Today, emergency medicine is a well respected and valued field of medical training and care. Known for its high-pressure and fast-paced nature, it is an often sought after speciality within Canada. In fact, according to data provided by the Canadian Resident Matching Service, the number of first-choice applicants to emergency medicine consistently exceeds the number of residency spots available. For instance, in 2022, there were 121 applicants who ranked emergency medicine as their first choice for residency, but only 70 available spots (CaRMS, n.d.). As their data demonstrates, this trend is far from new. From 2013, the earliest year of data they provide, to 2022, each year reveals a high applicant to available positions ratio (CaRMS. n.d.), illustrating the competitive nature of emergency medicine training and practice.
However, before the late twentieth century, emergency medical care was not even established as a separate medical specialty. It took many years of effort and determination from the early emergency medical pioneers before the field began to gain the attention it deserved. In fact, it was not until June of 1980, following a long 10-year struggle between the Canadian Association of Emergency Physicians (CAEP), the Royal College of Physicians and Surgeons of Canada (RCPSC), and the College of Family Physicians of Canada (CFPC), when emergency medicine was finally granted speciality status by the RCPSC (Elyas 2007, 282).
Yet, even following this landmark decision, the struggle was not over yet. While the RCPSC was continuing to move forward with the development of an emergency medical speciality, the CFPC disagreed with the RCPSC’s decision, arguing that emergency medicine was within the sphere of family medicine, and should therefore be supplementary to a foundation in family medicine rather than a whole new speciality (Elyas 2007, 282-283).
As a result of their opposing views, the RCPSC and CFPC simultaneously decided to develop their own independent streams of Emergency Medicine training and certification, with each program designed to satisfy the desires and beliefs of the separate colleges. This decision made Canada one of the only countries in the world to have two separate EM training programs (Moore and Lucky 1999, 51). The residency training program from the Royal College, initially a four year program that was later expanded to five years (Steiner 2003, 1549), was intended for those looking to train solely for emergency medical practice. The longer program provided enough time for residents to learn and practice emergency medicine at an in-depth level. The RCPSC-EM program held their first examinations in 1983 (Elyas 2007, 283). On the other hand, the CFPC’s emergency medicine training program, which held their first examinations slightly earlier in 1982 (Elyas 2007, 283), was developed as a 1-year program to be taken after the two-year specialty training in family medicine. As noted by Kieran Moore and Cindy-Ann Lucky (1999) in their article on EM training in Canada, the shorter CFPC-EM program was intended by the CFPC as a way to optimize Canadian emergency care delivery, as much emergency care was already provided by family physicians in Canada (51). Thus, both programs, which are still in use today, were created with different intentions and niches in mind, yet both had the overall goal of creating competent emergency medical physicians who would be able to better serve the emergency care needs of all Canadians across the country.
References
CaRMS. n.d. “Quota and applications by discipline.” Accessed August 21, 2022. https://www.carms.ca/data-reports/r1-data-reports/r-1-match-interactive-data/.
Elyas, Remon. 2007. “The Birth of a New Specialty: the History of Emergency Medicine in Canada.” Conference Proceedings from the 16th Annual History of Medicine Days, Health Sciences Centre, Calgary, AB, March 30-31, 2007, 277-86. http://hdl.handle.net/1880/47538.
Moore, Kieran MD and Cindy-Ann Lucky, MD. 1999. “Emergency Medicine Training in Canada.” Canadian Journal of Emergency Medicine 1, no. 1 (April): 51-3. https://doi.org/10.1017/S1481803500007077.
Steiner, Ivan P. 2003. “Emergency Medicine Practice and Training in Canada.” Canadian Medical Association Journal 168, no. 12 (June): 1549-50. https://www.cmaj.ca/content/168/12/1549.
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