I read with interest the article by Nicholson and Levy (“Solving the primary care crisis,” BCMJ 2009;51:12-13). 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
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