Curing Canada's doctor shortage

[Guest guest]

Curing Canada's doctor shortage

National Post Published: Tuesday, January 15, 2008

We do not presume to know whether medical degrees should take four

years to earn; or only three, as an editorial in the latest edition of

the Canadian Medical Association Journal (CMAJ) suggests might be the

case. But we know this: The length of time must be determined by

medical necessity not fiscal expediency. Shortening the length of

doctors' professional education just so our socialized health care

system can graduate more physicians is a non-starter.

It's clear we have a problem. The country has approximately 15,000 too

few doctors, a figure roughly double the total number of students in

all years of study at our 17 medical schools combined. At a

doctor-patient ratio of just 2.3 per 1,000 population, we are 24th on

the list of 28 industrialized countries. Approximately 1.5 million

Canadians cannot find a family physician as a result.

If this scarcity can be alleviated, even in part, by shortening the

duration of doctor training, it might be worth a look, provided

Canadians can also be reassured the change will not dull the skill of

the country's new doctors. However, it doesn't go to the twin hearts

of the problem: socialized medicine and centralized planning of health

care. Graduating more doctors sooner won't cure the underlying

condition. Rather, it is more like treating a wound on the left hand

by suturing the right one.

The doctor shortage began in the mid-1980s -- not coincidentally, at

the same time the last Trudeau government passed the Canada Health

Act, which forbade user fees, balanced billing by doctors and private

clinics and hospitals. Immediately, doctors began moving to the United

States by the hundreds every year. The effects of this exodus were

compounded in the early 1990s when provincial health ministers

consciously decided to limit enrolments in their medical schools.

Doctors, they reasoned, were the enemies of health budgets; limit the

number of doctors and there would be fewer tests ordered, fewer

hospital beds filled, fewer surgeries performed and lower costs to

their department's budget. (By this thinking, eliminating doctors

altogether would really bring provincial cost into line.)

Over the quarter century since the Canada Health Act became law,

approximately 12,000 Canadian doctors have moved south. According to

another article in the CMAJ last winter, " this is the equivalent of

having two average-sized Canadian medical schools dedicated to

producing physicians for the United States " every year for 25 years.

Add to this the way politicians and bureaucrats deliberately reduced

the number of medical school graduates -- the number fell 14% between

1991 and 2000 -- and it is easy to see why there are too few doctors

in this country. It's not because our medical degrees are four-years

long rather than three.

The governing bodies for doctors in each province -- the colleges of

physicians and surgeons -- also deserve some of the blame. In most

cases, they have willingly gone along with government caps on the

number of doctors because it means less competition for existing

doctors. The burden of this closed-shop attitude has been borne

primarily by foreign-trained doctors who have more trouble being

certified to practise in Canada than in most other industrialized

jurisdictions. Many of the very best international doctors end up in

the United States -- even though some initially want to come here --

simply because they are more welcome south of the border.

The Association of Faculties of Medicine of Canada is already studying

what, medically, is the right length of time to school doctors. When

it reports in 2009, it may well suggest shortening medical school to

three years. But if it does, that will be tangential to solving our

doctor shortage. Med schools didn't create the shortage and they won't

be able to solve it. That will take courageous politicians willing to

open up our health system to private innovation and physician competition.

http://www.nationalpost.com/opinion/story.html?id=222287

The above is of course about Canada. What is interesting is that in

the USA, the three year training program for MD's has gradually been

eliminated in favor of the four year program. I have not heard of any

surveys being done to discover if 4th year medical students in the USA

and Canada are bored and would have preferred to graduate in three years.