CMAJ 1998;158:714

© 1998 Canadian Medical Association

Where we differ is in our interpretation of certain facts and in our opinion as to what can and should be done. Emson appears to argue that Canada is incapable of meeting its own requirements — that 40 years of talk should cause us to throw up our hands and remain forever in a colonial, dependent position. I disagree. I, like him, am proud and feel that we as Canadians have enough to offer that we should be net exporters of our expertise to the rest of the world.

It is ironic that he says the Royal College has not "addressed the issue in any concrete fashion." I believe the "facts" he cites are based on a 1988 Royal College survey and report, which was followed by another in 1995. The college persists in sounding the alarm that Canada will be desperately short of physicians generally, but specialists in particular, by 2011. What is perplexing is that we will have inflicted this wound upon ourselves by slavish adherence to bad advice from a succession of government advisers. Implicitly, they too appear to believe that it is better to have too few rather than too many doctors. After all, we can always import more if we need them.

Consider Saskatchewan. In 1977, its medical school produced 64 physicians. Since then, as in many other provinces, there has been a concerted effort to decrease enrolment. By ministry edict, only 55 students were allowed to enter medical school in Saskatchewan in 1997; throughout this decade, an annual average of fewer than 60 Saskatchewan residents have been able to secure a place in any Canadian medical school. The "relative opportunity" of a Saskatchewan resident to find a place in medical school ranks sixth in Canada — right at the national average, an average that is about 30% below that in the UK. Had the Saskatchewan College of Medicine been allowed (and given adequate resources) to increase enrolment by 10 students per year instead of being forced to decrease enrolment by the same number, the situation would be vastly better and different today in terms of the very real problems Emson describes.

Emson does not like "pejorative epithets" but he uses them freely to describe the Royal College and its Council, which has 2 elected members from Saskatchewan. I suggest we put away the hatchet and instead work together to solve an important and urgent problem that exists "from sea to sea."

Hugh M. Scott, MD
Executive Director
Royal College of Physicians and Surgeons
of Canada
Ottawa, Ont.

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