalangeal joint pain...) and wouldn't have been sent by someone with a tiny bit of competency. That's 2 hours of clinic wasted even though tons of patients are waiting.

[8fuewbf]

I just don't wanna get too off topic on this thread, but once again I'm looking for any and all insights into different sites for FM residency, including, but not limited to: call shifts per month, work-life balance, focus on teaching/learning, amount of elective time, and importance of wellness to the faculty.

Thanks!

[JohnGrisham]

5 hours ago, Snowmen said:

Which is an awful use of limited financial ressources and a bad thing for us in the long term because "physicians billing 200$ to see a patient for 10 minutes" is a catchy headline to promote paycuts.

Also, some of them are just awful and still eat up a ton of time. For instance, during rheumatology clinic, I had 3 referrals from the same FP in the same day and none of them were even close to being rheumatological (ankylosing spondylitis at 74, PMR with a normal CRP/ESR and suspected rheumatoid arthritis for distal interphalangeal joint pain...) and wouldn't have been sent by someone with a tiny bit of competency. That's 2 hours of clinic wasted even though tons of patients are waiting.

Of course, it is a complete and utter waste. Just stating that its a 2 way street - consultants also are not obligated to accept referrals and can reject them. But many don't and it sends the wrong message to the small subset of incompetent FM docs/referral sources.

[JohnGrisham]

3 hours ago, 8fuewbf said:

I just don't wanna get too off topic on this thread, but once again I'm looking for any and all insights into different sites for FM residency, including, but not limited to: call shifts per month, work-life balance, focus on teaching/learning, amount of elective time, and importance of wellness to the faculty.

Thanks!

It would help if you provide your location preferences. Even general like "west coast, central, Ontario, east coast".

[8fuewbf]

Interested mainly in BC and Ontario.

[indefatigable]

I may be a little naive here, but I tend to think that wherever you are training that you will best adapted to practice in that general region as you will know the resources, practice styles, codes, EHRs, etc..  

I agree that switching urban to rural is likely more challenging given the acute and more complex patient that may be managed by FPs in smaller locales.  But urban medicine has its own nuances (e.g. transgender patients, homeless,..) which rural training may not provide.  

I also believe that patient preferences and consultant availability are also driving practice patterns - if patients want to see specialist X and specialty X is relatively available, then a referral is more likely.  Patients may begin to expect to see specialists for relatively manageable issues - this obviously happens more in large urban centers where most practitioners are concentrated and can even be tacitly encouraged in some disciplines.  Plus, FPs can easily off-load any medico-legal risk by referring out at the slightest concern.  

tl;dr I imagine the transition to staff will be challenging regardless of training locale - probably easier if ending up in a similar practice setting to training.  

[frenchpress]

On 8/24/2021 at 7:21 PM, 8fuewbf said:

Interested mainly in BC and Ontario.

You’ll get the best information about things like call and work-life balance from residents of these programs, but some of the info you want people may not want to publicly post. It’s also an absurdly large amount of information - I had to keep a spreadsheet last year during CaRMS to keep it all straight. For stuff like #weeks of block and elective time, that’s available for the majority of sites on the archived CaRMS program descriptions from last year and/or on the university pages for each site (at least it is for UBC). 

You’ll have the opportunity in CaRMS to do zoom sessions (UBC last year had several at every site) - you’ll be able to get a lot of that information in those sessions, and get contact info for residents who may be willing to talk to you off the cuff about the programs one-on-one.

Edited August 27, 2021 by frenchpress