Can we finally change the system?
Online posting: April 11, 1997
Published in print: July 15, 1997 (CMAJ 1997;157:134)
Re: What are the facts concerning the number of residency
positions in Canada?, by Dale Dauphinee and Dianne Thurber, Can
Med Assoc J 1997;156:665-7; [full text / résumé] and Little room for error in Canada's
postgraduate training system, by Sandy Robertson, CMAJ
1997;156:682-4 [full text / en bref]
See response by: W.D. Dauphinee, A.D. Thurber
I am one of the "lucky ones" who was able to find a residency
in the specialty of my choice after first serving as a general
practitioner in an underserviced part of Ontario for 5 years. I
am now in my third year at the Medical College of Wisconsin,
Milwaukee. I am very grateful to the US medical community for
this wonderful opportunity.
I commend CMAJ for publishing these 2 articles and for
drawing some attention to this topic. However, I am hurt by Dr.
John Hoey's comments in the Editor's preface, which imply that
things are not as bad as they seem. If he is having trouble
understanding this issue, then I assume others are having the
same problem.
In this article about "the facts concerning the number of
residency positions," Dauphinee and Thurber fail to mention the
number of first-year residency positions! I would like to know
how the "re-entry trainees (Canadian graduates)" positions are
defined. They give figures of 632 and 489 in 1993 and 1994,
respectively. When I applied in those years, there were none!
Finally, I find no comfort in their concluding statement that
"they [physicians] can still get training, but it may not be the
training they want." Is this what we -- physicians and future
patients -- want?
I am glad that Sandy Robertson gave us the truth: "No subject
[postgraduate training in Canada] is more fraught with anger and
frustration than their [Canadian physicians] current inability to
enter a new postgraduate-training program. . . . Some see it as a
tragedy, but if it is, it is a tragedy without a villain." I
submit that those who have tightened the purse strings without
consideration to the ensuing hardships are potential candidates
for that label.
Robertson later states, regarding physicians who chose to
practise before entering a specialty, that "today that option
does not exist, and those who were in practice before the system
changed have found that most training posts are reserved for new
graduates. Finding a retraining position in another specialty is
difficult, if not impossible." I assume that Robertson knows that
no positions are available in Canada and that she is referring to
those of us who have left our native land, family and friends,
and have moved to the US.
It is intolerable that we have allowed this situation to
develop. I hope that the motion passed at the CMA's 1996 annual
meeting -- that "the CMA should convene a national meeting to
address the crisis in postgraduate medical education" -- is not
forgotten, and that physicians make this issue a priority.
Special thanks to the British Columbia Medical Association for
this long overdue motion.
Can we finally change the system?
Phil Narini, MD
Canadian Graduate
Resident
Medical College of Wisconsin
Narini@post.its.mcw.edu
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