Trust issues: Inside the disconnect between family physicians and the CFPC

Few, if any, family physicians would deny that the College of Family Physicians Canada (CFPC) faces a deeply complex and at times unwieldy mandate. In this era of burnout, physician shortages, long waitlists and allied health professionals’ expanding roles, like family physicians themselves, the organization is operating in a volatile environment with much to consider, balance and address.Nonetheless, many physicians have expressed frustration to the Medical Post about the CFPC. Criticisms include a lack of consultation with physician members, lack of transparency, lack of timely followup, insufficient communication, ineffective advocacy, concerns over high dues, allocations of funds and other reported missteps.“It’s not very transparent, and that doesn’t make it very accountable, and it’s getting a lot of people quite worried,” said Toronto FP Dr. Greg Dubord. “We need a healthy CFPC. It’s too important an organization not to be functioning well.”Dr. Paul Dhillon, an FP in Sechelt, B.C., has spent time and effort advocating for increased transparency and access to CFPC information, but says he has been mostly met with frustration. “I have the sense when I discuss with other family doctors that they don’t feel the college speaks for them in the same way that they would speak for themselves,” he said. “Some of this may be a disconnect between more academic versus practicing physicians—and those that likely want a more minimalist role for their national college or those that want a more active role. I fully acknowledge that they do have a challenging role.”Dr. Sohail Gandhi, a family physician in Stayner, Ont., and former president of the OMA, says the CFPC has fallen into practices common among provincial and territorial medical associations.Disenfranchised members“Unfortunately, sometimes a corporation like the CFPC or a PTMA (provincial/territorial medical association) becomes a little bit insulated from the membership,” he said. “There’s this business principle—a responsibility—where a corporation and the directors of a corporation have to have a certain amount of responsibility to the interests of the corporation. And that sometimes gets in the way of them advocating for members like they should.”CFPC leaders acknowledged that some family physicians feel disconnected from the organization and say rebuilding trust and communication has become a priority this year.“The question of connection is really, really important to us. When we hear concerns about people feeling disconnected, we take that really seriously,” said Dr. Sarah Cook, CFPC president and a family physician in Yellowknife. “What we would like is for the College of Family Physicians of Canada to feel like a professional home for all family doctors in Canada. There is work to be done. It became clear to me when stepping into this president role that communication was going to be the priority for me.”Several physicians recognized that with Dr. Cook at the helm and the addition of family physician Dr. Mike Allan as CEO in 2024, there is room for optimism.‘Supportive and understanding’“I have found that the current leaders at the CFPC are highly approachable, supportive and understanding,” said Dr. Marina Malak, an FP in Mississauga, Ont. “They truly care about the mandates of the CFPC and strive to support physicians. That being said, the environments that physicians are practising in have changed drastically over time. With that comes a reasonable expectation that the CFPC will do more for physicians.”Vancouver FP Dr. Eric Cadesky put it this way: “After violating the principle of first do no harm by trying to administer a poisonous third year into family medicine residency, the new leadership appears to be earnestly opening up the CFPC’s opaque processes through improved communication. I am watching with optimism and interest to see how the CFPC reinvents itself and justifies its near-monopoly on CME credits and certification.”Fee increase proposalOne key area of disconnect came up in late 2025, when the CFPC board proposed it be allowed to tie annual fee increases up to the Consumer Price Index (inflation) without having to consult the membership. This move rapidly met with resistance from members who felt the college should find efficiencies before asking for more money—and to be more transparent over allocation of existing funds.A source that chose to remain anonymous told the Medical Post that there are many physicians who feel trapped into a membership to the CFPC to keep their educational credits in one place so they can continue to renew their licence and their CMPA. “What exactly do family doctors get for that increase in fees?” the source asked. “People did not want to pay any more money to an organization that doesn’t seem to really do a lot for them.”Dr. Malak pointed out that most physicians don’t understand what their fees for the CFPC go toward. “Most of us understand that we need the CFPC to track our CME credits; beyond that, one questions what the thousands of dollars of membership go toward. Clearer information about the financial distribution for our fees is important,” she said. “We need hard data of exactly what our money is going toward and what benefits we received from being members of the CFPC.”Dr. Gandhi said the CFPC needs membership permission to raise fees. “As painful as it is, you have to go to the membership every year and justify a yearly increase,” he said. “You can’t just put something in place that gives you carte blanche to increase dues every year in perpetuity.”No recent increaseIn response, the CFPC pointed out that there had been no member fee increase since 2017, with cumulatively 25% inflation.“You can imagine how challenging that is for an organization to continue to operate with all of the things that we are trying to do, both for members and for protection of the self-regulation of the profession, without having increased fees to match inflation,” said Dr. Cook. “It’s kind of a standard for a lot of organizations to have inflationary increases embedded in their fees. The CFPC hasn’t done this before. It was really to try to stabilize our finances as an organization, to be able to continue to operate in the way that we need to.”Trying to put through this automatic potential annual increase is just one of several missteps physicians say the organization has made.PGY3 aftermathOne of the clearest examples physicians point to when discussing growing distrust in the CFPC is the organization’s failed attempt to move family medicine residency training from two years to three.The proposal, known as PGY3, was ultimately shelved after significant backlash from family physicians, many of whom say the process exposed a troubling disconnect between the organization’s leadership and its membership.Several physicians interviewed for this story described the rollout as opaque, top-down and lacking meaningful consultation with frontline doctors. One anonymous physician said the proposal “came completely out of the blue. . . . We’re already under-doctored, and you are going to take one entire cohort out?”“We learned a lot from that (PGY3),” said Dr. Cook. “It’s always going to be an evolution of thinking about the most effective way to educate family physicians. But we have moved past that. That was several years ago. We’re really working on connecting with people and figuring out what we can do best to support our profession.”Seeking transparencyBut it was more than just trying to push through PGY3. It was the aftermath: Members later voted in favour of reviewing how the PGY3 proposal originated and was greenlit. About 91% of members supported this motion, brought forth by Dr. Dhillon, calling for an analysis of the process.But, the board later stated in its board meeting summary report there was, “no further need for an analysis of this direction.”“It’s a direct violation of the wishes of the members, right?” Dr. Dubord said. “The members want to know how this thing happened that consumed lots and lots of dues money.”Several physicians interviewed described the episode as emblematic of what they see as a broader communication and transparency problem within the organization—one that continues to shape member frustration today and erode trust.The membership also passed a motion (approximately 95% in favour) to obtain ongoing access to board meeting minutes. In July 2024, the board formally deliberated releasing minutes to members and decided not, citing advice from legal counsel. Dr. Cook said: “The CFPC sought legal opinion on that question of what should be released. The recommendation was to share them, because we want to be transparent, but not to share detailed minutes, because there’s sensitive material in some of those discussions, and we need people to be able to speak freely in those board meetings,” she said.So since 2024, the CFPC has released meeting summaries of every board meeting, with the opportunity for members to provide feedback or ask questions. They are sent out through the CFPC’s leadership communications.“It was felt that we could meet the expectation of the members by providing quite a detailed document after every meeting—two pages, summarizing what went on in the meeting—while still making sure that we can maximize the benefit of having really fulsome board discussions,” said Dr. Allan.This is a common approach in Canada: Many member associations share summary documents or redacted minutes to increase transparency without exposing sensitive personnel, legal or commercial information. Indeed, under the Canada Not-for-Profit Corporations Act (CNCA) and Ontario’s Not-for-Profit Corporations Act, members have the right to access minutes from regular member meetings, but they do not have an automatic right to access board of directors’ meeting minutes. An organization’s bylaws or policies can grant members broader access to board minutes, but they don’t have to.Still, a reiteration of the motion to gain such access is among 10 filed in November 2025, by Dr. Dubord, with the input and support of other CFPC members. Dr. Dubord submitted five additional motions in February 2026 for consideration this fall at the 2026 annual meeting of members (AMM), covering topics ranging from open-to-all board elections and governance transparency to member engagement and organizational accountability. All 15 motions were disqualified in March for being filed outside the statutory window. They can be refiled this summer, something Dr. Dubord intends to do. Collectively, the motions reflect concerns held by many members about transparency, accountability, and how much say members have in the college’s decisions.Board positionsAmong the motions was a call for direct elections of the CFPC president and board directors through a one-member, one-vote system, replacing the current nominating committee process.“The college made changes which essentially restricted and made it more challenging for members to run for the board without being essentially vetted by a committee prior to being nominated, and I don’t think this had the intended effect of increasing member engagement and the responsiveness of the college to non-Ivory tower views,” said Dr. Dhillon.One anonymous FP said: “If they would be genuinely interested in engagement they need a complete board and culture overhaul. Unfortunately the recent proposal to further entrench board hopefuls to a short list of board approved candidates appears to be just the opposite.”Dr. Cook says recent governance changes were designed to strengthen the board’s skills and perspectives while preserving opportunities for members to seek election.The most significant changes came into effect in 2019, introducing a nomination pathway that allows the board to identify specific skills, experience and perspectives it needs in a given year. Rather than reserving seats for specific regions or groups, the organization looks for a mix of professional experience, practice settings, lived experiences and other attributes. This year’s priorities, for example, included a family physician practising in Quebec, a physician within the first 10 years of practice, a researcher and a physician recognized as a convener or influencer in family medicine.However, Dr. Cook stressed that members who are not selected through that process can still put their names forward through a self-nomination pathway.On the website, that self-nomination information is conveyed under About us > board nominations > 2026 board nominations> FAQs, at the very bottom of the page.Dr. Cook acknowledged this information about the self-nomination pathway is not easy for members to find. “It’s not that it doesn’t exist, but perhaps that’s important feedback that we can make that process more well known,” she said.CME: the good and the badContinuing medical education (CME) and the CFPC’s Mainpro+ credit-tracking system were another recurring source of frustration among some physicians interviewed for this story, though members had good things to say as well. One Toronto family physician, who requested anonymity, questioned the value physicians receive from their membership fees, and the CME “monopoly.”“Whether or not the CFPC offers value for dollars is debatable,” the physician said. “I do not understand how they are permitted to hold a monopoly on CME tracking which is required for maintaining licensure. Even in this simple regard they have stumbled repeatedly, with clunky dysfunctional websites which were updated to an even less usable format while simultaneously committing a massive cybersecurity lapse.”(Hackers accessed and copied data from the CFPC’s network on Oct. 25, 2023.)Others pointed not to the credit-tracking system itself, but to the process of accrediting educational programs and conferences.One anonymous Toronto family physician said the accreditation process has become increasingly burdensome for physicians who develop CME programs.“For those developing CPD (continuing professional development) and need to accredit their conference or educational program on a national level, the accreditation application is very onerous and costly, with them adding extra questions and requirements recently,” the physician said. “For physicians who are creating educational programs for other physicians and allied health, this is not only an administrative burden on an already busy clinical schedule, but also discourages the creation of further CPD.”Another physician described the accreditation process as “crazy expensive.”Dr. Gandhi said the CME credit system has historically been difficult for physicians to navigate, but that the CFPC has taken steps to improve access to educational opportunities.“In fairness, there have been some improvements. I think you should give credit where it’s due,” he said. “The CFPC has made partnerships with people who provide low-cost or even free CME, and they’re making that kind of education more available. That’s a good thing. But we still need to simplify the credit system more.”The value of FPsDr. Allan says that while 56% of the budget goes to activities related to self-regulation, including setting educational standards, accrediting universities for residency programs, and setting exams, 44% goes to advocacy and education (for example, the Canadian Family Physician journal.)Both the CFPC and physicians we spoke to agree that that advocacy piece is especially important now, while doctors feel overworked and under siege.Several physicians interviewed questioned whether the CFPC has been forceful enough in advocating for family physicians amid the FP crisis, with some saying they want the organization to more aggressively defend the role and value of family physicians.It is precisely because it is such a difficult time for FPs, says Dr. Gandhi, that the CFPC is “desperately needed to be more effective at advocacy. If the CFPC had been as effective at advocacy as I personally want them to be, we wouldn’t have this situation of a family medicine crisis,” he said. “If they had consistently shown the public how important family doctors are and how much value they provide for the healthcare dollar, I think we wouldn’t be in this situation. I genuinely want them to be that successful.”More advocacyDr. Malak would also like to see the CFPC do more: “Things like advocating for fair pay across the board for all doctors—(meaning) more than simply making online posts or sending out announcements. It means going to the table with advisory boards and government officials, obtaining the voice of family doctors and hearing their concerns, etc. With difficult financial times and an increasing burden on physicians, a general percentage of how our fees are being used is not likely to satisfy most physicians. We need hard data of exactly what our money is going towards and what benefits we received from being members of the CFPC.”The college should start advocating not just within family medicine, but to the rest of the medical community as well, said Ottawa FP Dr. Jabir Jassam. “Language like ‘primary health provider’ is being used more and more by other disciplines to loosely describe what family physicians do. Collaboration across specialties should never come at the cost of demeaning the physicians who form the foundation of our system. The college should work to ensure that family physicians are shown the professional respect they are due, and call out conversations or catch phrases that mock or make light of family medicine.”Dr. Jassam thinks the CFPC could play a role in shining a light on the incredible complexity of family medicine cases, allowing community physicians to lead case discussions, and create awards or recognition for excellent longitudinal patient care. These “are just a few ways the college could reiterate to trainees and the public that family medicine is not a lesser specialty, but a specialty of synthesis, clinical judgment, and long-term accountability,” he said.“I would say, in fairness, it’s not all bad,” said Dr. Gandhi. “Sometimes you see really good advocacy from the CFPC. Most recently, they’ve got a campaign where they’re asking members to write to their Members of Parliament and demand that the money allocated for simplifying digital health and unifying IT systems actually be used for that purpose. So it’s not like they do everything wrong.”Indeed, CFPC notes it plays a large role in both setting national standards for family medicine and advocating for the profession publicly and politically. Dr. Allan and Dr. Cook said the organization works to ensure family physicians are heard and represented in national healthcare discussions.CFPC’s work“The frustration about how family doctors are undervalued, under-respected, all of those things—I think every member in our boardroom, of our board of directors, feels deeply frustrated with this and is committed to trying to make a change,” said Dr. Allan.He and Dr. Cook enumerated the many advocacy efforts the CFPC is involved in, including advocacy for long-term funding of AI scribes to save FPs administrative time. (While pilot funding exists through Canada Health Infoway, Dr. Allan said the CFPC is advocating for longer-term federal support.)Dr. Cook points to a CFPC public-facing campaign to help the public understand what is the unique value of a family physician. “We value working with pharmacists and nurse practitioners, but we’re not the same. So let’s stop wasting time talking about equivalency, because we’re not equivalent. But we can work really well together. So there was a whole campaign about that. We continue to advocate on that,” she said.Dr. Cook also pointed to several recent advocacy efforts that she said demonstrate the organization’s ongoing work on behalf of family physicians.Among them is the CFPC’s campaign to simplify the Disability Tax Credit application process. The CFPC has also been advocating for greater recognition of the role and expertise of family physicians within the healthcare system, including encouraging policymakers to use the term “family physician” rather than broader labels such as “primary care provider.”Finally, Dr. Cook said the organization is working to highlight practical solutions emerging from family medicine practices across the country. Through initiatives such as its Family Medicine Matters podcast, she said the CFPC is sharing examples of successful innovations that could be replicated elsewhere.“We really want to focus on practical solutions,” she said.

Trust issues: Inside the disconnect between family physicians and the CFPC

Register for free access or login.

Related Topics