To solve the physician supply problem, the training system must change

In its relatively short history, PAR-BC has had significant links with the BCMA. Our two associations have at times jointly faced similar issues. We also note with great pride that many BCMA leaders were once active in PAR-BC. Physicians such as Dr Arun Garg, Dr Derryck Smith, Dr Ian Courtice, and the BCMA’s president elect, Dr Marshall Dahl, have all served on PAR’s board of directors; Drs Garg, Smith, and Dahl as PAR presidents. And so, the BCMA’s anniversary celebrations provide an ideal opportunity for us to reflect on the past while gazing into our collective future.

It should come as little surprise that as much as things seem to change and move forward, the more they seem to stay the same. Many of you may well remember your days as residents with fond and maybe not-so-fond memories. Long hours combined with modest remuneration made for a difficult working and learning environment. The formation of housestaff associations in the 1970s, including PAR-BC in 1973, alleviated some of those problems. Yet residents today continue to face many of the same challenges.

Challenges such as significant pay cuts in the form of tuition fees loom over our heads; the continual and ongoing struggle for recognition as physicians in our own right and entitlement to appropriate working conditions, salaries, and benefits; the continual and ongoing justification that residents do provide significant patient care and contributions to the hospitals and health-care system. All that combined with a health-care system in tremendous flux leaves residents caught in the middle of many drafts and currents. Hospital downsizing and shortages of health-care personnel mean that residents, the front-line physicians, must perform amazing juggling feats to accommodate the demand.

“Closer to home,” or regionalized medicine, has meant fewer centralized training opportunities, but generally there is insufficient funding to allow residents to go to the various parts of the province. Through all of the challenges, PAR’s members have maintained the utmost professionalism in all aspects of medical practice, learning, teaching, and contribution to research knowledge. With the support of the many dedicated clinical teachers throughout the province, BC produces arguably some of the best-trained physicians in the country.

Unfortunately, BC does not train enough physicians. One of the most pressing issues facing the profession is the looming shortage of physicians. The need to train more is only partially related to the oft-spoken trends in demographics toward an older population, both in the general public and among currently practising physicians. The bottom line is that there are not enough “home grown” doctors in British Columbia. For the 1997–98 period, British Columbia lost 316 physicians due to attrition,[1] yet in 1998 there were only 133 BC-trained physicians entering practice in all of Canada.[1,2]

As a result, for years the province has relied on an influx from the rest of Canada and other countries. But the supply is drying up. New graduates do not even fill the vacancies left by physicians leaving medical practice, let alone start to address the serious supply deficiency. There are some who believe that the solution to solving the physician supply problem is to mandate newer physicians to practice in “select” areas. PAR-BC is strongly opposed to this type of coercive measure.

So-called under-serviced communities need physicians who genuinely want to practice there, and we are pleased that successive court decisions have ruled such measures to be unconstitutional. The focus must be on modifying the practice conditions to make those areas as attractive as possible, and we acknowledge the work that the BCMA has done. But, let us be clear: PAR-BC will continue to speak out against any coercive measures in a physician supply plan, and will vigorously oppose such measures should they be introduced again.

One of the factors that we believe has exacerbated the problem is an inflexible training system. Medical students are forced to pick a specialty two to three years into training. During residency switching between programs is difficult. Re-entering a residency program after a few years in practice is almost impossible. Physicians who would benefit from the knowledge and experience gained in the practice of broad-based medicine before specializing are prevented from doing so. Communities in turn are potentially denied access to a supply of generalist physicians. The residency training system must include increased re-entry and retraining opportunities.

As we move forward the medical profession faces significant challenges. PAR-BC is optimistic, however, that the innovation, goodwill, and flexibility of British Columbia’s physicians (in practice and in training) will bring about considerable advancements and reforms. We at PAR-BC look forward to continuing our alliance with the BCMA, for decisions that today affect the newest members of the profession will ultimately affect the established members of the profession in the years to come.

Dr Wong is co-president of the Professional Association of Residents of BC (1999–2000).