A year in the life of Canadian Forces Health Services

I find it extremely ironic to repeatedly read in the CMAJ that the Canadian Forces Health Service (CFHS) is “in critical need” of doctors, (3) that there are currently “severe shortages of uniformed personnel,” (4) and that “we must do something to ease the burden of our medical colleagues [in Afghanistan].” (5)

Despite this so-called “critical need,” it would seem that the CFHS simply has no use for specialists in emergency medicine, with their breadth of acute care experience and advanced skills in airway management, trauma resuscitation, procedural sedation, prehospital care, and aeromedical evacuation. Notwithstanding the fact that the U.S. and British militaries have been welcoming emergency medicine specialists with open arms for years, (6-11) the Canadian Forces still does not recognize the specialty of emergency medicine. EM specialists can only join the CF as general duty medical officers (GDMO’s), which means that, unlike our specialist colleagues in orthopedic surgery, general surgery, anesthesiology, radiology, and internal medicine, emergency medicine specialists cannot maintain their skills by working full-time in civilian hospitals when they are not deployed. Rather, emergentologists would be required to work between deployments as family medicine specialists in military clinics – something that we are simply not trained to do. This situation is not acceptable to emergency medicine specialists who are interested in joining the regular forces, as it would result in loss of skills and an inability to practice in our field of specialization.

I know of several other soon-to-be emergency medicine specialists who would be interested in a military career. However, until the Canadian Forces recognizes the specialty of emergency medicine and puts in place the necessary memorandums of understanding with “busy civilian hospitals” and “high-acuity practices in large centers” that will allow us to maintain our clinical competence just like Drs. Tien and Anderson, (12) young physicians like myself cannot in good-conscience join the regular forces. Perhaps when the situation really does become “critical,” Col. Haberstock, Capt. Johnston, and their CFHS colleagues will consider opening their ranks to specialists in emergency medicine.

Mathew Erskine, MDCM, MSc PGY5 Royal College Emergency Medicine Program McGill University

1) Personal Communication, November 2003.

2) Personal communication, October 18, 2006.

3) Capt. Anne Johnston, as quoted in “Afghanistan war poses unique challenges for military MDs” by Paul McLauchlin, CMAJ 2006;175(11):1357-8.

4) Haberstock M. A year in the life of the Canadian Forces Health Services. CMAJ 2006;175(11):1345.

5) CMA past-president, Dr. Ruth Collins-Naki as quoted in “Military MDs need support: CMA president” in CMA Bulletin. CMAJ 2006;175(1):117.

6) Lai MW and Lewin MR. Emergency physicians in the United States military: A primer. Ann Emerg Med 2003;42(1):100-9.

7) Strode CA, Adams B, De Lorenzo RA. Emergency physicians in the military: A sequel. Ann Emerg Med 2004;43(5):669-70.

8) Hughes JR. What military emergency physicians really do. Ann Emerg Med 2004;43(5):670-1.

9) McDonald E. Military emergency medicine. Ann Emerg Med 2004;43(5):671.

10) Arthur DC. Emergency physicians in the United States military. Ann Emerg Med 2004;43(5):672.

11) Dyer O. Doctors in the armed forces to get ₤50 000 “golden hellos.” BMJ 2002;325(7375):1261.

12) Tien HC, Farrell R, MacDonald J. Preparing Canadian military surgeons for Afghanistan. CMAJ 2006;175(11):1365-6.

Conflict of Interest:

None declared