Is It Time to Rethink How We Train Doctors?

Training Our Own, Specializing Earlier, and Using AI

For over a century, medical education has followed foundations influenced by the 1910 Flexner Report. Is it time to rethink how we train doctors?

How Long Must We Train a Doctor?

Alberta faces doctor shortages, lengthy waiting lists, and difficulties recruiting physicians to rural and northern communities. The usual solutions include recruiting internationally, increasing medical school seats, and offering incentives to practise in underserved areas.

These measures may help, but I believe we should also question the system itself. Are we training doctors as efficiently as possible? Are we making the best use of our time, technology, and taxpayer dollars?

Becoming a family physician in Canada generally takes about 10 years or more after high school, depending on the educational pathway. Specialists require additional training. A urologist, for example, normally completes five years of residency after medical school.

I recognize that doctors need extensive knowledge to diagnose illnesses and manage unexpected complications. But does every practitioner need the same breadth of training if their eventual work is much more specialized?

My Proposal: A Medical Apprenticeship System

Why not investigate a system similar to the trades?

Students could begin with a strong foundation in human anatomy, physiology, disease, and patient safety. They could then move into supervised practical training, specializing earlier in a defined area of healthcare.

For example, a practitioner might concentrate on hip replacement surgery, cataract operations, or particular diagnostic procedures rather than training to perform a broad range of operations.

This would not mean allowing someone to operate independently after a few years simply because they completed a course. They would need supervised experience, rigorous examinations, and demonstrated competence.

My question is whether we could train certain practitioners safely in less time, allowing them to enter the workforce earlier and potentially reducing the cost of education.

We Already Have an Example

The Aravind Eye Care System in India demonstrates how specialized healthcare can be organized efficiently.

Its hospitals perform large numbers of cataract operations using standardized processes, trained support staff, and continuous monitoring of surgical outcomes. Surgeons can concentrate on surgery while other qualified staff handle preparation and administrative tasks.

A study published in BMJ Open examined 718,120 cataract operations across ten Aravind centres between 2012 and 2020.

This does not prove that every operation can be performed with less training. It demonstrates that specialization, teamwork, and consistent procedures can help healthcare organizations deliver services at considerable scale.

Why shouldn’t Alberta investigate where similar principles could work?

Patients Need Teams, Not Superheroes

Patient safety must remain the priority.

Before surgery, patients need appropriate assessments. Someone with significant kidney, heart, or lung disease may require specialist consultation and additional monitoring.

During an operation, the team must recognize complications and have access to the appropriate expertise. Practitioners must understand their limitations and know when to seek assistance.

My proposal is not to eliminate experienced specialists. It is to use their expertise where it is needed, rather than assuming every practitioner must personally master every possible procedure.

AI and Nurse Practitioners Could Help Now

We do not need to wait for a completely redesigned medical education system to improve access to care.

Nurse practitioners already provide many primary-care services. With appropriate training and properly validated AI tools, they could potentially manage more routine assessments, follow-up appointments, and diagnostic support.

This could free physicians to concentrate on patients who require their particular expertise, especially those with complex or serious conditions.

AI is not infallible, and robotic surgery does not guarantee error-free operations. Both require appropriate safeguards, independent evaluation, and accountability. Nevertheless, Alberta should investigate how these technologies can safely expand healthcare capacity.

Train Our Own Healthcare Workforce

International recruitment can help, but it cannot be our only long-term strategy. Other countries have their own healthcare needs, and competition for trained professionals is international.

Alberta needs a sustainable plan to educate and retain enough healthcare workers for its own population.

The government should work with universities, healthcare professionals, and patients to investigate alternative training pathways. Pilot programs could measure safety, complications, costs, and patient outcomes before any expansion.

If focused training proves safe and effective for particular procedures, we should consider adopting it. If it does not, we should learn from the results.

Patients and Taxpayers Deserve Answers

We should not automatically assume that producing more doctors requires following exactly the same training pathways. Nor should we assume shorter training is necessarily better.

We should ask whether we can train more people earlier, use AI and nurse practitioners more effectively, and provide better access to care in rural and northern Alberta.

My challenge to our government and universities is simple: Why aren’t we investigating every safe and effective way to train our own healthcare workforce more efficiently?

I welcome your thoughts.

1. Should Alberta investigate apprenticeship-style training for specific medical procedures?
2. Could AI-supported nurse practitioners reduce pressure on family physicians?
3. Should we invest more in training our own healthcare workforce?
4. What safeguards would you require before allowing practitioners with specialized training to perform procedures independently?