250+ Unfilled FM Spots Nationally

[When the Moon Forgot]

Received a letter from our residency program informing us that there are over 250 unfilled FM spots nationally after first iteration (268 to be exact).

Even U of T and UBC have unfilled spots. This is seriously astounding to me.

Thoughts? Do you think this is start of an overall decline in interest toward family medicine?

 

U of T - 2 unfilled /165 (1%)

UBC - 2 unfilled /186 (1%)

Mac - 11 unfilled /101 (11%)

Western - 28 unfilled /78 (36%)

Queen's - 19 unfilled /73 (26%)

Ottawa - 14 unfilled /77 (18%)

NOSM - 26 unfilled /44 (59%)

Alberta - 21 unfilled /74 (28%)

Calgary - 21 unfilled /85 (25%)

[ChemPetE]

Alberta - 42. Yes

[When the Moon Forgot]

Unfilled spots in FM after first iteration in 2023: 268

Unfilled spots in FM after first iteration in 2022: 225

Unfilled spots in FM after first iteration in 2021: 207

Unfilled spots in FM after first iteration in 2020: 170

Unfilled spots in FM after first iteration in 2019: 138

 

Provincial government and professional associations have a lot of soul-searching to do.

[ThugLyfe]

 

"It is encouraging..." Professional associations are failing the profession. Much soul searching needed indeed. 

[Edict]

3 hours ago, ThugLyfe said:

 

"It is encouraging..." Professional associations are failing the profession. Much soul searching needed indeed. 

It looks like they increased the number of spots which probably contributed. I do think family medicine has come under fire recently because of the growth in NPs south of the border and concern this will spread here no top of the low pay and hours in family medicine. The majority of primary care providers in the US are now non-physicians. 

[When the Moon Forgot]

1 hour ago, Edict said:

It looks like they increased the number of spots which probably contributed. I do think family medicine has come under fire recently because of the growth in NPs south of the border and concern this will spread here no top of the low pay and hours in family medicine. The majority of primary care providers in the US are now non-physicians. 

Increase in FM spots certainly contributed somewhat to the spike in unfilled spots. However, between 2019 and 2022 the number of overall spots remained pretty stable, while unfilled spots shot up from 138 to 225 during that period. Regardless of how CFPC tries to spin this, things aren't looking rosy for FM.

[HeroX37]

This is going to be an absolute shitshow if they transition FM to 3-years. Might be the death of FM?

I know many FM residents who would never have chosen the field if it was 3 years. 

Sad times ahead 

[ThugLyfe]

I think there are a various factors contributing to medical students not ranking family medicine as highly, and family medicine residents choosing not to practice full scope family medicine:

1) As Edict mentioned, growth of allied health professionals with increased scope and a perception that this will ultimately replace family medicine. However, I have seen teams where nurse practitioners, nurses, pharmacists, and family doctors co-exist and work well together - minor hiccups aside. For example, nurse practitioner led pap test clinics and preventative care screening, well child visits tag teamed with nurse and family doctor,  etc. Which leads in part to the second point:

2) Many different practice and payment models. Most residents (myself included) will train as part of a family health team where the aforementioned team dynamic between various professions does work to support a variety of patients. However, most doctors practice in a fee for service model. The idea of trying to manage all the care that we are lucky enough to share with allied health professionals in a team based setting, alone in a more typical practice is daunting. Team based practice helps consolidate well defined roles for healthcare professionals and can help address some of the concerns around "scope creep". Moreover, patients are becoming older, the medicine is more complex, and yet compensation models have not changed in most parts of Canada, though I am hopeful with the longitudinal family physician model in British Columbia. It is crucial to implement models that actually acknowledge quality and complexity of care that family doctors provide; perhaps this includes reimbursement based on quality metrics like how caught up patients are in preventative care, how accessible their doctor is, how many ED visits for their patients, and so on. 

3) With increased complexity, both in terms of medicine and the infrastructure we work in, comes increased administrative demands on a family doctor. It is on the family doctor to assess every referral (declined referrals, referral notes, redirected referrals, etc.), test result (sometimes even those which we did not order but have been advised we need to follow-up on, for example, incidental findings while a patient was admitted in hospital or findings while they were being investigated by a specialist), government forms, workplace and insurance notes, on top of the usual in terms of documenting patient encounters. Obviously, inefficiencies in electronic medical records, referral systems, health technology, etc. all compound the issue. 

4) Mental health infrastructure. It is sorely lacking. Trying to get adequate supports for patients with complex mental health needs is like pulling teeth. Family doctors are essential and at times overburdened with providing psychiatric care for patients once an acute episode of mania, or suicidality, psychosis, etc. has passed. Again, when not working in a team based environment, the family doctor may end assuming role of social worker or therapist which they are not trained to do (nor in an ideal world would they have to). Psychotherapy is expensive, and not everyone has insurance/coverage. It is especially unfortunate because we often tout this as first line therapy aside from medications and yet funding programs/program planning is deficient. 

5) The future move to a 3 year program. Only time will tell how this will play out in terms of implementation and what they end up choosing to do with that third year. But I cannot imagine many medical students choosing 3 years of family medicine residency over a different specialty in the current climate, at least not as a first choice specialty. 

I have a lot more I could say. And this is not to add any further negative press to the field. I have come to love family medicine. It is the specialty of relationships. And all the above issues can be addressed. But our professional groups, government and leaders need to come together to advocate for us. I like to think of myself as not particularly prone to hysterics, but I do worry that without change we will slowly see this field fizzle away. I recently watched a CBC video, a day in the life type of thing, which I will leave here:

 

[When the Moon Forgot]

4 hours ago, HeroX37 said:

This is going to be an absolute shitshow if they transition FM to 3-years. Might be the death of FM?

I know many FM residents who would never have chosen the field if it was 3 years. 

Sad times ahead 

I for one would never have pursued family medicine if it was 3 years rather than 2. I don't know how these idiotic decisions are made.

[indefatigable]

7 hours ago, Edict said:

It looks like they increased the number of spots which probably contributed.

Exactly - the quota to applicant ratio has improved a lot over the past several years after the "unmatched" crisis a few years ago.  At the same time, IM & non-surgical positions are at near all time highs with surgical spots recovering to former levels (graphs below).  So there are more spots and more FM spots relative to applicants - hence more "left over positions.

Still, there's no doubt that FM is becoming a less preferred specialty with fewer people choosing FM as a first choice.

5 hours ago, ThugLyfe said:

. I recently watched a CBC video, a day in the life type of thing, which I will leave here

There's really a messaging issue here - no doubt the doctor is hard-working, but driving a new luxury vehicle isn't going to win a lot of sympathy with the general public .. which brings to another question - does he really need to follow 5 000 patients (unclear how much "help" he is getting)?  That's far above the average of most FPs and if this damaging his work-life balance does he need to have the luxury car lifestyle?

5 hours ago, HeroX37 said:

This is going to be an absolute shitshow if they transition FM to 3-years. Might be the death of FM?

I know many FM residents who would never have chosen the field if it was 3 years. 

The CaRMS choices or "menu" are relatively fixed.  Not everyone can be derm, ophtha, plastics..  For most graduates, the alternative choice of not pursuing residency is significantly worse than matching to FM.  To me this is part of the reason why the Queen's MD-FM model makes sense - fills a need and could result in better outcomes/more satisfaction.

With respect to NPs, I find it really interesting that the BC government did almost a complete turnaround in it's approach - at first it was almost promoting NPs almost to the detriment of FPs .. now all of a sudden they have come up with a new agreement incentivizing longitudinal FPs.  Underlying their policy switch I think is the realization that NPs cannot replace FPs in terms of efficiency, volume and quality of care.  NP numbers are almost growing exponentially with little standardization in their training especially in the US- this creates potentially unsafeness which is pretty much the biggest red flag in health care.

In the video, the FP had 5 000 patients - the NP contracts in BC were for a minimum panel of 1 000.  Despite the car, the FP cost much less than 4-5 NPs and there's obviously no implication that quality of care is being compromised (not even including NP pension obligations, overhead..) .  

[HeroX37]

3 hours ago, indefatigable said:

The CaRMS choices or "menu" are relatively fixed.  Not everyone can be derm, ophtha, plastics..  For most graduates, the alternative choice of not pursuing residency is significantly worse than matching to FM.  To me this is part of the reason why the Queen's MD-FM model makes sense - fills a need and could result in better outcomes/more satisfaction.

With respect to NPs, I find it really interesting that the BC government did almost a complete turnaround in it's approach - at first it was almost promoting NPs almost to the detriment of FPs .. now all of a sudden they have come up with a new agreement incentivizing longitudinal FPs.  Underlying their policy switch I think is the realization that NPs cannot replace FPs in terms of efficiency, volume and quality of care.  NP numbers are almost growing exponentially with little standardization in their training especially in the US- this creates potentially unsafeness which is pretty much the biggest red flag in health care.

In the video, the FP had 5 000 patients - the NP contracts in BC were for a minimum panel of 1 000.  Despite the car, the FP cost much less than 4-5 NPs and there's obviously no implication that quality of care is being compromised (not even including NP pension obligations, overhead..) .  

You make some great points friend. Though I do wonder if people are just going to be applying to the US instead for residency instead of going for FM. Or if everything else is just going to be hypercompetitive, IM and peds especially. Or if we're going to have more and more people match into FM and then up quite unhappy, and then finding some sort of niche practice instead of longitudinal FM. 

I just don't see the 3 year switch benefitting FM at all. Personally, I see FM going through an identity crisis.

The current slew of residents will be okay ish, but the coming cohorts ? Going to be an interesting time. 

[Edict]

Lets not also forget that nearly all (not sure about some of the Quebec spots) will get filled by IMGs. So Canada is still getting its doctors one way or another. 

[bearded frog]

On 3/25/2023 at 5:25 PM, Divine Comedy said:

I for one would never have pursued family medicine if it was 3 years rather than 2. I don't know how these idiotic decisions are made.

Serious question, what would you have tried to do instead? I get maybe someone interested in obstetrics considering FM vs OB but they are vastly different specialties in reality, and when I think of other fields I can't think of anything close enough to (traditional at least) FM that a year of training would be a big enough difference? Perhaps FM vs IM if you just wanted to be a hosptialist but that doesn't seem like a great plan to choose FM if that's one's goal.

[When the Moon Forgot]

5 hours ago, bearded frog said:

Serious question, what would you have tried to do instead? I get maybe someone interested in obstetrics considering FM vs OB but they are vastly different specialties in reality, and when I think of other fields I can't think of anything close enough to (traditional at least) FM that a year of training would be a big enough difference? Perhaps FM vs IM if you just wanted to be a hosptialist but that doesn't seem like a great plan to choose FM if that's one's goal.

Probably IM then subspecializes, emerg, derm, ophtho or anesthesiology. Lots of interest.

[bearded frog]

6 hours ago, Divine Comedy said:

Probably IM then subspecializes, emerg, derm, ophtho or anesthesiology. Lots of interest.

The day to day and overall career/practice/lifestyle of all those are wildly different than FM, (ok maybe not outpt derm as much), so the idea that one less year of training in a 30+ year career will tip the scales is still quite confusing to me.

[When the Moon Forgot]

3 hours ago, bearded frog said:

The day to day and overall career/practice/lifestyle of all those are wildly different than FM, (ok maybe not outpt derm as much), so the idea that one less year of training in a 30+ year career will tip the scales is still quite confusing to me.

I can’t speak on behalf of other family med residents but I find that we tend to have many interests (hence why we choose family medicine). I can really see myself in any specialties. That one year would be a dealbreaker for me. I would have opted for IM if FM were three years. My thinking would be something along the lines of... "if FM is the same length as IM, I might just as well add 2~3 years and subspecialize in something."

Endocrinology, GI, heme/onc, ID, card all interest me.

[frenchpress]

3 hours ago, bearded frog said:

The day to day and overall career/practice/lifestyle of all those are wildly different than FM, (ok maybe not outpt derm as much), so the idea that one less year of training in a 30+ year career will tip the scales is still quite confusing to me.

Agreed. I can see how people who like hospitalist medicine might want to do, for example, IM instead. But there’s a lot of reasons to choose family you just can’t easily replace with another specialty. 

It remains unclear what the 3rd year will consist of, so it’s too early to say whether it would have been a deal breaker to me. But I doubt it would change my mind - nothing else is really like family medicine, and that’s what I enjoy the most. And a lot of residents and recent grads I know are doing extra training anyways, either full enhanced skill years or 3 or 6 month programs, because there is ultimately that recognition that we have a tonne of gaps on graduation. 

[indefatigable]

On 3/25/2023 at 11:43 PM, HeroX37 said:

You make some great points friend. Though I do wonder if people are just going to be applying to the US instead for residency instead of going for FM. Or if everything else is just going to be hypercompetitive, IM and peds especially. Or if we're going to have more and more people match into FM and then up quite unhappy, and then finding some sort of niche practice instead of longitudinal FM. 

I just don't see the 3 year switch benefitting FM at all. Personally, I see FM going through an identity crisis.

The current slew of residents will be okay ish, but the coming cohorts ? Going to be an interesting time. 

The highlighted part seems to be what is happening - I'm not sure if all FM residents are unhappy, but I don't hear of many FM graduates actually doing longitudinal FM.  Other areas might continue to get a little more competitive, although there seems to have been a drop-off with psych this year and I really don't see mass matching to the US as a possibility.  FM dissatisfaction seems to be even more marked by staff in comparison to other disciplines.

 I also don't see a general third year greatly benefitting FM either - except if it allowed more access to focus areas of practice than the system in place - e.g. I know of numerous grads that weren't successful in obtaining +1 in various areas.   I expect that it wouldn't allow this so trainees would end up having to do "+1" or 4 years for training that wouldn't be considered as strong as FRCPC.

[ytho]

On 3/25/2023 at 8:31 PM, indefatigable said:

There's really a messaging issue here - no doubt the doctor is hard-working, but driving a new luxury vehicle isn't going to win a lot of sympathy with the general public .. which brings to another question - does he really need to follow 5 000 patients (unclear how much "help" he is getting)?  That's far above the average of most FPs and if this damaging his work-life balance does he need to have the luxury car lifestyle?

while I see your other points, I think this is a bad take tbh. On top of all the other garbage that is thrown at fam docs, they are also not allowed to enjoy the fruits of their labour for the sake of winning sympathy from the public? doctors get paid higher than the general public, it's not a secret. they can still be burnt out despite being paid more.

if someone in the public is going to get angry over that, then they deserve the crisis. 

[SpeakWhite]

3 year family medicine = 1 extra year of free labor and PGY-1 supervision.

One day, a 5 year FM residency + 2 years of fellowship + PhD will be required for rotating locum positions.

My advice: learn French ASAP

[Andrew]

On 3/25/2023 at 12:29 PM, ThugLyfe said:

I think there are a various factors contributing to medical students not ranking family medicine as highly, and family medicine residents choosing not to practice full scope family medicine:

1) As Edict mentioned, growth of allied health professionals with increased scope and a perception that this will ultimately replace family medicine. However, I have seen teams where nurse practitioners, nurses, pharmacists, and family doctors co-exist and work well together - minor hiccups aside. For example, nurse practitioner led pap test clinics and preventative care screening, well child visits tag teamed with nurse and family doctor,  etc. Which leads in part to the second point:

2) Many different practice and payment models. Most residents (myself included) will train as part of a family health team where the aforementioned team dynamic between various professions does work to support a variety of patients. However, most doctors practice in a fee for service model. The idea of trying to manage all the care that we are lucky enough to share with allied health professionals in a team based setting, alone in a more typical practice is daunting. Team based practice helps consolidate well defined roles for healthcare professionals and can help address some of the concerns around "scope creep". Moreover, patients are becoming older, the medicine is more complex, and yet compensation models have not changed in most parts of Canada, though I am hopeful with the longitudinal family physician model in British Columbia. It is crucial to implement models that actually acknowledge quality and complexity of care that family doctors provide; perhaps this includes reimbursement based on quality metrics like how caught up patients are in preventative care, how accessible their doctor is, how many ED visits for their patients, and so on. 

3) With increased complexity, both in terms of medicine and the infrastructure we work in, comes increased administrative demands on a family doctor. It is on the family doctor to assess every referral (declined referrals, referral notes, redirected referrals, etc.), test result (sometimes even those which we did not order but have been advised we need to follow-up on, for example, incidental findings while a patient was admitted in hospital or findings while they were being investigated by a specialist), government forms, workplace and insurance notes, on top of the usual in terms of documenting patient encounters. Obviously, inefficiencies in electronic medical records, referral systems, health technology, etc. all compound the issue. 

4) Mental health infrastructure. It is sorely lacking. Trying to get adequate supports for patients with complex mental health needs is like pulling teeth. Family doctors are essential and at times overburdened with providing psychiatric care for patients once an acute episode of mania, or suicidality, psychosis, etc. has passed. Again, when not working in a team based environment, the family doctor may end assuming role of social worker or therapist which they are not trained to do (nor in an ideal world would they have to). Psychotherapy is expensive, and not everyone has insurance/coverage. It is especially unfortunate because we often tout this as first line therapy aside from medications and yet funding programs/program planning is deficient. 

5) The future move to a 3 year program. Only time will tell how this will play out in terms of implementation and what they end up choosing to do with that third year. But I cannot imagine many medical students choosing 3 years of family medicine residency over a different specialty in the current climate, at least not as a first choice specialty. 

I have a lot more I could say. And this is not to add any further negative press to the field. I have come to love family medicine. It is the specialty of relationships. And all the above issues can be addressed. But our professional groups, government and leaders need to come together to advocate for us. I like to think of myself as not particularly prone to hysterics, but I do worry that without change we will slowly see this field fizzle away. I recently watched a CBC video, a day in the life type of thing, which I will leave here:

 

I'm a family doctor working in Vancouver and my take on why med students don't go into FM is largely:

1. The overall pay sucks relative to specialties, and there's a lot of paperwork or unpaid time.

2. The disrespect. FM is not prestigious, both patients and other doctors view you as inferior to a specialist.

 

In terms of the moving from a 2-year to a 3-year Residency most of the above posters are negative on this, however I view this change as a positive, and I think future Residents should as well. The 3-year training time will result in more "prestige"=pay. The training length is now the same as General Internal Medicine!!! (you have to think about how this gets sold to politicians/patients in terms of bargaining new contracts. Yes, you "waste" a year of your life for PGY-3 pay but, every year after that, every FM WILL get more pay as a result of longer residency. To extrapolate this argument further, if we made FM a 5-year residency, we could then bargain for Specialist pay, citing the length of residency. In the eyes of politicians/patients Years of training = Prestige = Pay.

With regard to your point about NPs or Physician-Assistants replacing FMs, I have no worries about this at all. There are more than enough patients to go around. I'm confident that these NPs don't offer nearly the same level of care/expertise as a FM, but there's no shortage of work today or in the foreseeable future for FMs. In terms of being "replaced", well, one day we are all going to be replaced by ChatGPT/AI bots. The first Specialities to be fully replaced will be the Diagnostic specialties: Radiology, Pathology and Dermatology. These 3 specialties are basically viewing an image and giving a diagnosis, this is the kind of task that current (future AI will only get better) AI is already great at handling provided you train it on a large enough data set (e.g. training on a dataset of 100 million x-rays obtained globally would allow a current AI to replace or likely even surpass a human radiologist). The AI tech is already sufficiently advanced today, it's just a matter of whether government will allow tests to occur and whether AI can pass safety legislation or considerations like that.

FM will be the LAST type of doctor to be replaced because of the "human nature" interaction, but even then, a sufficiently advanced ChatGPT AI inside some kind of WestWorld chassis will eventually replace me (not within my remaining career probably though).

[indefatigable]

3 hours ago, Andrew said:

In terms of the moving from a 2-year to a 3-year Residency most of the above posters are negative on this, however I view this change as a positive, and I think future Residents should as well. The 3-year training time will result in more "prestige"=pay. The training length is now the same as General Internal Medicine!!! (you have to think about how this gets sold to politicians/patients in terms of bargaining new contracts. Yes, you "waste" a year of your life for PGY-3 pay but, every year after that, every FM WILL get more pay as a result of longer residency. To extrapolate this argument further, if we made FM a 5-year residency, we could then bargain for Specialist pay, citing the length of residency. In the eyes of politicians/patients Years of training = Prestige = Pay.

Length of training is likely to only overall have at best a neutral effect on FP finances.

• increased length of training in other disciplines, including fellowship, hasn't resulted in increased billing code or fees afaik.  Pediatrics recently added a year of training for its subspecialty training with no fee code change that I know.
• pay is more a result of legacy billing codes/fee structures often resulting in procedures getting better paid - in the past some procedures were much slower which explains partly the differences in pay.  Relativity adjustment in Ontario at least changes very little year to year.  Outside of QC, psych isn't generally a high-billing specialty.
• the opportunity cost of an extra year of training is unlikely to be offset by any hypothetical minimal increase across the board.  Without access to more lucrative codes or billing opportunities, 3 year trained grads will probably do the exact same thing as 2 year trained grads but a year later
• FM PGY3s could be a valuable commodity for staff though.  
• Bargaining power from some specialist groups partly derives from the fact that they are the only ones that can do some procedure or diagnostics.  This isn't true for FM where relatively speaking there is a huge supply including midlevels.

 

[Andrew]

On 3/29/2023 at 4:10 PM, indefatigable said:

Length of training is likely to only overall have at best a neutral effect on FP finances.

• increased length of training in other disciplines, including fellowship, hasn't resulted in increased billing code or fees afaik.  Pediatrics recently added a year of training for its subspecialty training with no fee code change that I know.
• pay is more a result of legacy billing codes/fee structures often resulting in procedures getting better paid - in the past some procedures were much slower which explains partly the differences in pay.  Relativity adjustment in Ontario at least changes very little year to year.  Outside of QC, psych isn't generally a high-billing specialty.
• the opportunity cost of an extra year of training is unlikely to be offset by any hypothetical minimal increase across the board.  Without access to more lucrative codes or billing opportunities, 3 year trained grads will probably do the exact same thing as 2 year trained grads but a year later
• FM PGY3s could be a valuable commodity for staff though.  
• Bargaining power from some specialist groups partly derives from the fact that they are the only ones that can do some procedure or diagnostics.  This isn't true for FM where relatively speaking there is a huge supply including midlevels.

 

FM is a unique beast, so IMO cannot be compared to what you are describing which is subspeciality/fellowship training years like a 5+2 or 5+3. Incidentally, many programs now require a 1-year Master's (or some kind of research) as an add-on during Residency in addition to the usual 5+whatever if you want to have any hope of working in a major hospital/city. This is more of a way to differentiate potential hires rather than for the purpose of "more years of training for more pay".

What you're referring to is legacy from hip replacement/cataract waitlists of old which resulted in a bonus for these procedures, which results in ophthalmologists doing nothing but cataract surgeries all day and getting paid a ton.

In BC, the MSP fee codes weren't changed for basically 10 years since I started working in 2013, with the exception of the recent overhaul with the new LFP payment model (which is basically a 40-50% increase in pay for the same amount of work). But fee codes aren't the only way FMs get paid in BC. Prior to the LFP, we had "Complex Chronic Care Billing codes" for HTN, Diabetes, CHF etc. which billed extra ($100 annually for HTN, $150 annually for DM2, and around $350 annually if I recall correctly for a patient with say DM2 and CKD), and an extra annual longitudinal care bonus was introduced I believe around 3-4 years ago (around $10-20K annually). There are other ways government has paid FMs other than directly through fee codes.

What I think (and really, only time will show if I'm correct or not), is that If/When FM Residency moves to 3 years, the overall Prestige of FM goes up in the eyes of politicians and patients. With a rise in Prestige and training years, it's much easier for FMs to negotiate next time the BC Physician Master's Agreement is up for renewal.

Add a 3-year FM residency, to the pendulum already swinging in favor of increased FM pay (many people complaining they cannot get a FM), and the political will should be there for another juicy increase to FM pay as a result of longer residency.

IMO politicians and patients are simple, they see only the number of years of training. If we made FM a 5-year residency (whether this actually useful or not), the prestige would be on par with specialties.

[Andrew]

On 3/29/2023 at 4:10 PM, indefatigable said:

• FM PGY3s could be a valuable commodity for staff though.  

 

I feel like I should address this specifically. The entire Residency system is obviously filled with servitude, the Canadian medical systems/hospitals rely on Residents as cheap labor to function. Stating that FM PGY3's are a "valuable commodity", I think you are insinuating they would be providing free labor for attendings.

This is not unique to FM. You can't tell me that the entirety of PGY-1 for a surgical resident isn't mostly useless non-surgical off-service rotations. Why don't we make all the surgical specialties 4 years?

On 3/29/2023 at 4:10 PM, indefatigable said:

• the opportunity cost of an extra year of training is unlikely to be offset by any hypothetical minimal increase across the board.  Without access to more lucrative codes or billing opportunities, 3 year trained grads will probably do the exact same thing as 2 year trained grads but a year later

 

The entirety of Medicine is an opportunity cost. Doctors get paid well, but I could absolutely have done way better financially in Tech (or another field).

The minimum time of training for FM was 4+2 (and adding on to the fact that I didn't get into med school immediately following undergrad). If I went into Tech even as a programmer, by now I would be in senior management (many of my high school classmates of comparable ability that went into Tech are probably richer net worth than I am now, with better pay, better vacation and benefits). Programmers start at around $100K these days in Canada, way higher in the US (if you are good, you can live in Canada and work remotely and get paid in USD). By going to medical school + FM, I instantly lost $600K in wages + tuition + interest (assuming no promotions/raises). Medicine is a losing proposition if you view it strictly from a money perspective.

For PGY-3, FM are still getting paid whatever PGY-3 get paid $70K (?). They forego $200-300K in FM pay, so the net loss is  $130-230K. Let's assume the average FM graduate is around 30 years old. They have up to a 40-year career remaining. As long as PGY-3 in some way leads to a pay increase of that amount plus interest over 40 years, you break even. But IMO, the corresponding increase in pay for a longer residency is likely to exceed that over a 40-year career.

IMO it's foolish to think an extra year of training won't in some way result in higher pay in the future.

[Synth1]

Family medicine is approximately 50% off-service in both years though (5-6 blocks per year in most programs), we are basically the scut workhorses of the residency system. If the third year is just another year of the same thing I am firmly against. If the third year is directed by learning goals or functions as a supervised practice year it could be beneficial. I'm not as optimistic as you that it will translate in to any improvements for the profession financially or otherwise.