Shortage Of Doctors – A 10-Point Plan To Fix The Problem

Almost every Canadian is aware that we need more doctors. Ipsos-Reid poll done for the Canadian Medical Association indicates that MD shortages rank second only to the economy in a list of election issues (CMAJ July 1, 2008).

According to Statscan, more than four million Canadians do not have a family doctor. Currently, Canada produces 2,300 new doctors a year but we need about 3,200 doctors a year (The Medical Post, June 3, 2008). How can we find 900 more doctors each year?

According to Draft 2005 Alberta’s Physician Resources Planning Committee Report Data, Alberta, one of the richest Canadian provinces, will be short of 1,541 doctors by 2010. Dr. Dale Dauphinee, executive director of the Medical Council of Canada, coauthored a report in 1999 that calculated that Canada needs to recruit 2,500 new doctors a year. This would cover both physicians retiring or leaving the country and population growth. Our own graduates can’t fill the void.

That was in 1999, which is almost 10 years ago. Has anything changed since? Looks like things are worse now.

Over the years, so much has been said and written about finding a solution to the problem that one would think that the problem would have been solved by now.

Reports indicate there are numerous factors contributing to Canada’s shortage of physicians. Some of these factors are: migration of doctors to the United States, reluctance of medical students to choose specialties and locations where they are most needed, and new practice patterns (lifestyle goals and use of the health care system) and there are fewer doctors now partly because of a 10 per cent reduction in medical school enrolment that was imposed across the country in 1993.

What Canada has failed to do is to utilize the resources already available in our country and in overseas medical schools. We know thousands of international medical graduates are in Canada who are unable to practice because they are unable to get a license. According to CMAJ (April 10, 2007), Association of International Physicians and Surgeons of Ontario has a membership of 1800. So, how many international physicians and surgeons are in Canada who are delivering pizza or driving a taxi?

We also know there are thousands of Canadian citizens who are studying abroad because they could not wait to apply to a Canadian medical school. Generally speaking, a Canadian applicant to a medical school in Canada has roughly six per cent chance of admittance (CMAJ April 10, 2007).

There are Canadians studying in Ireland, the U.K., Europe, Australia, in several medical schools in Caribbean islands, South America, Cuba and the U.S.A. I have been to the island of Antigua twice in the last eight months and visited the American University of Antigua College of Medical School (www.auamed.org) in St. John where my son is a student. I have met and spoken to some of the people who run this place.

According to Mr. Vito Barbiera, Director of Marketing for the American University of Antigua College of Medicine (commonly known as AUA), AUA has 1200 medical students. Of these 20 per cent are Canadians, 70 per cent are Americans and the rest are from Antigua and different parts of the world.

According to the Canadian Medical Association Journal (April 10, 2007), more than 300 Canadians are now studying at four Irish medical schools, and 60 to 70 new ones join them annually. Who knows how many Canadians are all over the world striving to get a medical degree.

According to Mr. Dick Woodward, AUA’s Vice President for Enrollment Management,
AUA College of Medicine provides medical education equal to the highest U.S. medical education standards. The purpose of the training at AUA is to prepare students to pass the U.S. Medical Licensing Examination (USMLE), for U.S. medical licensure, and to provide the foundation for postgraduate specialty training in the U.S.

Woodward says, “The AUA School of Medicine is fully recognized and approved by the government of Antigua to confer the degree of Doctor of Medicine upon students who fulfill the School’s admission requirements and complete the prescribed curriculum.”

Barbiera proudly reiterates what they say on their website that AUA is the first medical school in the Caribbean with a U.S. model medical education to be hospital-integrated. AUA’s program of medical education has been approved by the State of New York and pursuant to its approval, one of the few international schools that can place its students in New York Hospitals for 2 years of clinical training.

Woodward says that AUA had a first graduating class of eight in 2007. Last year AUA produced 21 doctors and this year they expect to graduate 50 doctors. He said all AUA’s graduates have been matched in the U.S. residency programs. If these graduates are absorbed in the U.S. medical system, the question is: why cannot we engage the services of these doctors in Canada?

AUA has very ambitious plan for the future. On June 15, 2007 AUA broke ground on its new $60 million, 17-acre campus. The plan is to create an educational institution on Antigua that would provide a comprehensive state-of-the-art learning facility for students who aspire to become highly skilled compassionate physicians and plan to practice medicine throughout Canada, the United States and the Caribbean region, says AUA website.

Antigua is just one example of how U.S. is taking full advantage of recruiting and absorbing international and American physicians who pass their licensing examination by giving them opportunities of doing clinical rotations and residency program.

I propose a 10 point mini-Marshall plan to be implemented on a national level to utilize the services of international graduates in Canada who have no license to practice and Canadians studying abroad:

1. A national medical manpower czar should be appointed by the federal government. He should have sufficient budget and manpower to undertake the enormous task of making Canada self-sufficient in medical manpower.
2. The czar should create a registry of all international medical graduates who are in Canada but have no license to practice medicine. This can be done by announcements in the media.
3. The czar should conduct a survey of these graduates to find out what each one of them requires to be fully licensed to practice medicine.
4. From the responses received the czar should create conditions and provide financial help (in conjunction with teaching institutions, hospitals, licensing bodies and provincial governments) to help these graduates to be fully licensed in one year.
5. Those who fail to get a license should get one more try. If they fail again then they should be told to pursue other careers.
6. Those who accept the government help should promise to work in an underserviced area for two years before they move to another city.
7. The czar should also create a registry of Canadian medical students in all overseas countries. This can be done by announcing in the media for the parents of these students to register their children with the czar’s office.
8. The czar should take survey of these students to find out how many of them want to return to Canada to do residency program and practice here.
9. The czar should constantly stay in touch with these students and encourage them to pass LMCC (Canadian licensing examination) when they prepare for the USMLE (American licensing examination). To make it easier, the Canadian licensing bodies should accept USMLE to be equivalent to LMCC.
10. The czar should offer them financial incentives to come back to Canada by offering them signing bonuses. This can be done in conjunction with hospitals and provincial governments.

The international medical graduates and the Canadians who study abroad did not cost the Canadian tax payers a single penny. What is wrong with investing some money on them and absorb them into our system? That is better than spending thousands of dollars on Canadians who obtain their M.D. in Canada and then move to U.S. Here is a free supply of precious commodity. Canada, open your arms and take it.

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