A GOFM and damn proud of it!
CMAJ 1998;158:713-4
See response from: H.M. Scott
In his letter explaining the Royal College of Physicians and Surgeons of Canada policy on acceptance of non-Canadian specialist training ("Where does our duty lie?" CMAJ 1997;157[12]:1740 [full text / texte complet]), Dr. Hugh Scott loyally attempts to defend an apparently indefensible position. His last sentence — "surely, our first duty is to Canadians" — contradicts the rest of his thesis. Certainly our duty does lie there, and the first duty of the Royal College is to do all that it can to ensure skilled specialist services are available for Canadian patients today, not at some indefinable point in the future.
When I came to Canada in 1956, I received credit for 2 years' training in Europe. I did 2 more years of residency training in Saskatoon and passed the certification exams in 1958. We were desperately short of specialists then, and 40 years later things haven't changed in the provinces perceived as unattractive.
We still rely heavily on physicians born and trained, in whole or in part, outside Canada. I have listened to 40 years of talk about self-sufficiency, maldistribution and the export of physicians, during which the Royal College has not addressed the issue in any concrete fashion. Consider the facts in Saskatchewan: there are 5 radiologists where there should be 12 and 2 endocrinologists where there should be 12. Certainly the fault is not the Royal College's alone, but equally certainly the college should not be exacerbating the situation.
Are we really to believe that candidates for specialty examinations who receive part of their training in "the UK, Ireland, South Africa, Australia and New Zealand" have "little chance of success" and a "failure rate . . . exceed[ing] 90%" in Canadian examinations? I would like some hard figures. Does only the US train to Canadian standards? Does the Council of the Royal College expect its policy to produce a magic flood of Canadian-trained specialists from sea to sea, including the unattractive bits? The policy seems much more likely to make things worse.
During the last 40 years I have become accustomed, if not inured, to derogatory and pejorative epithets on my origins — FMG [foreign medical graduate], GOFM [graduate of a foreign medical school] and the like. However, Canada still depends on people like me for much of its medical care. The Royal College should remember that, and we at the grassroots and in the stubble should remember that the Council is an elected body.
Harry E. Emson, BM, BCh
Saskatoon, Sask.
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