Choosing Family Medicine First:
A reflection on trends for graduates of Canadian and international medical schools
By Steve Slade | April, 2026
As data and information consumers we learn quickly that diverging and converging trend lines generally mean something. They pique interest and make us wonder what’s going on behind the data, what’s driving the trend. They may confirm or challenge our impressions. They can raise concerns or signal progress being made. They flag something that needs talking about.
The following trend lines do that for me, and maybe you too.
This data is from the Canadian Residency Matching Service (CaRMS), which is the gateway to specialized residency training in Canada. As part of the CaRMS process, medical graduates select one or more disciplines and training programs, indicating their topmost and lesser preferences as they do so. The figure shows that, among graduates of international medical schools (IMGs), family medicine accounts for an increasing share of the disciplines ranked first. Among graduates of Canadian medical schools (CMGs), family medicine accounts for a decreasing share of top-ranked choices.
These trend lines cut through an era of increasing primary care crisis in Canada, a crisis that is defined by both population healthcare needs and health workforce challenges. We are in a time where we increasingly look to IMGs for relief. Against this backdrop, the diverging trajectories demand consideration of what is driving the trends and what, if anything, might be done to adjust their course.
1. The IMG trend is, in many ways, congruent with what we are observing across the system. Canada is leaning more heavily on IMGs, and family medicine is front-and-centre in workforce planning conversations. IMGs may be responding to that reality—seeing clearer pathways into practice or more targeted recruitment and bridging supports in primary care. If family medicine is increasingly positioned as the place where IMGs are most needed, it is not surprising to see that reflected in their first-choice rankings.
2. The CMG pattern is more perplexing. Despite our intense concern about access to primary care, relatively fewer CMGs are ranking family medicine as their top choice. One plausible explanation is that CMGs are more tuned in to the prevailing narrative about family practice in Canada—often a narrative dominated by heavy workloads, administrative burden, burnout, and poor pay. Those issues are real. But when they become the whole story, they distort perceptions and, understandably, how medical students would weigh their discipline choices.
As a long-time data user I know that, across broad sources, the data has a much better story to tell about family medicine. Data published by the Association of Faculties of Medicine of Canada show that medical students have their best experiences in family medicine. Data from The College of Family Physicians of Canada shows that almost all family medicine residents are proud to become family doctors. The Canadian Medical Association’s National Physician Health Survey shows high levels of wellness among family physicians—higher than other physicians and surgeons. At a systems level, many jurisdictions are taking concrete steps to strengthen primary care through payment reform. Also, family physicians have broad professional latitude: while they are core primary care providers, many also practice in emergency rooms, hospital inpatient wards, care homes, and other settings. In other words, family practice is demanding, but it is also diverse, portable, intrinsically rewarding, and of great value to patients and the healthcare system.
Telling this better story of family medicine matters for many reasons. If IMGs are increasingly selecting family medicine first while CMGs are doing so less often, we may be drifting toward a two-track model of workforce supply—one in which primary care depends disproportionately on IMGs. That may be a necessary reality in the short term, but it raises longer-term questions about sustainability, equity, and retention. At the same time, the unduly negative story of family practice may dissuade CMGs from a career path that would bring great professional satisfaction.
The CMG-IMG trend lines push us to think about who sees family medicine as their best first choice—and why. In many ways the IMG trend adds up, but the CMG trend is puzzling and suggests the need for a more accurate, data-driven narrative about family practice—one that reflects not only pressures, but also wellness, reform, and professional latitude. A more balanced, evidence-informed narrative about family practice would point to progress that is being made. It could buoy those who work in family medicine today. Perhaps most importantly, it would better serve medical students in Canada as they consider their career choices. It would give reassurance that it’s not wrong to feel good about choosing family medicine first.