Objective: To examine how Canadian medical schools contribute to the family physician workforce.
Design: Population-based repeated cross-sectional study.
Setting: All Canadian medical schools.
Participants: All Canadian medical graduates (CMGs) between 2000 and 2023.
Main outcome measures: Multivariate Poisson regression models were used to estimate incidence rate ratios (IRRs) of the associations between age, sex, and medical school attended, and entry into family medicine (FM) training. Trends in the proportion of CMGs entering FM postgraduate training were examined by medical school and region using linear regression models to calculate average annual percent changes (AAPCs).
Results: Of 55,883 CMGs, 22,849 (40.9%) specialized in FM. Quebec had the highest proportion (44.5%) of graduates specializing in FM. McGill University (31.7%), Queen's University (31.8%), and the University of Toronto (33.0%) had the lowest proportions of graduates specializing in FM. Entry into FM was more likely among females (IRR=1.30, 95% confidence interval [CI] 1.26 to 1.33) and those aged 31 years and older at entrance into FM (IRR=1.47, 95% CI 1.41 to 1.53). After adjusting for age and sex, CMGs from NOSM University, the University of Sherbrooke, and the University of Montréal were most likely to specialize in FM, while graduates from McGill University, the University of Toronto, Queen's University, and the University of Calgary were least likely. Nationally, the proportion of CMGs entering FM increased from 36.2% (2000-2004) to 43.0% (2019-2023) (AAPC=0.36%, 95% CI 0.22% to 0.51%). Several universities saw a significant increase over time in the proportion of graduates entering FM (Laval University, University of Sherbrooke, University of Montréal, McGill University, Western University, the University of Manitoba, and the University of British Columbia) while NOSM University showed a decline in graduates entering FM (AAPC=-1.01%, 95% CI -1.65% to -0.37%). Regionally, growth was highest in Quebec (AAPC=0.52%, 95% CI 0.34% to 0.71%), followed by Ontario (AAPC=0.33%, 95% CI 0.16% to 0.50%), Central-Western Canada (AAPC=0.25%, 95% CI 0.01% to 0.49%), and Eastern Canada (AAPC=0.07%, 95% CI -0.17% to 0.30%).
Conclusion: Substantial variation exists in the proportion of CMGs specializing in FM by medical school. These findings may highlight differences by school in the characteristics of medical students, undergraduate medical curriculum, social accountability mandates, and student experiences. Ongoing efforts to understand and address these differences are crucial to strengthening Canada's primary care workforce.
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