Ben Chan's recent report on Canada's physician workforce1 and subsequent media coverage of it — including CMAJ's2 — trivialized 2 major factors in the physician-supply equation: the 10% cut to undergraduate enrolment recommended in the 1991 Barer–Stoddart report3 and the emigration of Canadian physicians.
The 10% cut is often criticized by the medical community because it was implemented at a time when many medical schools had already cut enrolment, the physician-to-population ratio had plateaued and 700 physicians were leaving for the United States each year. As well, governments were not monitoring retirement trends, which started to show steady increases during the 1980s. In reality, first-year undergraduate enrolment decreased by 15% from 1983/84 to 1992/93 and declined again in the late 1990s.
Chan has suggested that a bigger decline in the output of training programs was caused by an increase in the length of training required to meet new certification standards in family medicine and an increase in the number of graduates opting for specialty training. He could have pointed out that the switch to a 2-year family medicine program was needed to increase portability within Canada and to meet international standards in education. The government did not provide any additional postgraduate positions to accommodate the extra year of training and instead used the re-entry positions usually reserved for international medical graduates and specialty training.
It is also worth noting that there was a net loss of 4000 physicians from Canada in a single decade, at a total cost of approximately $6 billion to the taxpayers who paid for their education. A physician pool that includes a substantial proportion of aging physicians cannot afford to lose any of its young physicians this way.
Hugh E. Scully Cochair, Task Force II Human Resource Strategy for Physicians Canadian Medical Forum Ottawa, Ont.