Re: Solving the primary care crisis

I read with interest the article by Nicholson and Levy (“Solving the primary care crisis,” BCMJ 2009;51[1]:12-13). As an FMG who has practised in the distant reaches of rural Canada, I have always been struck by the lack of any real incentive system to attract physicians to those underserviced areas. The system proposed by the authors has merit, except in the suggestion that medical education should be “free.” In my opinion, creating one category of university students who enjoy so-called free education, whilst all other students and their tax-paying parents subsidize them, will never fly. A simpler solution, already utilized in many other countries, is for any interested community or health region to create a bursary system for eligible candidates. I my­self was the recipient of such a system in South Africa, with partial coverage of my education costs in return for a service contract with the provincial government. Such a system would create an internal market for graduating students and allow the health regions to plan appropriately and to budget for future needs. A year’s worth of education bursary would translate into a year’s worth of service—the service would be according to the needs of the health region, but obviously would allow for some measure of choice for the newly graduated MD. In addition, should the MD wish to, breaking the contract would always be an option, with repayment of the bursary. This option encourages bursary-offering regions to offer competitive salaries and other incentives to discourage their bursary recipients from locating elsewhere.

—Alister Frayne, MD

Alister F. Frayne, MB ChB, MBA, CCFP, FCFP. Re: Solving the primary care crisis. BCMJ, Vol. 51, No. 3, April, 2009, Page(s) 104 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply