My report on Canada's physician workforce1 does not trivialize the impact of undergraduate enrolment cuts in the future, but it rejects the notion that such cuts were the driving force behind Canada's declining physician supply over the past decade. This is simple arithmetic: an enrolment cut in 1992 would not have been felt until 1998 at the earliest, when those taking the shortest route to licensure entered the workforce.
My paper draws attention to other, more significant policies, such as the decision to increase the ratio of specialists to family physicians trained. This change was not made to accommodate more doctors opting for specialty training or because of insufficient funding, as Scully suggests. Rather, it was an attempt to meet the vague objective of ìrestoringÎ the 50:50 mix of specialists to family physicians, at a time when some provinces had slightly more of the latter.2 This policy was implemented without public debate, documented evidence of need or projections of its impact. It led to a precipitous drop in the inflow of new doctors over several years and was the single biggest factor behind Canada's declining physician supply.
I agree with Scully, in principle, that the net loss of Canadian physicians abroad over the past decade represents a heavy burden for our nation. I welcome any attempts by policy-makers to encourage physicians to remain in Canada. However, Canada has lived with the brain drain for over 20 years, and its magnitude has not changed appreciably during the past decade. Hence, the brain drain was not a pivotal factor in the drop in our physician supply. Furthermore, our brain drain has historically been buffered by a “brain gain” from other countries. Yet the entry of foreign medical graduates was drastically curtailed in the 1990s, because of decisions by governments and organized medicine.2
Ultimately, my report was not intended to point the finger at governments, doctors or the academics who supplied the numbers. No one can be expected to predict the future with complete accuracy. Rather, I have offered some feedback to policy-makers on the impact of their actions, both intended and unintended. It is through feedback that we learn from our inevitable mistakes so that we can do a better job next time. Peltekian is correct in asserting that we need a comprehensive, coordinated framework for health human resource planning. We must monitor trends every year, set plans more frequently, and continually fine-tune our policies on admissions, postgraduate training and foreign graduate intake. We must do a better job of anticipating future demand, identifying more efficient models of care and reducing inappropriate care. Finally, we must start behaving like a nation and engender the kind of cooperation across the provinces that is needed to serve the public.
Benjamin T.B. Chan Consultant Canadian Institute for Health Information Ottawa, Ont.
References
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