Royal College rule changes
Can J Rural Med vol 2 (2):92
© 1997 Society of Rural Physicians of Canada
There was spirited correspondence on RuralMed in January about the changes to the rules governing foreign-trained specialists proposed by the Royal College of Physicians and Surgeons of Canada. The Royal College intends to discontinue accreditation of physicians who have received their training outside Canada and the US. As of July 1, 1997, these doctors will no longer be eligible to write the Royal College exams unless they have repeated their residency training in Canada. The College has never given credit for residency training undertaken in most countries, but an exception has been made for some Commonwealth countries. The College is now closing that loophole. It claims that it simply does not have the means to assess the quality of every country's training.
One RuralMedder characterized this move as a knee-jerk reaction to the oversupply of physicians in urban areas and stated that it will adversely affect rural patients and their access to health care. The consensus was that it would mean the end of specialist care in rural Canada, because rural areas have for years depended upon foreign-trained doctors. This change would have a domino effect: with no specialists, there would be no elective surgery, and GPs would no longer be able to maintain their expertise for any but the most uncomplicated cases involving surgery or obstetrics. As one RuralMedder wrote, "We will face a future of coordinating ambulance traffic to and from the urban centres."
The Newfoundland medical community was so concerned with the proposed rule changes that a joint letter was sent to the College from the Department of Health, the Newfoundland Medical Board, the Faculty of Medicine of Memorial University of Newfoundland, the Newfoundland and Labrador Health Care Association, and the Newfoundland and Labrador Medical Association, 5 groups that have not had a history of unanimous agreement. They argued that the College has sufficient experience concerning training in some countries that a blanket restriction is unnecessary. They warned of Newfoundland's inability to ensure availability of medical services throughout the province if the new rule goes forward.
The Royal College sees no reason why Canada cannot be self-sufficient in terms of specialists in rural areas and insists that Canadian graduates must be served first. The College believes that relying on the "easy entrance" of foreign-trained doctors is counterproductive, because other solutions are ignored. RuralMed sees no problem in serving Canadian graduates first, but such statements ignore the facts: for whatever reason, Canadian graduates don't want these jobs. Writes one RuralMedder, "If the College now virtually turns off the supply of trained foreign specialists without being able to check the drain of Canadian-trained specialists to the US, there can be only one result: northern deprivation in the future."
The Royal College suggests that there are not enough doctors being trained and that the federal government has some responsibility. The government has set a cap of 1 medical student per 20 000 population (on par with Albania; Australia has 1 for every 12 000). RuralMed agrees that the government has responsibility, but this does not negate the fact that the Royal College rule change will be detrimental to rural medicine.
Solutions to generate made-in-Canada specialists need to be found before the plug is pulled on foreign graduates, solutions such as allowing GPs to return to university for training in anesthesia, surgery and other specialties. This used to be a good route for rural doctors, one that yielded specialists who returned to the north after their training knowing the conditions they would face. Medical schools are not training replacements for rural Canada's slowly ageing GP anesthetists and general surgeons. The Royal College and Canada's universities have never, for example, considered rural general surgery or rural anesthesia as disciplines. It's time they did.
