Physician resources
Aerospace medicine course launched
For the first time, Canadian physicians can pursue a career in aviation and aerospace medicine at a Canadian university. The first two physicians enrolled in the two-year University of Toronto Fellowship in Aerospace Medicine course last summer. [CMAJ 1999;161(9):1176]
Antiphysician billing restrictions protested
Alberta doctors launched a vigorous campaign to derail legislation they say would dictate how they bill for services. The Alberta legislature was attempting to fast-track Bill 7, which stipulates that all claims for insured services must be submitted electronically, thus preventing physicians from billing patients directly. [CMAJ 1999;161(4):428]
Brain drain
The Canadian Institute for Health Information reports that 569 Canadian physicians moved abroad in 1998, a significant decline from the 659 doctors who left in 1997 and a 27% drop from the 1994 peak of 777 physicians. Doctors leaving Canada tend to be male (70%) and young, with just over half having 10 years' experience or less. [CMAJ 1999;161(7):791]
Physicians cite myriad reasons for heading south of the border. Specialists may feel they don't get enough operating room time, family physicians say they are forced to see too many patients and others say the postgraduate training opportunities are better in the US. [CMAJ 1999;161(8):1028-9]
A Gallup poll released in September 1999 shows that most Canadians agree that the country is experiencing a brain drain to the US. Nearly three-quarters (73%) of respondents said that a large number of Canadians are leaving the country to work in the US. That figure jumps to almost 80% (79%) among respondents older than 65. The results are based on interviews with 1,014 adults across Canada and are considered accurate to within 3.1 percentage points, 19 times out of 20. [CMA News 1999;9(11):3]
Concerns over qualifications for foreign graduates
Several national medical organizations took the Federation of Medical Licensing Authorities of Canada (FMLAC) to task for its new policy for evaluating international medical graduates (IMGs) recruited to Canada because of demands for specialists in underserviced areas. The policy was discussed at the June 1999 meeting of the Canadian Medical Forum, where several members said they are worried that the new policy will create a de facto third path to licensure in Canada by allowing IMGs to avoid Royal College evaluation exams. The new specialist evaluation process will include a clear description of public need, an in-depth recruitment process that includes a detailed job description that has been advertised locally and nationally before an ad is placed internationally, a specialist evaluating exam, clinical assessment period and a restricted, province-specific licence to practise. Beginning in the fall of 1999, the FMLAC plans to apply the new process to psychiatry, anesthesia and obstetrics and gynecology in order to evaluate its effectiveness. [CMA News 1999;9(7):4-5]
First-year enrolment declines
There has been a steady decline in the size of first-year classes at Canadian medical schools during the past 15 years, the Association of Canadian Medical Colleges says. The data have major implications for Canadian physicians and patients because the cuts are occurring amidst predictions of a physician shortage. In 1997, 1,577 students enrolled in first-year classes, compared with the peak of 1,887 student in 1983 (a 16% reduction). [CMAJ 1999;160(6):772]
ER docs threaten to resign
Early last summer, all 19 emergency physicians at Montreal's Royal Victoria Hospital said they would resign en masse as of Sept. 1, 1999. The physicians asserted that they were being harassed by the Régie de l'assurance-maladie de Québec, which for the third time in 10 years was investigating their billing practices. At the 11th hour the Régie agreed to withdraw their investigation. [CMAJ 1999;161(3):306 ]
Is fee-for-service vanishing?
The Ontario College of Family Physicians opened discussion on a "possibly revolutionary" proposal that would spell the end of fee-for-service medicine and solo practice for more Ontario family physicians. In a bid to provide more comprehensive care for Ontarians while improving doctors' quality of life, the college proposed a revamped primary care system that emphasized prevention and treatment and featured a multidisciplinary group-practice team that offers "24-7" service. [CMAJ 1999;161(7):861]
Military offers signing bonuses
The physician shortage in Canada's armed forces has become so desperate that newly minted family medicine residents are being offered an $80,000 lump sum to sign on for four years' service. In addition, captains who stay beyond their initial four-year commitment will earn $110,000 annually, up from $86,000. The measure is designed to improve retention. If current trends continue, the armed forces will be short about 44 junior medical officers by the end of 1999, and 99 by 2001. [CMAJ 1999;160(6):889-91]; [CMAJ 1999;160(9):1279]; [CMAJ 1999;161(2):124]
Physicians and infectious disease
Canadian licensing authorities are trying to determine how to strike a balance between safeguarding patient safety and protecting fundamental human rights when they deal with physicians who have hepatitis or other infectious diseases. Last year Health Canada called for mandatory screening for hepatitis B infection and, for those who tested positive, forced suspension of privileges to perform "exposure-prone" surgical procedures. The CMA did not endorse them because they failed to guarantee the rights of privacy, confidentiality and autonomy for the health care workers they affected. The CMA and other medical organizations argue that voluntary testing and strict adherence to universal precautions is a much better formula for minimizing the risk of blood-borne disease transmission by health care workers (CMAJ 1998;159:45-6 and 159:64-5). Currently, the provincial colleges in BC, Alberta, Saskatchewan, Manitoba and Ontario either have formal policies in place or have approved them in principle. Several other jurisdictions rely on ethical principles spelled out in the CMA Code of Ethics or the association's policy on preventing the transmission of hepatitis B. Many hospitals and regional health bodies have developed their own policies. Although developing a common policy that would cover all health care workers in Canada might be the goal, the fact that some jurisdictions currently enforce mandatory testing while others refuse to could make that a very difficult task. [CMA News 1999;9(8):5]
Radiologist shortage looms
In late 1999 there was a shortage of at least 105 radiologist in Canada, meaning that about 4% of the estimated 1,500 positions were vacant. But with 12% of radiologists at retirement age and another 10% considering retirement, that shortage could quickly reach 26%. [CMAJ 1999;161(11):1433]
Recruiting rural doctors
What factors induce young physicians to practise in rural areas? New research finds that even as medical schools try to provide more exposure to rural practice, physicians with rural roots are still much more likely to practise in a rural area than those from an urban background. The authors studied 159 physicians who graduated from the Family Medicine Program at Queen's University between 1977 and 1991, and found no relationship between early exposure to rural practice and the decision to practise in a rural location. [CMAJ 1999;160(8):1159-63]
An editorial laments the lack of data on rural recruitment efforts. The authors also dismissed coercive measures as unproven short-term interventions that do not provide real answers to the problem. [CMAJ 1999;160(8):1173-4]
Residents' strike averted
After four years without a contract and six years without a salary increase, 2,000 medical residents in Quebec voted in late April to accept a new contract that brings their salaries and tuition fees in line with those in other provinces. The vote came just two days before rotating strikes were slated to begin. Tuition fees were one of the most contentious issues. Quebec residents pay some of the highest fees in North America - $3,007 annually - for providing care 72 hours a week. Under the new agreement the residents will pay only $700 a year. [CMAJ 1999;160(11):1545]
Reversed brain drain
Canada is prime destination for doctors fleeing the political uncertainty in South Africa. Although Canada has complained bitterly about physicians moving to the US, this country appears to be one of the main reasons for South Africa's own brain-drain epidemic. Canada is home to 1,338 known graduates of South African medical schools and is actively recruiting more. [CMAJ 1999;160(11):1615-6]
Shortage of physicians
Two experts presented the facts about physician shortages. They argued that the shortages are not the direct consequence of the 10% cut in medical school enrolment in 1993, since these physicians are only now completing their training. The number of physicians who left Canada in 1998 was lower than that in the two previous years, and the number returning was greater. Retirement of "baby boomers" is not yet significant. Since physician shortages persist despite a 170% increase in the supply between 1964 and 1993, enrolment increases in medical school in the absence of other initiatives are not likely to solve the problem. [CMAJ 1999;161(8):983-4]
One of Canada's leading researchers on physician resources says the rush to implement oversimplistic solutions to ensure that Canada has an appropriate number of physicians has likely done more harm than good. "Policymakers are making the mistake of assuming that these are simple problems," Dr. Mamoru Watanabe, former dean of medicine at the University of Calgary, told the joint meeting of CMA committees and councils. [CMA News 1999;9(5):5]
Tuition fee fight
A physician who is also a chartered accountant offered his perspective on the issue of levying tuition fees on residents. The facts that the fees represent only 20% of the true cost of education and that physicians earn higher-than-average incomes upon graduation seem to support the imposition of fees. However, the author asks, if tuition fees should rise to market levels, shouldn't resident wages also rise to the same level to reflect the amount of training required, the skills demanded, the responsibilities undertaken and the time expended? [CMAJ 1999;161(7):825-6]
A campaign launched by the Professional Association of Internes and Residents of Ontario (PAIRO) successfully headed off the University of Toronto's plan to charge residents an annual tuition fee of $1,950. Although the situation at the U of T came to a head in June, the issue of charging residents fees for the training they receive dates back to 1995, when education funding was cut by the provincial government. Over the past several years the other four Ontario medical schools decided against charging residents tuition fees. The U of T's decision to charge the fees was widely criticized, to the point where a Toronto Star editorial called the move a "money grab." [CMA News 1999;9(8):1]
Violence in the ER
Verbal and physical violence is common in emergency departments at urban hospitals and affects staff working conditions, but several studies indicate that it remains an under-reported problem. In a survey of emergency department personnel working at a hospital in downtown Vancouver, researchers found that 90% of the 106 respondents experienced verbal abuse at least once a week, and 57% reported being physically assaulted at work during 1996. Nurses and security personnel experienced the highest proportion of physical assault. As a result of this exposure to violent incidents at work, 73% reported some fear of patients and 38% had considered a job outside of health care. [CMAJ 1999;161(10):1245-8]
A year of firsts in academia
During 1999, Canada's medical schools set three firsts. A family physician was named dean of medicine for the first time. Dr. Brian Hennen began his five-year appointment as dean of the Faculty of Medicine at the University of Manitoba on July 1, 1999. Previously, specialists or basic scientists always held deanships in Canada. Hennen was the chair of the Department of Family Medicine at the University of Western Ontario. [CMAJ 1999;160(13):1865]
On the East Coast, another precedent was set with the hiring of a female dean of medicine. Dr. Noni MacDonald, former head of infectious diseases at the Children's Hospital of Eastern Ontario in Ottawa, became the dean at Dalhousie University's medical school on July 1, 1999. [CMAJ 1999;160(7):1042 ]
And the University of Western Ontario combined the previous two firsts when it hired Canada's first female family physician as a dean of medicine and dentistry. Dr. Carol Herbert, formerly of the University of British Columbia, is also a member of CMAJ's editorial board. [CMAJ 1999;161(2):123]
