Can we finally change the system? CMAJ 1997;157:136 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 Dauphinee and Thurber acknowledge that major changes have occurred in "physician-resource policies and medical-licensing requirements in Canada." It is also true that "discussions and decisions based on valid facts" are critically important. Unfortunately, their "facts" related to re-entry positions are grossly misleading. Currently, few re-entry positions are available in Canada. A recent national meeting noted that only 7 unlimited re-entry positions were available in Canada (1 in BC, 2 in Newfoundland and 4 in Nova Scotia). Ontario has 24 re-entry positions with "return-of-service" clauses. Manitoba, Saskatchewan, Alberta and Quebec have no formal re-entry positions. Some 1-year positions are available for GP/FPs, and other re-entry positions become available when residency positions go unmatched. The current limited number of positions available should be cause for concern, particularly in a province such as Manitoba, where 20% of specialists have taken the re-entry route. Medical students are forced to decide which aspect of medicine to pursue far too early in their training. Who wants to be cared for by an uninterested or depressed physician or surgeon? Why is it so difficult to attract Canadian graduates to rural medicine? Is it possible that trainees think rural or remote practice will lock them out of the cities or specialties for the rest of their lives? Easy access to re-entry positions for GP/FPs who choose to practise and learn more about medicine and themselves in a rural or remote setting may help correct our physician distribution problems. The time I spent as a "country doc" before turning to specialty training benefited me, my patients and my communities, past and present. It gave me a view of medicine from beyond the "ivory tower," and I would urge the Medical Council of Canada and the Canadian Post-MD Education Registry, training programs and credentialling bodies to share it. Allan B. Becker, MD Associate Professor Section of Allergy and Clinical Immunology Department of Pediatrics and Child Health University of Manitoba Winnipeg, Man. Send a letter to the editor responding to this letter Envoyez une lettre à la rédaction au sujet de cette lettre | CMAJ July 15, 1997 (vol 157, no 2) / JAMC le 15 juillet 1997 (vol 157, no 2) |