Good medicine: new programs train country doctors 

Three years ago, Queen’s University in Kingston, Ont., started a program to train medical students to become family doctors in rural and remote areas.  

Now, as the first cohort prepares to head into medical residencies in 2027, the Université de Montréal (UdeM) is launching a similar program to address the shortage of GPs in small Quebec communities, far from the major metropolitan centres of Montreal and Quebec City.  

The program will welcome its first ten students in 2027,with hopes to expand admissions to 25 students annually. “That may not seem like a lot, but these doctors will make a huge difference in the regions,” said Patrick Cossette, dean of the Faculty of Medicine at UdeM. 

Instead of letting medical students wait until the end of their degree to choose a specialty in rural family medicine, UdeM is now asking them to express their interest up-front — and taking this factor into account in the admissions process, along with academic marks, cross-disciplinary skills, and interviews. 

“It’s a moral commitment,” said Dr. Cossette. “The idea is not to limit medical students’ options, but to match the best candidates to the available positions. We reserve a residency for them in a remote region and trust that they will take it, once they’ve completed their coursework and clerkship.” 

Queen’s pioneering model 

UdeM is the third Canadian university to create this sort of program, following in the footsteps of Queen’s in Ontario and Dalhousie University in Nova Scotia.  

“Family doctors possess a wide range of skills that enable them to support patients at every stage of their lives, whether they are welcoming a new baby, undergoing minor surgeries or managing chronic illnesses,” said Richard van Wylick, vice-dean of health sciences education at Queen’s. “They’re capable of solving all kinds of problems. They play a crucial role, but there is a nationwide shortage, especially in rural areas.” 

Queen’s designed its program to select the people best suited for those challenges at every stage — from candidate selection to residencies. The program is offered in collaboration with Lakeridge Health, an organization encompassing five hospitals and more than 20 community health centres providing care to residents of the Durham region. 

“We know that how you practise is influenced by where you train,” said Dr. van Wylick. “That’s why it’s important to train family doctors outside of major cities, so they can feel at ease and confident practising in small and medium-sized communities.” 

Queen’s also guarantees family medicine residencies to its program’s graduates. “They have experience with this type of practice because they were trained by family doctors,” said Dr. van Wylick. “That alleviates some stress because they no longer have to navigate the residency application process.”  

A specialized practice environment 

Similarly, candidates selected for UdeM’s program must show an interest in practising family medicine in rural and remote regions, where practice looks different than in major cities.  

“For example, certain specialist services may be harder to access in more remote regions,” explained Jordan Volpato, director of UdeM’s department of family medicine and emergency medicine. “Family doctors in these areas develop distinct habits and learn different skills to better meet the population’s various needs.” 

“Being able to practise autonomously in a wide range of clinical areas is key for doctors in small communities,” said Dr. Cossette. “Whereas in places like Montreal, for example, practice tends to be highly specialized. Populations and ailments can also vary considerably in the regions. For instance, Abitibi is home to a significant Indigenous population. Every region has its own characteristics and culture.” 

To better prepare students for this reality, the program will be delivered at a satellite campus in Trois-Rivières or Saint-Jérôme. Clerkships will mainly be supervised by family doctors in rural areas. Residencies will occur at university family medicine groups affiliated with UdeM, in regions where needs are greatest. The entire training program will take place outside of Montreal. 

“Students at satellite campuses who are exposed early in their training to family doctors with a community practice are more likely to settle in that region or choose a similar practice in another region,” said Dr. Cossette. 

A sustained effort 

UdeM’s program comes on top of a decade sustained efforts  to increase the number of family doctors in Quebec.  

The percentage of Quebec MD students specializing in family medicine has risen from 45 per cent ten years ago, to 55 per cent today — and that percentage remains steady, even as the province has increased its medical school enrolment by 42 per cent since 2019.  

“By the numbers, Quebec is training the most family doctors in Canada,” said Dr. Cossette. “Yet some graduates go on to work elsewhere, including in other provinces, which means nine or 10 per cent of residencies go unfilled each year.” 

Dr. Cossette said the vacancies always occur in the same regions: Abitibi-Témiscamingue, Haute-Mauricie, the Upper Laurentians and Maria in Gaspé.  

“The program may be attractive to people with backgrounds in health care, such as physiotherapists and occupational therapists, who would like to become doctors and already have roots in these regions,” he said. 

Back at Queen’s, Dr. van Wylick is thrilled at how the selection process has unfolded and how cohorts have evolved. “We always have a deep pool of excellent candidates, and we’ve filled all 20 cohort slots every year,” he said. “Some may still choose another path after finishing their training, but our goal is to keep every program participant in family medicine. I think we’ll achieve that goal with our first cohort, although we don’t have official statistics yet.”  

Participants in UdeM’s new family doctor program will also be closely monitored. “Their progress will be assessed at different points in time,” said Dr. Cossette. “We’ll be looking closely at their choice of residency, where they settle to practise, and overall retention.”