Opinions
Paul Baker/the Gauntlet

The upcoming doctor dilemma

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With the looming mass defection of baby-boomers from the whitewashed halls of hospitals to the white-sand beaches of retirement, a critical shortage of doctors is expected to hit a medical industry already scarily understaffed.

The planned solution to this problem is to "fast-track" medical school. There are two facets to this proposal, neither of which is sufficient. There is another solution, and one which would seemingly offer a viable way to mitigate the problem, but it is so far unarticulated.

The first aspect of the now-being-considered solution is to allow students into medical school without having first completed an undergraduate degree. As things currently stand, it is theoretically possible to gain admission to medical school having completed two years of undergraduate studies, but this feature of entry requirements is chronically underused. The idea is to begin allowing these two-year university veterans into medicine (assuming they have successfully completed other entry requirements and testing), or even, as is done in Europe, to create a program wherein high school grads directly enter medical school (through a six-year program instead of four, with required pre-med courses in the first couple of years). This seems like a plausible solution to the problem, until one realizes that it has no effect on the number of doctors exiting the system.

It matters little whether individuals are entering medical school after completing their undergrad, after two years of study, or directly from high school. If the number of spots at medical school remains unchanged, this will have no impact upon the number graduated. The only scenario in which this solution could work is if there were vacancies at medical schools that were not being filled.

This is not the case, with far more people applying than being accepted. Even if this measure were coupled with an increase in medical school capacity, it would provide a boon only for those two years. After that, there would be a drop-off of individuals capable of becoming doctors. Letting some into medical school two years early will not mean that others of that age-range suddenly develop a propensity to be a doctor which they otherwise would not have. Perhaps the admission of two-year veterans should become as common as are students with that level of training who are competent to be in medical school, but this will do nothing to alleviate the problem posed by the beachcombing ways of the boomers.

The second idea is to reduce the program from four years to three. Taking away a year of training from members of society who need to be highly skilled would be craven mismanagement of the highest order. The only way in which this is a viable option is if the course load is made up by extending the school year. Some institutions (including the U of C) operate on a near-year-round basis, which allows them to graduate doctors in three years instead of four. By removing a year of study, the total number of students would be spread across three years, and thus more would graduate each year. There is nothing wrong with this, but it will not be enough on its own to amend the problem. Surely there will be a significant number of students to whom an 11-month school year is unappealing. They may simply want to have a break, or they may need the usual four summer months for work, trying to offset some of the exorbitant cost of their schooling. Further, a medical school operating in this fashion would require a professorial staff that worked through the summer. Perhaps this is possible, but it seems that there may need to be a rotation system whereby professors are getting time to take a break or conduct research. This being the case, the number of students who can be in each particular year may not rise, thus not actually resulting in the graduation of more students. It may be assumed that some programs can successfully make the switch to this mode, but it is unlikely all will do so. It is simply the case that many individuals--professors and students--will be unwilling to spend almost all year in classes. As such, this solution, though providing for some increase in the graduation rate of doctors, falls short of adequately addressing the problem.

Having shown both of these solutions to fail, what is Canada supposed to do about its shortage of doctors, and the coming crisis of the boomers' long fishing trip?

Obviously, capacity at the medical schools should be increased. This is a no-brainer. This does not mean that the entry requirements should be lowered (as that would be as misguided as cutting a year from the program), it merely assumes that a great number of individuals meeting the entry requirements of medical schools are being turned away.

As well, medical school should be financially accessible. Surely the exorbitant cost of post-secondary education in this country prevents a number of capable individuals from pursuing this career. Efforts should be made through reduced tuition, increased scholarships, and more substantial financial aid to make medical school accessible to all.

The final part of the solution is to allow doctors immigrating from other countries to practice here. Certainly, they should be held to the same standards as those trained in Canada, but once these standards have been met, they should be granted a medical licence. Detractors may suggest that doctors trained in other countries won't necessarily meet Canadian standards, or they will not know the specifics of Canadian medical practices. This impasse can be met by the development of a special training program for doctors coming from abroad. Further, this program should be funded by the federal government so that individuals wanting to pursue this option are not deterred by financial inaccessibility. Clearly, there will be some who are simply incapable of attaining Canadian standards of medicine--the individuals that should be duly denied a licence. There will, however, be a number of doctors from other countries who do attain Canadian standards and there is no reason for not allowing them to practice.

The current proposal to mitigate the shortage of doctors in Canada falls short of its objective. The true solution lies in the threefold changes of increasing the number of spots in medical schools, making medical school financially accessible to all, and allowing doctors educated in other countries to practice in Canada after meeting Canadian standards. The solution is there, it just needs to be implemented.

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Comments

The all IMG must be trained in an approved preinterneship program accessable to all of those physicians who passed QE-1 and QE-2.