Can we finally change the system? [response]
Online posting: May 23, 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]
In response to: P. Narini; A.B. Becker; D.H. Smith; R.F. Maudsley; D.G. Marshall
Along with Drs. Becker and Smith we are sensitive to the
plight of the post-1989 medical school graduates who have been
charting their medical careers in the midst of a tangle of
changing regulations. This transition period put a virtual stop
to the option of re-entry because all existing government-funded
positions were filled by the new graduates completing the
requirements for certification and licensure. The number of
re-entry trainees was the number of all trainees who had
previously been in practice. This number decreased by 40% between
1988 and 1995 because no new re-entry trainees were admitted to
replace those who had completed and left training. Smith noted
our oversimplification that all current graduates will have
completed specialty training before licensure. His point is well
taken. We recognize a continuing need for re-entry training of
our current graduates and the significance of this option for
specialties such as psychiatry, community medicine and laboratory
medicine, which have obtained many of their physicians through
re-entry.
Dr. Narini is obviously 1 of many physicians victimized by the
situation that our data describe. Unfortunately, his letter
implies that our figures fail to validate his experience. On the
contrary, our data confirm his personal experience and explain
why it happened.
Because those involved in funding postgraduate training
realize that a physician who re-enters training will not result
in a new addition to the total practice pool, we expect that in
the future training positions will become available for more
practising physicians. The decreased number of new Canadian
graduates who will start training in July 1997 and the impending
retirement of specialists, who form our oldest category of
physicians, mean that space in training should become available
for practising physicians who are seeking further specialty
training.
We are surprised by some of the reaction to our article. The
accompanying Editor's preface may have inadvertently set the
stage by suggesting that things are not be as bad as they seem.
In our view, the opportunity for re-entry to postgraduate
training will improve only if sufficient re-entry positions are
supported by governments in a time of restraint and if the
profession and organized medicine support the need for these
positions. If provincial ministries cut the number of entry
positions to only those needed for graduating students, a key
opportunity to avoid the experiences of Narini and others like
him will be lost.
W. Dale Dauphinee, MD
Executive Director
Medical Council of Canada
A. Dianne Thurber, MA
Director
Canadian Post-MD Education Registry
Ottawa, Ont.
ai395@freenet.carleton.ca
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