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Where have all the residents gone? Part 2: Renewing interest in family medicine.

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Canadian Family PhysicianLe Médecin de famille canadien Vol 52:  july • juillet 2006

College Collège

Where have all the residents gone?

Part 2: Renewing interest in family medicine (continued from June 2006) Rashaad Bhyat,

md

V

arious factors have contributed to the recent decline in applications to family medicine residency pro- grams in Canada. The first article in this series1 described some of the reasons medical students are not choosing family medicine, such as perceived low prestige, heavy workloads, and breadth of knowledge required. It also explored this trend in the context of increasing finan- cial pressures involved in studying medicine.

Perhaps 2006 will be a banner year for family medicine.

Newly implemented strategies could well revive enthusiasm for family medicine despite deteriorating student interest in the discipline. The College of Family Physicians of Canada has already taken the initiative by creating scholarships and prizes for medical students showing strong interest in family medicine. The criteria for these awards must be augmented to include Canadians studying medicine abroad. These stu- dents number in the hundreds at medical schools in the United States, Europe, and Australia2,3; their repatriation should be encouraged. Furthermore, the awards should be partly contingent on beginning a residency in family medi- cine; anecdotal evidence suggests that a few award recipi- ents do not actually pursue careers in family medicine. The awareness campaign surrounding Family Doctor Week is another innovative idea that builds on Canadians’ consider- able trust in their GPs. The Canadian Federation of Medical Students, the College of Family Physicians of Canada, and Health Canada have all helped to raise the profile of family medicine by supporting Family Medicine Interest Groups in our medical schools.

Efforts need to be redirected toward attracting capa- ble, interested students who might otherwise be scared away from family medicine before they even apply.

Governments must implement more progressive stu- dent loan policies, specifically making loan repayments income sensitive, with long-term amortization. In addi- tion, medical schools should grant student status to resi- dents, to allow deferral of loan repayments until the end of their training; some schools have already implemented this policy.4 Furthermore, pressure must be maintained on governments to control tuition so that increases are accountable and justifiable to students; hikes that greatly exceed the rate of inflation are indefensible.

The most important step will be disseminating posi- tive information to prospective students at the secondary

and undergraduate levels. These students, particularly underrepresented groups, need early reassurance that they will not be forever in debt if they pursue careers in family medicine. A rural outreach program run by the Canadian Federation of Medical Students already exists, designed to increase interest in medicine among rural high school students. Family medicine organizations, however, are ideally positioned to take a leading role in formalizing outreach programs that would promote family medicine as an attainable, rewarding, and inter- esting career. Providing outreach activities, including speaking tours, information days, and individual men- torship for secondary students, could increase the num- ber of applicants to medical school who already hope to practise family medicine. Students’ career intentions at entry to medical school are, in fact, strong predictors of specialty choice.5

These 2 articles have assessed the current reduced interest in family medicine as a career option for new physicians. Increased tuition and debt loads weigh heavily on medical students, residents, and students contemplating studies in medicine. Family medicine residencies struggle with a declining applicant pool because of perceived lower prestige, lower income, and heavier workloads. As the medical student demo- graphic shifts in response to financial pressure, family medicine residencies might be losing out on potential applicants before they even apply to medical school.

Several initiatives are already under way to improve this situation, but more innovative ideas need to be implemented at a grass-roots level to renew enthusi- asm for our discipline.

Dr Bhyat is a second-year family medicine resident at Memorial University of Newfoundland in St John’s.

References

1. Bhyat R. Where have all the residents gone? Part 1: Putting the declining family medi- cine match rates into context. Can Fam Physician 2006;52:805,807 [Eng], 806-7[Fr].

2. Sullivan P. Large numbers of would-be Canadian MDs migrating down under. CMAJ 2002;167(9):1043.

3. Sullivan P. Shut out at home, Canadians flocking to Ireland’s medical schools—and to an uncertain future. CMAJ 2000;162(6):868-71.

4. Professional Association of Internes and Residents of Newfoundland. Know your contract. St John’s, Nfld: Professional Association of Internes and Residents of Newfoundland; 2004. Available from: http://www.med.mun.ca/pairn/pages/

know_your_contract.htm. Accessed 2006 May 24.

5. MacKean P, Gutkin C. Fewer medical students selecting family medicine. Can family practice survive? Can Fam Physician 2003;49:408-9 [Eng], 415-7 [Fr].

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