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
I was pleased to see the 2 articles on residency positions in Canada. We are now witnessing a failed experiment in medical education. Every clinician and student I have talked to feels that the loss of the rotating internship has been detrimental. Rather than having a common year of training for physicians who will become GPs or specialists, medical students must now make a forced and irrevocable choice during their third year in medical school. In many cases they have to make a lasting commitment to a clinical specialty before they have even experienced it.
I disagree with Dauphinee and Thurber's statement that "future demands for these [re-entry] positions will decrease since all of today's graduates will have completed their specialty training before being licensed." In fact, the opposite is true. Many physicians are uncertain about their future specialty training. Because of this, many have gone into general or family practice to experience real-life practice. After 3 to 5 years they may, sensibly, make a choice for further specialty training. Currently, these physicians are completely locked out of the system. In retrospect, the error was that additional demands were placed on the system -- a second year of training for all family practice trainees -- without any commitment from government to supply additional training positions.
I was surprised to read that Sandra Banner believes there is flexibility in the system and that more than 200 successful switches were made from one training program to another in 1996. This has certainly not been the case in BC.
It is distressing to learn that the College of Family Physicians of Canada is now "allowing additional training for extended roles in family medicine." This is well and good, but, unless additional positions are available, it will worsen existing problems.
As directed by General Council, the CMA is hosting a conference on the crisis in postgraduate medical education, and I believe some consensus will emerge. Still, the training system in place today is inferior to the one I trained in 20 years ago. We need to reinstate the rotating internship and lobby to have additional training positions so there is some flexibility in the system. There is an acute need for more re-entry positions, and we certainly should not add any more training requirements without a firm commitment for additional training spots. All CMA members should lobby our national medical associations so that a solution can be developed quickly.
Derryck H. Smith, MD
President
British Columbia Medical Association
Vancouver, BC
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