Lessons from Canada’s first circumpolar medical residency site (2024)

After four years of operation, an NWT family medicine residency site has trained medical students who have provided care in close to 20 small and isolated communities.

Residency is a stage of training where newly licensed doctors, fresh from medical school, spend several years of their career training in a more specific field.

In Canada, medical students complete three to four years of medical school before moving on to a residency for two to eight years of extra training in areas like family medicine, pediatrics or internal medicine.

Dr David Pontin worked to create and now co-directs the Yellowknife residency site, which opened in 2020 and currently takes in two residents per year.

Residents over the past few years have been “absolutely extraordinary people,” who “have contributed to our community and to our health system in all kinds of big and small ways,” Dr Pontin said, including bringing down appointment wait times and improving primary care screening.

Run in partnership with the University of Alberta, Yellowknife’s family medical residency is the first to educate and train family physicians in the North.

Residents spend two years based in Yellowknife with rotations in Nunavut, Edmonton and a variety of NWT communities. The intention is that by training physicians up here, they’re more equipped to deal with the unique aspects of practising in the North, and more likely to stay here and work afterward.

The first four residents who graduated from the program all currently practise in the the North: Dr Thomsen D’Hont works as a family doctor in the Tłı̨chǫ region, Dr Kajsa Heyes is an emergency physician at Stanton Territorial Hospital, Dr Sonja Poole works in Yellowknife and Dr Eleanor Crawford is working in Iqaluit.

So far, the program is surpassing its goal of having at least 50 percent of residents sign a three-year contract in the NWT or Nunavut.

Seeing that return this early is “amazing,” Pontin said, likening the start of a residency program to planting an orchard and waiting for fruit.

“Residency programs don’t usually start to see that kind of return on recruitment until they’re about six, seven or eight years down the line,” he said.

Dr Heyes, who was one of the first residents, said she probably wouldn’t have come to work in the North if she hadn’t done her residency here.

“If I hadn’t been exposed to coming here, I don’t think there would be much incentive,” Dr Heyes said.

Doctors are attracted to work in certain places based on good experiences in training or doing loc*ms (short stints of work) there, feeling well supported in their job, and being compensated well, she said.

“This probably would not have been a place that I would have come unless I had had previous experience,” said Heyes, “recognizing that it was quite a nice place to work with really wonderful, supportive colleagues.”

She describes her residency as a “profoundly positive experience.”

Compared to other places in Canada, where Heyes said residents are viewed as trainees, in Yellowknife she always felt respected by the doctors and treated as “someone with the potential to become a colleague who would stay in the North.”

That experience made Heyes look forward to becoming staff and setting up a life here with fiancé Dr D’Hont. Since finishing their residencies, both Heyes and D’Hont have signed three-year contracts to work in the NWT.

D’Hont was born and raised in Yellowknife and is Métis. After finishing high school, he went away for university and was a competitive cross-country skier before going to medical school in Prince George, BC.

Being placed in a medical residency involves going through a complicated matching system in which applicants rank the residencies they want and the programs rank applicants. When Dr D’Hont learned he was matched with Yellowknife, he felt “relieved and happy to be coming home.”

The residency was an “amazing learning opportunity,” D’Hont said. As a resident in a small program, he was able to involve himself in a wider variety of meaningful work. He also got work in nine or 10 communities around the Northwest Territories, which he found “really rewarding.”

Now, he spends most of his working time in the Tłı̨chǫregion, which both he and Pontin say hasn’t had a dedicated family doctor in about 30 years. That in itself is a “transformational event,” Pontin said.

While most places across Canada must work hard to recruit doctors, D’Hont said, “we kind-of have our own unique challenges.”

“Something like a residency program is a great way to get people training here, and get them really familiar with this location and to help them put down roots here,” he said.

“Every new cohort of residents we have here just really integrates with the community, and I think that’s one thing that keeps people coming back.”

He also thinks there’s more that can be done to encourage people who are from the NWT to go into medicine, and he wrote an article addressing some of the barriers for Indigenous students who want to pursue medicine – and how those barriers could be lifted.

“Often, the goal is trying to recruit people from down south to come up,” he said, but he sees the “potential to focus more on local work, workforce development.”

Expanding the program

Each year, the family medicine residency in Yellowknife now receives approximately 120 to 130 applicants.

Those numbers are pretty high for such a small program, Pontin said. He characterized the applicants as generally “really serious” and people who “have deep connections to the North, or have spent a lot of time here, or, in fact, live here.”

“There’s a lot of Northwest Territories med students out there, actually, and who want to come home,” he said. “There’s a clear interest in this kind of work … but you have to capture people early in their training, you know, and get them hooked.”

The program has shown that “teaching residents in the North is possible,” Pontin said.

With such high interest in the program, are there plans to expand?

“I would love to have more,” said Pontin, “and I think we could probably get to three [residents] per year, possibly four,” but the logistics of the North can make bringing in more residents a tricky task. Pontin said they’d have to make sure they have enough staff to train residents, as well as enough funding to do it.

“One of the challenges we’re having right now is that as our physician staff shrinks, so do our potential supervisors, so that can put pressure on the system,” Pontin said. He’s also concerned that Yellowknife’s housing shortage could become a pinch point for residents in future years.

Dr Hannah Shoicet, co-director of the site, said while the program is a time-intensive and money-intensive investment, “it’s really paying its dividends in terms of the recruitment.”

Dr Shoicet said that they’ve “felt really well supported by the Department of Health in this endeavour … I think that they are seeing the benefits of it as well, and continue to be supportive of the program.”

Having the residents around has proved to be a morale booster for staff, as well.

“Healthcare is a pretty tough place to work,” Pontin said. The residency has been “such a positive, bright thing for us.”

Inspiring other programs

In the meantime, the success of the Yellowknife program is inspiring others.

In December 2023, the Government of Yukon announced it would develop a rural family medicine program based in Whitehorse with a stated goal of helping to recruit and retain health workers.

The Yukon is keen on starting up a residency program largely because of the success of the Yellowknife program, Pontin said. “Classic Whitehorse and Yellowknife rivalry,” he joked. “This always happens this way.”

It makes sense that Whitehorse wants a program as well, because the residents provide a service to any local healthcare system while they’re there.

“During Covid, when we had trouble keeping our hospital program running, the residents helped filled those gaps,” Pontin said. Another time, when Hay River was going to shut down its emergency department over a weekend, “Thomsen, Kajsa and I flew down and kept their ER open.”

Residents “provide very important emergency stopgaps to staffing shortfalls up here sometimes,” Pontin continued, “and they see a lot of patients, so it’s actually a fairly cheap way” for health systems to provide care.

Residents are always accompanied by their instructors and, though they may be young, it’s outstanding care, Pontin said.

“They’re learning … but at the same time, they’re providing a very, very important service to our community as they train.”

Correction: July 19, 2024 – 1:51 MT.This article initially stated Dr Sonja Poole works in Whitehorse. She works in Yellowknife.

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