US vs. Canadian family med training

[leviathan]

Which will give you better training as a family physician? Are Canadians at a disadvantage with only 2 years vs 3 in the US? Anyone have insight into this?

[moo]

Probably the US. I think the extra year does make a difference... US programs also tend to be a bit more rigorous (depending but the top university programs are at least) than Canadian programs. In Canada, there's too much fluff stuff going on.

[leviathan]

Probably the US. I think the extra year does make a difference... US programs also tend to be a bit more rigorous (depending but the top university programs are at least) than Canadian programs. In Canada, there's too much fluff stuff going on.

That's good to know. I don't know why, but I always hear these rumors that Canadian residency programs are much more rigorous and provide better training than Americans. That rumor includes the fact that Canadians practice a style of medicine that is much more evidence-based and they avoid doing million dollar workups on every patient.

 

An example I always hear is that American internists have a high failure rate on the Royal College IM board exams. So then that makes me skeptical about whether or not I'd want to try for a family med residency in the US. Ultimately I'm just interested in getting the best training and it's hard to find objective info about this kinda stuff.

[moo]

I don't think it's as much a function of the program as the person taking the test. People in US programs (especially lower tier ones) are IMGs who tend not to be as book smart as those who got into Canadian/US schools. That may be a reason. Also US programs don't tailor their grads to pass the royal college exams. Same thing can be said for Canadian students who have a hard time with USMLE Step I. Canadian schools just don't tailor their grads to take that exam. Does that mean they are poorly trained? Probably not.

 

Canadian FM programs have too much BS going on. All the FIFE BS just to pass the CCFP SOOs. In may be better to do a Canadian program, however, if you plan on working in Canada because it will introduce you to the billing system and other nuances of working in Canada (labs). As for evidence based medicine, as someone training to be a physician epidemiologist, I can tell you that Canadian FM programs certainly TRY to be evidence based but the knowledge level of my classmates and other family docs on epidemiology is very very low, much lower than the level of my med school classmates. Of course, this is just anecdotal, but my point is it really depends on the person and not on the training they receive.

[leviathan]

Of course, this is just anecdotal, but my point is it really depends on the person and not on the training they receive.

True true. After thinking about it, it sounds like you hit the nail on the head with this point. I totally agree probably 90% of what kind of doctor you become depends on you and your intelligence and how hard you work to learn.

[thebouque]

An example I always hear is that American internists have a high failure rate on the Royal College IM board exams.

 

General internal medicine in Canada and USA are 2 very different things. In the USA, internists are primary care providers to adults whereas in Canada they act as consultants. It's no surprise that american internists have a hard time passing the canadian boards.

[Fred]

General internal medicine in Canada and USA are 2 very different things. In the USA, internists are primary care providers to adults whereas in Canada they act as consultants. It's no surprise that american internists have a hard time passing the canadian boards.

 

thebouque is quite right.

 

In the US, general internal medicine is considered primary care, only the subspecialists are considered, well, specialists. They deal with much more primary care stuff than in Canada

In Canada they are considered specialists so the exam is more focused on "specialty stuff" if I can use the term.

[olecranon]

yeah i don't understand why there's family medicine primary care and the internal medicine primary care...i guess if you don't like kids...

[bongobingo]

What should I do if I am an american citizen who wants as much flexibility to work anywhere in canada/us and take large vacations, always be employed, etc? I am obviously going to do a residency in the u.s.. As I understand if I do FM, i can take canadian boards. If I do IM+specialty I can again at least take general IM boards in canada? If I do a 3yr ER residency+2yr fellowship in something like toxicology, would I be able to take any kind of boards in Canada?

Which of those specialties would make the most money per hour if he wanted to work in a rural area? How about if you just want an outpatient clinic in a big city like Toronto, would you be better off as IM or FM?

[thebouque]

Which of those specialties would make the most money per hour if he wanted to work in a rural area? How about if you just want an outpatient clinic in a big city like Toronto, would you be better off as IM or FM?

 

It depends what you like but from what you're telling us, I think you should go for FM

[leviathan]

General internal medicine in Canada and USA are 2 very different things. In the USA, internists are primary care providers to adults whereas in Canada they act as consultants. It's no surprise that american internists have a hard time passing the canadian boards.

I partially agree. Internists may be primary care providers in the US for a lot of adults, but they are specialists in adult / internal medicine, not generalists. Still, I have to say from my experience so far it seems like there is a lot of consulting of specialties for things that could probably be dealt with by the internist. I'll have to see how it compares to Canada when I do my rotations up there.

[thebouque]

I don't quite understand what you disagree with. I'm not saying American internists are generalist (whatever that means nowadays). All I'm saying is that Canadian internists are strictly consultants (ie you can't just walk into an internal medicine clinic in Canada), not primary care providers, unlike American internists who can be primary care providers to adults (as well as consultants). And yes, American internists are specialists of adult medicine, there's no doubt about that.

[leviathan]

I don't quite understand what you disagree with.

I disagreed with the fact that being primary care physicians is the reason they have more trouble passing Canadian board exams. Residency programs in either country train them as consultants to manage the same problems. If an internist in the US decides to not be a consultant after graduating and only do primary care is a choice that would happen after they've finished and written their boards.

 

PS - Why there is a higher failure rate I'm not sure. I would love to hear from any internists hanging around here who may have written both board exams and to know if there is any difference in content or difficulty.