Lessons learned from rebuilding a primary care infrastructure: a Canadian perspective.

ing more compassionate, more effective family physicians;” in fact, only 0.8% believed this would occur. In July 2011, the ACGME’s revised duty hour rules went into effect, in part based on voluminous research into the effects of fatigue and sleep deprivation on performance, but also due to external political pressures that forced the ACGME to take action and try to preserve the vestiges of a profession before Congress, governmental agencies, and activist groups forced more draconian measures. Considering the previously surveyed opinions of program directors, one can draw 2 conclusions concerning the impact of duty hour revisions on the quality of our residents’ education and on patient care. The fi rst possibility is that program directors collectively were wrong and that the duty hour changes will in fact result in better family physicians and improved care for patients. This is 1 circumstance where most program directors hope they were indeed wrong. The other possibility is that the collective wisdom of the group responding was generally correct. Regardless, Congress, advocacy groups, residents, and recently graduated family physicians (who may not fully appreciate their level of preparedness or have a basis for comparison) will not likely agree to go back to less restrictive duty hour rules. Assuring adequate experience levels for independent practice, teaching professionalism, and providing residents a glimpse of the joy of deep and meaningful patient relationships needs to be addressed in new ways. John Wooden said, “If you don’t have time to do it right, when will you have time to do it over?” The realistic answer is never, CME reforms notwithstanding. As family medicine educators, we need to get it right the fi rst time! As the effective amount of training time continues to diminish (1 estimate is that a resident now will train the equivalent of 2.4 years compared to a 3-year residency of the past), we owe it to our residents and the public to honestly and actively study the length of family medicine residency training to minimize any unintended negative impact of duty hour restrictions. Producing quality family physicians cannot be even partially sacrifi ced for other important goals such as meeting primary care workforce needs. We need to assure that a board-certifi ed family physician stands out from mid-level practitioners and other generalist physicians, both in scope of practice and skills. This may require more time than we currently give ourselves to provide our residents the new skill set needed to lead in the future health care system. Joseph Gravel, MD; Stoney Abercrombie, MD; Sneha Chacko, MD; Karen Hall, MD; Grant Hoekzema, MD; Lisa Maxwell, MD; Michael Mazzone, MD; Todd Shaffer, MD; Michael Tuggy, MD; and Martin Wieschhaus, MD References