Physician Resources

Attitudes are barriers for gay and lesbian medical trainees

Gay and lesbian medical students and residents often feel they must balance the risk of disclosing their sexual orientation against enduring homophobic attitudes or even damaging their career. A qualitative study of the experiences of 29 gay or lesbian physicians training in four cities paints a picture of trainees struggling between being honest and true to themselves and risking negative — and even hostile— reactions from peers. Those coping with their first awareness of themselves were found to be especially vulnerable. The authors recommend more proactive training programs acknowledging and supporting diversity, and more use of professional and peer role models as methods to improve the situation. CMAJ 2000;162(3):331-4.

Canada’s new doctors turning backs on family practice

Results from the 2000 residency match indicates that fewer of Canada’s new doctors are choosing family medicine, while interest in obstetrics and gynecology appears to have rebounded. Data from the first iteration of this year’s match, completed in mid-March, indicate that 58 of the 445 family medicine residency positions went unfilled. Only 29% of new graduates selected family medicine as their first choice, compared with 32% last year, and nearly 35% in 1997. CMAJ 2000;162(9):1347.

Desperate government begs Yellowknife’s MDs to stay

Physicians in Yellowknife are the latest to benefit as desperate governments continue upping the ante in a bid to keep rural or remote doctors on the job. In August, the Yellowknife Health and Social Services Board assumed the overhead and operating costs of the city’s four medical clinics — an expense estimated to consume 40% of the 18 physicians’ gross incomes. The physicians are also being enticed with new salary and benefits package. Depending on their on-call arrangements, the doctors can earn between $130,000 and $180,000 a year, plus up to $12,000 extra for emergency department shifts, cash bonuses for being on call, and an annual retention bonus of $5,000. Yellowknife, which has 17,000 residents, was down to only 14 physicians in the summer of 1999. Until recently the territory has depended on locums to provide up to half of its physician workforce. CMAJ 2000;163(7):873

Doctors earning less

Census data from Statistics Canada indicate that average physician net earnings before income taxes fell between the 1981 and 1996 censuses. The average net earnings decreased from $107,500 in 1980 (adjusted to 1995 dollars) to $105,200 in 1995. Interestingly, earnings fell for all age groups among physicians under age 55 but increased for those who were 55 or older. CMAJ 2000;162(6):860.

Doctors take NB government to court

The Professional Association of Residents in the Maritime Provinces (PARI-MP) and four New Brunswick physicians are suing the provincial government, claiming that a physicians’ resource management plan the health department introduced in 1992 infringes on four of their rights under the Canadian charter of rights and Freedoms. The plan restricts mobility for people wishing to enter the province and gives physicians already there an "unfair" advantage says PARI-MP. The plan, introduced eight years ago, placed a cap on the number of physicians allowed to practise. Since it was introduced, the province has experienced one of Canada’s most sever physician shortages. In 2000 there were 50 unfilled positions; simply to reach the national per capita average, New Brunswick would need to attract another 300 doctors. The claimants say the plan violates the charter by restricting doctors’ mobility. CMAJ 2000;162(8):1186

In April, the New Brunswick Court of Queen’s Bench ruled that the limits on physician resources are constitutional. PARI-MP plans to appeal the ruling. CMAJ 2000;162(12):1726.

Enrolment increased

Quebec added 30 new places to first year medical school enrolment in 2000 and 65 the year before. This brings Quebec’s total number of first-year students to 531, or roughly one-third of medical school admissions across Canada. CMAJ 2000;163(5):582.

The University of British Columbia medical school is considering a modest increase in enrolment next year. The existing intake of 120 students has remained unchanged since 1980; it is the smallest intake per capita among provinces that have medical schools. The UBC’s dean of medicine says he hopes for a significant increase of up to 60 places within five years. CMAJ 2000;163(6):753.

Ontario announced in August that it would increase medical school enrollment by 7.5%, bringing the provincial total to 572 first-year places. Ontario’s 40 new slots will be spread among all five of its medical schools. CMAJ 2000;163(7):876.

Family and med school don’t mix

A survey of medical students, residents and physician teachers at the University of Saskatchewan, found that women at all levels were more likely than men to be single, to be childless and to discourage their peers from becoming parents. Female physician teachers spent approximately the same amount of time at work as their male counterparts (52 v. 58 hours) but spent twice as many hours per week on family and household chores (36 v. 14 hours). The authors also report that trainees are less satisfied with their careers and level of family involvement compared with doctors in practice.

Due to the demands of medical training, the study suggests that the optimal time for parenthood is after training has been completed. This carries repercussions for the health care system as the number of women physicians continues to increase. CMAJ 2000;162(5):637-40.

A related editorial, comments on how solutions to juggling home and career are both obvious and elusive. The author recommends that the trend toward an ever-expanding work week end, and be replaced by more flexible workplaces that can accommodate time required for parenting. CMAJ 2000;162(5):663-4.

Hospitalists fill gap

Canada’s shortage of family physicians is so severe that it is creating unprecedented demand for a new type of medical specialist, the hospitalist. These new specialists, usually internists but sometimes family physicians, take over responsibility for the care for "orphan patients" who arrive in hospital without an FP or someone else to assume the role of more responsible physician during the patient’s hospital stay. In many cases, patients become orphaned when family doctors resign their hospital privileges because of the increasing demands associated with hospital-based care. CMAJ 2000;162(9):1345-46.

International grads accuse BC college of discrimination

The College of Physicians and Surgeons of British Columbia has been hit with an unprecedented provincial Human Rights Commission ruling in a case brought by five foreign-trained physicians seeking the right to practice in Canada. The commission ruled that the college discriminated against the doctors by required them to do extra training and an internship. The college was ordered to reach a financial settlement within 60 days of the decision or the case would be reopened. It is currently preparing an appeal. CMAJ 2000:162(6):854.

Irish medical schools have a distinctly Canadian flavour

It has become so hard to enter medical school in Canada, where roughly five candidates vie for every available training spot, some Canadians have given up and moved to Ireland for training. The more than 100 Canadians now enrolled in Ireland outnumber the first-year students at nine of Canada’s 16 medical schools. Canadians studying in Ireland face a bill of at least $45,000 annually — tuition alone costs about $30,000 a year — and some expect to be $300,000 in debt by the time they graduate. However, the Irish schools are actively recruiting Canadians, and finding plenty of interest. When the Canadians do graduate, there’s no guarantee they will be allowed to practise in Canada; many expect to end up in the US. CMAJ contacted 11 of these students to determine why they chose the Emerald Isle. Many wonder why, in the face of a serious physician shortage, they are shut out of pursuing a medical education in their own country. CMAJ 2000;162(6):868-71.

Med-school applicants haven’t increased with population

Canada’s populated has grown by 30% since 1976 while the number of medical school applicants have remained stagnant at about 7500. This may change though, if governments accept a call by the CMA and a coalition of other medical bodies for a 28% increase in first-year undergraduate enrollment at Canada’s 16 medical schools. CMAJ 2000;162(2):255.

Military medical service no longer has MD at helm

For the first time, a nonphysician is in charge of the Canadian Forces Medical Service. The post now belongs to a health care administrator — the director general health services — to whom the surgeon general, the military’s highest-ranking physician and former head of the service now reports. One medical officer told CMAJ that the move has "caused a certain amount of consternation among the forces’ 212 doctors. CMAJ 2000; 162(4):561.

Physician numbers lag behind population

A Canadian Institute for Health Information (CIHI) report revealed that, while there has been "moderate growth" in the number of health professionals in Canada over the last 10 years, the increase has not kept pace with Canada’s population growth. Health Personnel in Canada, 1988 to 1997, found that even though the number of health professionals grew from 499,603 to 547,580 over the 10-year period, the number of professionals per 10,000 population declined by 1.7%, from 185 to 182.

The Yukon/Northwest Territories, Newfoundland and New Brunswick had higher rates of growth in the number of health professionals than population and saw the highest increase in the number of health professionals per 10,000 population (43.8%, 22.4%, and 15.5%, respectively). Ontario, Alberta and British Columbia experienced moderate growth in the number of health professionals and a more significant increase in population, resulting in a decrease in the number of health professionals per 10,000 population (7.6%, 11.3% and 6.5%, respectively). CMA News 2000;10(7):3.

Profession fights rising tuition fees with bursaries

With Ontario’s medical school tuition fees more than doubling in the past 2 years, the province’s doctors are being asked to raise $8 million for a new medical student bursary fund. Other provinces are following that lead in the face of high tuition fees and related concerns about equitable access to education. CMAJ 2000:162(10):1477.

Programs for international medical graduates

Following a hunger strike by international medical graduates (IMGs) in British Columbia in 1991, the provincial government set up a licensure program for IMGs, providing two entry positions per year for postgraduate training. The authors describe the program and the 26 successful candidates to date, who represent 22 countries and six continents. Twenty have completed the postgraduate training and have achieved full licensure; six are still in training. Recent graduation from medical school seems to predict success. CMAJ 2000;162(6):801-3.

A related commentary addresses the need for national standards for IMG accreditation. CMAJ 2000;162(6):795-6.

Solving a staff shortage problem

When confronted with an increasing number of admissions and a shortage of pediatric residents available to provide after-hours on-call coverage, Toronto’s Hospital for Sick Children instituted a clinical departmental fellowship program to fill the void. The program, launched in 1996 with three fellows, expanded to 20 fellows last year and attracts physicians from around the world. Those involved say the program has not only helped solve clinical coverage problems at Sick Kids, but has also added to the academic strength and international reputation of the Department of Pediatrics. CMAJ 2000;163(3):287-9.

A related commentary by world-renowned pediatrician Richard Goldbloom states that the program is an innovative solution to a serious problem and deserves examination by other academic centres. CMAJ 2000;163(3):298-9.

The greying of Canada’s physicians

The Canadian Institute for Health Information reports that the average age of Canadian physicians rose over the last five years, from 46.3 years in 1995 to 47.2 years in 1999. The proportion of doctors aged 50 to 59 also increased, from 19.6% in 1995 to 22.8% in 1999. The number of physicians younger than 40 fell during the same period, from 33% of the total to 28.1%. CMAJ 2000;163(7):876.

Tuition fees up 27% at U of T

The bad news for students entering medical school at the University of Toronto last year was that their tuition fees rose by 27%. The good news, says Dean David Naylor, is that further large increases are "extremely unlikely." The U of T now has the highest fees in Canada. New students will pay $14,000 this year, up from $11,000 in 1999. Students already registered in the program will face a five% increase. CMAJ 2000;162(13):1861.

Copyright 2000 Canadian Medical Association or its licensors