National health human resources plan “a hard sell”
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* Ann Silversides

*   © 2008 Canadian Medical Association

Ramping up the number of medical school spots without developing a national health human resources plan could perpetuate the boom-and-bust cycle of the past few decades, says the president of the Association of Faculties of Medicine of Canada.

Simply hiking enrolment doesn't answer vital questions such as how to integrate doctors into team-based models of care or determine the appropriate scope of practice for health care workers in order to avoid overlap, says Dr. Nick Busing. But the federal leadership and support that is needed to develop a central planning mechanism is missing and developing a national plan “is a hard sell with this government.”

“For them, health care is a provincial issue, but I would argue they should be leading the discussion.”

Busing says medical school teaching resources are already strained, because of recent increases in the number of students and the shift to regional campuses.

First-year medical school enrolment spots increased by 63% in the decade ending in 2007-08 (to 2569 spots from 1577), and the satellite campus approach has meant a “bringing on board a whole new cohort of teachers.”

About one-third of Canada's doctors already assume clinical teaching roles, but many lack formal training in pedagogy, and support and remuneration are variable, according to the association. Busing notes that none of the federal money transferred to provinces under the 2003 First Ministers' Accord on Health Care Renewal has been earmarked for education.

What's needed is a mechanism to monitor the number of trainees, conduct research and “provide careful recommendations to help us plan our health human resources into the future.”

The European Union is working to harmonize its health human resource planning and Australia, where health care responsibility lies at the state level, has taken a federal approach to planning, Busing notes.

In the early 1990s, medical school spots were cut without adequate analysis of issues such as the aging physician workforce, shifting morbidity patterns and changes in doctors' roles.

“I'm concerned that now we are ramping up again, but we still haven't done the analysis. We are reacting to legitimate needs, but again we aren't doing this in an evidence-based way,” says Busing.

The need for a pan-Canadian approach to health human resource planning was emphasized in the final report of Task Force Two, the multi-stakeholder 2006 group that examined physician human resource strategy for Canada (*CMAJ* 2006;174[13]:1827-8).

“Jurisdiction-specific policies are appropriate where systems of health care are completely separate. However, Canadian health care systems have a high level of inter-dependency,” the report states.