Buffeted by harsh economic winds,medical schools turn a wary eye to the future

All parts of Canada''s health care system are facing fiscal pressures these days, but they are particularly great at Canada''s medical schools. However, Dr. David Hawkins of the Association of Canadian Medical Colleges is optimistic that all 16 of Canada''s medical schools will remain open, mainly because of the huge impact they have on health care in their local communities. “We don''t just turn out students — we raise the standard of health care in a whole community,” he says.     

Morbidity,Mortality and Medical Care in the Keewatin Area of the Central Arctic—1967

The available medical facilities in the Keewatin area of Canada''s Central Arctic have been described, along with the problems relating to provision of medical care. Causes of death and population statistics for 1967 have been detailed. The more frequent disease conditions have been discussed.Recommendations for improvements in medical care have been made; these include research into various conditions, an increased number of specialist visits and the inclusion of Churchill Hospital in a residency training program. Other recommendations relate to community planning, community sanitation and employment opportunities.     

REPORT FROM OTTAWA

In a national disaster, the medical profession would lose physicians and auxiliary personnel and would need assistance. Canada''s 22,000 physicians and 85,000 nurses are located for the most part in potential target areas. Survivors among Canada''s 6396 dentists could supply 30% reinforcement. The dentist''s training, his manual dexterity and experience acquired in the management of hemorrhage, shock, débridement, suturing, reduction and immobilization of fractures, and control of pain and infection would be valuable. Additional functions he could perform would be first-aid, including but not limited to artificial respiration, early management of chest wounds, preparation of casualties for movement, and assistance in general surgical procedures. Dentists with special training in anesthesia, oral surgery or public health could be of particular value in relieving anesthetists, surgeons, radiologists and public health officers of some of their duties. Joint training of physicians and dentists in mass casualty care could increase the efficiency of the team work in disaster and is being considered by many medical and dental faculties.     

Time's running out as physicians await Y2K fallout.

Canada''s hospitals are slowly coming to grips with the millennium bug, but Anita Elash reports that no one really knows what impact the move into the year 2000 will have on computers and medical devices, either in the hospital or doctor''s office.     

Death of phone service indicates Canadians not willing to pay for medical advice

The two physicians who started Canada''s first national pay-per-use medical-advice line closed the service after determining that Canadians are not willing to pay directly for their medical services. The issue of public versus private payments will likely be raised during the CMA''s annual meeting later this month.     

Medical schools seeking new ways to cope with funding cutbacks

Cuts in government funding mean that Canada''s medical schools have to seek new ways to raise funds. Susan Thorne examines some of the ways faculties of medicine are coping with change. In the brave new world of medical education, schools are combining classes for medical students and other health professionals, seeking business alliances, encouraging attendance by full-tuition students from other countries and diversifying revenue bases through new programs, such as McGill''s new 5-year MD-MBA degree.     

The Class of 1989 and physician supply in Canada

BACKGROUND: "The Class of 1989" is a study of 1722 people who were awarded an MD degree by a Canadian university in 1989. This paper reports on migration, specialty choices and patterns of post-MD training in order to assess the contribution of the graduating cohort to the physician workforce of Canada. METHODS: A longitudinal study was conducted over 7 years after graduation to trace the current location, the post-MD training history and the professional activity of the graduating cohort. Several medical professional and educational associations in Canada and the United States provided year-by-year information on field and location of post-MD training, certification achieved, whether in practice and location of practice through to spring 1996. Information from all sources was linked to a list of 1989 medical school graduates. RESULTS: From entry to medical school through to 7 years after graduation the cohort was diminished by about 16%. The main reason for loss was migration to other countries: 193 graduates (11.2%) were outside Canada in 1995-96. Internal migration was extensive also; for example, by 1995-96 relatively few of the graduates were located in Newfoundland or Saskatchewan. Of the 1516 graduates active in Canada in 1995-96, 878 (57.9%) were in general practice/family medicine, and only 638 (42.1%) were practising or training in a specialty. INTERPRETATION: The "yield" of the Class of 1989 for Canada''s physician workforce is insufficient to meet annual physician inflows from Canadian sources to serve population growth and to replace retiring or emigrating physicians. As output from Canada''s medical schools drops even further, the gap between requirements and supply will grow even wider.     

No hospital is an island when it comes to Y2K bug

If a recent meeting on the millennium bug is any indication, Canada''s health care facilities have plenty to worry about as the year 2,000 approaches. Topics discussed included the state of readiness within the health care sector and potential legal issues that may arise.     

After rejection in Canada,more Canadians pursuing career dreams at offshore medical schools

Being denied admission to medical schools here isn''t necessarily the end of the line for would-be Canadian doctors. The number of Canadians applying to medical schools in the Caribbean and Mexico is increasing, and graduates of some of them are winning respectable postgraduate training spots in the US, United Kingdom and even Canada. Milan Korcok looks at the calibre of these offshore medical schools and the impact they are having on training and accreditation in North America.     

Historical origins of current problems in cancer control

Canada''s provinces have some of the most highly developed cancer control systems in the world, but the recent crisis in waiting times for radiotherapy has drawn attention to many weaknesses and inadequacies. Focusing on the province with the largest cancer control system, Ontario, this paper explores the historical origins of current problems in cancer control and shows that they are directly related to policy decisions made in the early years of the system. The development of cancer control in Ontario from the 1920s to the present is outlined, and the historical origins of 3 specific problems related to patient care are discussed: fragmentation of care, which has resulted from an emphasis on radiotherapy rather than comprehensive care and from tensions between the medical profession and government; variation in practice, which can be traced to the empirical origin of much cancer treatment and the slow implementation of research programs; and inequitable access to care, which can be attributed to the emphasis on geographic centralization of services. Attempts to reform Ontario''s cancer control system are unlikely to be successful unless these fundamental issues are recognized and addressed.     

Business leaders begin to rally in support of public health care system

There appears to be growing concern among Canada''s business leaders about the future of Canada''s health care system. At a recent meeting in Montebello, Que., that was cosponsored by the CMA and several Canadian corporations, some business representatives said Canada''s publicly funded system gives them a competitive edge in an increasingly global market.     

Tuition fees for residents: one physician's perspective

Although the education, expertise and guidance of Canada''s academic physicians cannot be overlooked, individual universities appear to see tuition fees for residents as an easy source of much needed revenue. If tuition should "rise to market levels," perhaps residents'' wages should similarly rise to reflect the amount of training received, skills required, responsibilities discharged and time expended. Unfortunately, tuition fees will be an area of contention for some time. Support of provincial resident associations and medical societies may lend both moral and, possibly, financial support to future members of the profession.     

A system worth saving.

The country will mark Canada Health Day on May 12, so CMAJ asked Dr. Michael Gordon to reflect on Canada''s health care system and the changes it has seen and will see. The special day, cosponsored by the Canadian Public Health Association, is designed to highlight "the need for better communication between health professionals and the communities they serve." In this article, Gordon reflects on the dangers facing Canada''s medicare system and the need to protect it from the inroads threatened by privatization.     

Victoria conference highlights differences in federal,provincial stands on health care issues

When Canada''s health ministers met in Victoria recently, the number of issues debated were yet another sign of the many problems facing Canada''s health care system. There were dis-agreements about the use of facility fees by private clinics, and concern about the huge impact federal cuts to transfer payments are going to have on provincial governments. British Columbia, for instance, faces 1996 federal cuts totalling $375 million — 5.8% of the province''s health care budget. As well, ministers debated the merits of a report discussing alternatives to the fee-for-service method of paying physicians. Dr. Jack Armstrong, the president, said the CMA does not favour one particular remuneration system over another, but feels strongly that doctors should have the right to choose the system they want.     

Could changes in the wheelchair delivery system improve safety?

Despite emerging evidence about the high incidence and severity of wheelchair-related injuries, regulations governing wheelchair safety are almost nonexistent in Canada. The authors believe that, to improve wheelchair safety, a concerted effort by government, manufacturers, purchasing groups, users and clinicians is needed. Health Canada''s Health Protection Branch should treat wheelchairs as medical devices (as defined in the Food and Drugs Act 1985) and improve its injury-reporting network. Manufacturers should give a higher priority to safety in wheelchair design, improve their educational materials and formalize postmarketing surveillance. Purchasing groups should try to ensure that they do not stifle innovation in wheelchair design by setting unrealistic reimbursement ceilings and should use their market power more effectively. Users should obtain their wheelchairs in specialized settings, heed safety warnings and make more effective use of litigation when such action is warranted. Clinicians should ensure that patients are equipped with the most appropriate wheelchair for their needs, that they are given adequate training in safe wheelchair use and that they understand the dangers involved. Rapid changes in wheelchair technology and emerging evidence about the high incidence and severity of injuries related to wheelchair use suggest that such changes are needed in the wheelchair delivery system.     

Would you recommend a medical career to your children?

Physicians are frustrated by cutbacks, threats to their practices, income restrictions and government interference. However, in spite of complaints from practising physicians medicine remains an attractive career option for Canada''s best and brightest, with four to five candidates for every first-year position in medical school.     

Failure to perform autopsies means some MDs "walking in a fog of misplaced optimism".

Once the cornerstone of medical-school training because they taught the fundamentals of anatomy and the ravages of disease, autopsies are now done so infrequently that many of today''s doctors graduate from medical school without ever having seen one performed. In 1950, 50% of deaths were followed by autopsy; in 1995, that rate has dropped as low as 7% in some North American hospitals. Critics say the procedure is expensive and that modern diagnostic technologies will reveal all they need to know about a particular disease process or illness; some physicians also fear lawsuits might be launched if autopsy data reveal they made an incorrect diagnosis. However, pathologists insist that the true value of autopsies is the quality assurance and ongoing education that they provide.     

The health of Indians in Canadian cities: a challenge to the health care system

It is well known that Canadian native people living on reserves have high morbidity and mortality rates, but less is known about the health of those who migrated to urban centres. Several studies have shown that these people have high rates of mental health problems, specific diseases, injuries, infant death and hospital admission. In addition, there is evidence that cultural differences create barriers to their use of health care facilities. The low socioeconomic status, cultural differences and discrimination that they find in cities are identified as the primary blocks to good health and adequate health care. More epidemiologic studies need to be done to identify health problems, needs and barriers to health care. Federal, provincial and civic governments along with the appropriate departments of faculties of medicine should begin working with native organizations to improve the health of native people living in Canada''s cities.     

Refugee MD not wasting skills even though door to medical practice in Canada is closed

Dr. Lula Hussein, a Somali refugee with a medical degree from East Germany, is not licensed to practise in Canada, but she is making her mark in Ottawa''s Somali community by counselling, advising and helping her fellow refugees. One of her particular interests is in ending the practice of female genital mutilation, which still finds favour among some of Canada''s refugees and immigrants.     

Micmac medical student becomes role model for his community

When Robert Johnson graduates from medical school in 1998, he will become Canada''s first Micmac physician. For him, going to medical school is a major responsibility because he is a role model for an entire community. He hopes he is only the first of many Micmacs to make this career choice.