|Canadian Medical Association Journal Home|
Medical students shunning family medicine, residency match indicates
March 12 was "match day" for Canada's medical students - the day they learn what residency program they have been accepted into - and for Canadian communities pleading for family doctors, the news couldn't be much worse.
Family medicine emerges from the first round with an unprecedented 19% of its 476 openings unfilled. Although many of the 91 vacancies will be filled by foreign medical graduates during the second round of the match later this month, the executive director of the Canadian Resident Matching Service says unfilled spots point to serious problems within the formerly popular specialty. "Students appear to be voting with their feet," says Sandy Banner. This seems to be particularly true of the Dalhousie University program, in which 21 of 41 family medicine slots remained unfilled after the first round.
The news is also bleak for Canada's rural communities, because 33% of all positions set aside to train doctors to practise in rural areas also went unfilled.
CMA President Peter Barrett said this year's results in the family medicine match didn't come as a complete surprise. "Concern has been growing about this over the past year," he says.
Dr. Paul Rainsberry, director of education with the College of Family Physicians of Canada, says the college participated in preparing a questionnaire for 2001 match participants and it plans to hold focus groups with medical students. "Our view is that the training programs are very good but something about family medicine as a career is not as attractive as it once was."
Rainsberry is worried that universities are failing to promote family medicine as a career, in effect asking medical students: "Why be a family doctor when you're so good?"
Another factor is lifestyle issues, particularly in rural areas. Rainsberry says the shortage of FPs is now so severe that family doctors can set up shop in underserviced cities without going near a remote community. This probably explains why Class of 2001 members avoided rural medicine programs - 14 of the 20 new rural medicine slots in Alberta were unfilled after the first round.
Even though many of the 91 empty slots will eventually be filled, Rainsberry says the college is worried about possible trends. "If the problem is evenly spread out among programs you don't worry so much, but Dalhousie has had poor results 2 years in a row, and that's very distressing."
Jan Kasperski, executive director of the College of Family Physicians of Ontario, attributes the declining interest in family medicine to changes taking place within primary care and to unfavourable reports in the media. She attributes the declining interest in family medicine to changes taking place within primary care - "any time you introduce major changes you make people uncomfortable" - and to unfavourable reports in the media.
"The medical students have heard reports that we are facing a shortage of family physicians, at least here in Ontario," she says, and some are probably left worrying about the increased workload pressure they will face because of this if they enter family medicine.
If there is a ray of sunshine, says Banner, it concerns the 500 international medical graduates (IMG) who received their medical training outside Canada and applied for the match. This year there were 77 more positions available than there were Canadian-trained medical students to fill them, and after the first round of the match there were 153 vacancies, including the 91 in family medicine; only about 40 Canadian-trained students who didn't get matched in the first round will be applying for them.
Although IMGs aren't guaranteed clear sailing, since there are limits on residency applications from IMGs in some provinces, Banner says "it looks like the doors are opening" for them.
Banner says the 2001 match was full of surprises:
- Eight of the 37 positions available in orthopedic surgery remained unfilled on match day in a speciality that has seldom seen a single vacancy before.
- Anesthesia, one of the most popular specialties in 2001, was one of the least popular just 5 years ago.
- The popularity of obstetrics and gynecology continues to suffer, with 20% of residency slots remaining unfilled. In psychiatry, 9 of 79 slots went unfilled.
"For me, anesthesia was a real surprise," says Banner. "Seventy-six applicants made it their first choice, and there were only 58 spots." She also noted that 22% of the unmatched medical students are unmatched because they chose only anesthesia.
Banner, who noted that radiation oncology and laboratory medicine specialties like pathology were more popular this year than in the past, hopes a survey of match participants will provide a hint about family medicine's lost lustre. "Maybe hospital-based practices with more regular hours are more in line with lifestyle choices," she said.
As for the future of family medicine, Banner said the 2001 results left her shaking her head. "When 20% of family medicine positions go unmatched," she says, "we've entered uncharted territory."
The CMA's Barrett says the first step is to find out why today's medical students appear to be shunning family medicine. "Once we know that, we can act," he says.
Patrick Sullivan, eCMAJ