Ontario students choosing family medicine
New data shows all 546 of province’s residency spots in primary care were filled this year
In a dose of good news for Ontario, all of the province’s family medicine residency positions — spots for new medical school graduates in training — have been filled for the coming year, despite an ongoing crisis in primary care nationwide.
New data released Thursday shows that 87 positions for medical school graduates across all specialties remain vacant in Canada in 2024, an improvement from last year, which saw 110 positions go unfilled, according to the Canadian Resident Matching Service (CaRMS).
All 546 of Ontario’s family medicine residency spots were filled this year, prompting Health Minister Sylvia Jones to say on X that the provincial “plan to expand access to primary care is working and we’re just getting started!”
Last year, 100 unfilled positions were in family medicine across the country. This year that number dropped to 75 out of a total of 1,702 available positions, meaning roughly 96 per cent of family medicine residency spots across Canada were filled. The vast majority of the unfilled positions are in Quebec.
While medical leaders point to the improving trend of graduates choosing to train in family medicine, they caution that targeted reforms for the profession, including higher billing rates and lower administrative burdens, are crucial to encourage graduates to become full-time family doctors — and retain them in that role.
They also caution that though graduates are being matched to family medicine, it isn’t clear the specialty is their first choice or that they will stay in the field.
“Just because we train them in family medicine doesn’t mean they will work in comprehensive family medicine if the practice environment isn’t good,” said Dr. Mike Green, president of the College of Family Physicians of Canada. He noted that doctors trained in family medicine can move into other areas, including palliative care and emergency care, and take on hospital-based positions. “Governments need to be pushing to make it (comprehensive family medicine) an attractive thing for people to do at the end of their residency.”
About one in five Canadians do not have a primary care provider, according to the nationwide OurCare Project, and roughly 2.3 million people in Ontario don’t have a family doctor. The Ontario College of Family Physicians says that number is expected to reach 4.4 million by 2026.
The federal government has stressed that bolstering family medicine is a national priority, and Ontario is making it easier for internationally educated physicians to join the workforce and is building two new med schools, including one focused on primary care. On Thursday, the province announced it will drop the requirement that sick employees produce sick notes from their doctor for the first three days of sick leave, a step in reducing administrative tasks for physicians.
The Ontario Medical Association (OMA), which represents the province’s 43,000-plus physicians, med students and retired doctors, expressed concerns that family medicine is increasingly not the first choice of medical students, pointing to data released in March showing that the field had 252 vacancies after the first round of matching.
Each year, CaRMS matches medical school graduates in two rounds; students who are not matched to their top pick of specialty programs can enter the second round to have a chance of matching with remaining open positions.
To become a doctor in Canada, students must graduate from a licensed medical school and then complete a residency — a training period lasting several years, depending on the specialty.
Of the 75 unfilled family medicine spots this year, 70 are in Quebec and one in British Columbia. The remaining four vacancies are in Ontario and Alberta but are specially funded positions for military applicants only and not part of the regular competitive application pools.
Green said provinces have different mixes of residency positions and different rules for the matching process. In Ontario, for example, he said the first round is only open to those who train in Canadian medical schools, while the second is opened to internationally trained graduates. This, he said, could account for why Ontario had a high number of unmatched spots for family medicine in the first round.
Quebec, which has a higher proportion of family medicine spots than other provinces, has had “a large number of unmatched positions for the past number of years,” said Green, noting an improvement this year. He noted that internationally trained medical students tend to come from English-language medical schools.
Dr. Ramsey Hijazi, founder of the Ontario Union of Family Physicians, which represents some 2,100 doctors, recently gave up his Ottawa-area family practice of 10 years to work in a local hospital.
He says he decided to leave family medicine beacuse of the “mounds and mounds” of paperwork and the financial challenges associated with running his own office.
“Being able to run a family practice is becoming so difficult now,” Hijazi says. “All our staff are needing raises or they go to private clinics or dental clinics. Our rent has gone up. The only way we can maintain services is at the end of the day when we do our billings, we end up taking less and less of the pie home.”