ArticleCanadian family physician Medecin de famille canadien2026
Regional and medical school variation in family medicine specialization choice: Canadian medical graduates from 2000 to 2023.
Article in Canadian family physician Medecin de famille canadien, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo examine how Canadian medical schools contribute to the family physician workforce.
designPopulation-based repeated cross-sectional study.
settingAll Canadian medical schools.
participantsAll Canadian medical graduates (CMGs) between 2000 and 2023.
main outcome measuresMultivariate 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).
resultsOf 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%).
conclusionSubstantial 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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