Training and rural physicians.
I have just read Dr Roger Strasser’s article1 on training rural physicians. He suggests beginning by aiming our attention at rural high school students and then continuing to support and encourage these students during their undergraduate years. 
 
I then read Cal Gutkin’s article2 on a common first year of postgraduate training (PGY-1) and the Wilson and Cox reports3,4 suggesting that there should be three PGY-1 streams: one for family medicine residents, one for specialists, and one for those who have not yet decided. 
 
I then read the letters to the editor5-12 about extending residency to include a third year—be it an extra year of family practice or a year to focus on a speciality, such as emergency medicine, which has historically caused residents to practise in that area of interest, rather than in family medicine. 
 
Now putting these thoughts all together, should we not be looking at the undergraduate years? In the past, Canada had a 2-year premedical program. Returning to this system would capitalize on Dr Strasser’s suggestion and allow for more help to rural students. If all medical students were in the same undergraduate program, rural students could then receive the extra attention that Dr Strasser considers necessary. 
 
Students currently complain that MD really means “mega debt,” and adding years of study compounds this, as some of the letters to the editor argued. Many medical schools now require a 4-year undergraduate degree before admission to medical school. McMaster’s first class of medical students essentially consisted of PhD students, the second class, Master’s students, and the third and subsequent classes, students with 3-year undergraduate degrees. This implies that less is equally good. 
 
If we went back to a 2-year premedical program, or even if we required a 3-year undergraduate degree, then adding a PGY-3 requirement would not be the hardship that many students currently fear. If we went back to a 2-year premedical program, then attention and help could be given to rural students, and these students could be encouraged to practise family medicine.