UBC med school marks 50th birthday with call for increased enrolment
Heather Kent
CMAJ 2000;162:1200
Dean John Cairns' outlook is serene as the University of British Columbia's medical school turns 50 this year. This may not seem particularly surprising, given that a golden anniversary is usually a time for positive reflection. However, the past 20 years haven't been particularly kind to his school, which has faced funding cuts and a static number of undergraduate students in a rapidly growing province.
 | Deans past and present include (from left) Dr. William Webber (19771990), Dr. Martin Hollenberg (19901996), Dr. John Cairns (1996 to present) and Dr. David Bates (19721977). Photo courtesy of UBC |
Still, Cairns begins an interview by focusing on the successes of the faculty's researchers and the excellence of the school's graduates. Indeed, UBC medical faculty are world leaders in areas such as genetic and neurodegenerative research, and 25% of the university's spin-off companies originated in the Faculty of Medicine.
It is at the undergraduate level that Cairns is seeking change. The number of students who enter the school each year — at 120, the smallest number in Canada in terms of the population drawn from — has remained unchanged since 1980. At the same time, the undergraduate fees, frozen at $4000 annually for the last 4 years, are the lowest in Canada outside Quebec.
The academic upside is that the students who are selected have the highest MCAT scores among students attending Canadian medical schools, but the downside is that many potentially outstanding students are turned away from careers in medicine. Cairns, who notes that BC's population has increased by 50% in the past 20 years, would like to increase the annual undergraduate intake to 160 or 180 students. "BC has not taken responsibility for educating an appropriate portion of its own physicians," he said. "It never has."
Cairns, a 1968 UBC graduate, said problems don't end at the undergraduate level. "We are unique in having fewer first-year residency positions than the size of our graduating class," he said. This means that BC depends on the rest of Canada and other countries both to train many of its own graduates and to provide many of its practising physicians. Cairns warns that the policy "makes us very vulnerable. It's a short-term policy that ultimately will fail."
He says recruitment of foreign doctors is already becoming more difficult as traditional overseas sources, such as Britain, are retaining more doctors. The province has enough doctors now — on a per capita basis it ranks second only to Quebec — but this situation won't last because of retirements.
Cairns would prefer to see the "enormous amount of money" health boards are spending recruiting doctors spent on increased enrolment at UBC. While the provincial government remains preoccupied with the overall ratio of physicians to population, says Cairns, "we struggle with the development of a provincial vision in which the medical school is seen as integral to the health care system. We haven't yet achieved that [integration]."
He also thinks the school's relatively small undergraduate and postgraduate capacity means that it has to work harder to establish relationships with doctors from other regions. He says this is not the case in Alberta and Ontario, both of which train a much higher proportion of their physicians. "Alberta is very progressive, and Ontario is addressing its problem."
Cairns does think that talks with the BC government are going in the right direction. "It's critically important that real progress be achieved."
The school is also dealing with the increasing role of nurse practitioners and health providers such as midwives. "There are many responsibilities that physicians currently carry out that do not require their training and education and could be assumed by individuals with less training," says Cairns. He thinks nurse practitioners work well in remote parts of the province, where they have "a kind of social attractiveness," and in intensive care units that have a "clear hierarchy of accountability. Problems arise when their expertise is exceeded."
Despite all the challenges, Cairns is optimistic: "The focus of the Canadian public on health care, the absolute requirement for Canada to educate more of its own physicians, the development of a federal vision around health research and the quality of BC life, are very solid reasons for optimism."
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Heather Kent is a Vancouver journalist.
© 2000 Canadian Medical Association or its licensors
