National Committee on Physician Manpower subcommittee report: valuable or potentially damaging? D.A. GEEKIE
The Royal College of Physicians and Surgeons could reduce, increase or change the mix of specialty training positions available. The federal government, in consort with the provinces, is already discreetly discouraging the migration of physicians to Canada - or at least discouraging the migration of some types of physicians to some parts of Canada. It may shut off the migration tap entirely, or it may further refine the sieve through which migrant physicians must slip. Canadian medical schools could tailor their physician production mechanisms to produce the predetermined, required number of general or family physicians (including the number and percentage of 1-year internship versus the 2-year residency type) versus orthopedic surgeons versus ophthalmologists etc. The current freedom of medical graduates to select their own disciplines may be markedly reduced in the future. Provincial government financial support of postgraduate training programs and positions may be put on a more proved need basis versus demand basis than has existed in the past. Indeed, some provinces may be inclined to look at the financing of medical schools in terms of their own provincial needs "to hell with financing the production of physicians for New Brunswick, Prince Edward Island or wherever the graduates beyond our own needs migrate to." The potential ramifications of implementing the recommendations of the National Committee on Physician Manpower's requirements subcommittee are extensive and important. As CMA Past President Dr. Lloyd Grisdale said in his valedictory address. "This report may be of real value and benefit to medical care in Canada - or it may result in considerable damage to our health care system. Some of the recommendations will receive wide support. others will be highly controversial. For example, the report recommends that
by 1981 we increase the number of physicians practising in this country so that the physician:population ratio will increase from 1:721 to 1:665. That recommendation, I suspect, will find widespread support. But it also recommends that we reduce the percentage of primary care given by general practitioners in favour of increasing the primary care given by specialists. Will this improve the quality of care? Will it decrease the cost? Why did the working party of general practitioners, who developed the basic report on general practice, recommend that the number of general practitioners not increase (and therefore decrease relatively speaking) in the years ahead? "Why did the requirements committee that wrote the final report agree?
OTTAWA RLE Both committees were made up of physicians who are experienced, respected and knowledgable. The most obvious answer is that they made the recommendation because it is right and will result in an improvement in our health care in the years ahead. But is it? Will it?" There is little question that in spite of its weaknesses - a soft data base, unsubstantiated mathematical models and projections - the report is important. It warrants close study by all concerned. The report had 11 agency parents, a gestation period of 3 years and over 200 attending physicians; it ended up a three-volume series with 30 working-party appendices, over 2000 pages and a multitude of recommendations. The report is actually the work of the requirements subcommittee of the National Committee on Physician Manpower formed in 1971. Having com-
pleted its assigned task, it has now been disbanded. The parent committee may disagree with some of the content or may not support implementation of all or any of the subcommittee recommendations or conclusions, but the subcommittee's baby has been delivered. Several medical groups have voiced their concern that the subcommittee report has been widely distributed to government and nongovernmental agencies in its current raw state. It has not been subjected to detailed review or comment by the National Committee on Physician Manpower or its constituent agencies. They are concerned about the possible implementation of subcommittee recommendations on a fragmented or arbitrary basis before the entire report has been subjected to sober review. For its part, the CMA has accorded the report top priority study. Copies have been distributed to all provincial divisions and affiliated specialty bodies. They have been requested to submit their comments, criticisms and viewpoints in writing and to attend a special national conference to be held in early September. Several CMA council subcommittees have reviewed the report. The establishment of association policy will be a priority item on the agenda of the Oct. 1-2 board meeting. Past President Dr. Lloyd Grisdale, the association's representative on the National Committee on Physician Manpower. has also expressed the desire that the association provide as much opportunity as possible for general membership input. To that end, this issue of CMAJ contains a condensation of the subcommittee report. Comments or constructive criticisms should be forwarded to Dr. N.P. DaSylva, CMA director of medical services, at CMA House, P0 Box 8650, Ottawa, ON KiG 0G8. A limited supply of single copies of the 2000-plus page report, in its entirety, are available from Dr. Derek Geliman, director general, Health programs branch, Health and Welfare Canada, Ottawa, ON KlA 1B4.
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The Royal College of Physicians and Surgeons could reduce, increase or change the mix of specialty training positions available. The federal government, in consort with the provinces, is already discreetly discouraging the migration of physicians to Canada - or at least discouraging the migration of some types of physicians to some parts of Canada. It may shut off the migration tap entirely, or it may further refine the sieve through which migrant physicians must slip. Canadian medical schools could tailor their physician production mechanisms to produce the predetermined, required number of general or family physicians (including the number and percentage of 1-year internship versus the 2-year residency type) versus orthopedic surgeons versus ophthalmologists etc. The current freedom of medical graduates to select their own disciplines may be markedly reduced in the future. Provincial government financial support of postgraduate training programs and positions may be put on a more proved need basis versus demand basis than has existed in the past. Indeed, some provinces may be inclined to look at the financing of medical schools in terms of their own provincial needs "to hell with financing the production of physicians for New Brunswick, Prince Edward Island or wherever the graduates beyond our own needs migrate to." The potential ramifications of implementing the recommendations of the National Committee on Physician Manpower's requirements subcommittee are extensive and important. As CMA Past President Dr. Lloyd Grisdale said in his valedictory address. "This report may be of real value and benefit to medical care in Canada - or it may result in considerable damage to our health care system. Some of the recommendations will receive wide support. others will be highly controversial. For example, the report recommends that
by 1981 we increase the number of physicians practising in this country so that the physician:population ratio will increase from 1:721 to 1:665. That recommendation, I suspect, will find widespread support. But it also recommends that we reduce the percentage of primary care given by general practitioners in favour of increasing the primary care given by specialists. Will this improve the quality of care? Will it decrease the cost? Why did the working party of general practitioners, who developed the basic report on general practice, recommend that the number of general practitioners not increase (and therefore decrease relatively speaking) in the years ahead? "Why did the requirements committee that wrote the final report agree?
OTTAWA RLE Both committees were made up of physicians who are experienced, respected and knowledgable. The most obvious answer is that they made the recommendation because it is right and will result in an improvement in our health care in the years ahead. But is it? Will it?" There is little question that in spite of its weaknesses - a soft data base, unsubstantiated mathematical models and projections - the report is important. It warrants close study by all concerned. The report had 11 agency parents, a gestation period of 3 years and over 200 attending physicians; it ended up a three-volume series with 30 working-party appendices, over 2000 pages and a multitude of recommendations. The report is actually the work of the requirements subcommittee of the National Committee on Physician Manpower formed in 1971. Having com-
pleted its assigned task, it has now been disbanded. The parent committee may disagree with some of the content or may not support implementation of all or any of the subcommittee recommendations or conclusions, but the subcommittee's baby has been delivered. Several medical groups have voiced their concern that the subcommittee report has been widely distributed to government and nongovernmental agencies in its current raw state. It has not been subjected to detailed review or comment by the National Committee on Physician Manpower or its constituent agencies. They are concerned about the possible implementation of subcommittee recommendations on a fragmented or arbitrary basis before the entire report has been subjected to sober review. For its part, the CMA has accorded the report top priority study. Copies have been distributed to all provincial divisions and affiliated specialty bodies. They have been requested to submit their comments, criticisms and viewpoints in writing and to attend a special national conference to be held in early September. Several CMA council subcommittees have reviewed the report. The establishment of association policy will be a priority item on the agenda of the Oct. 1-2 board meeting. Past President Dr. Lloyd Grisdale, the association's representative on the National Committee on Physician Manpower. has also expressed the desire that the association provide as much opportunity as possible for general membership input. To that end, this issue of CMAJ contains a condensation of the subcommittee report. Comments or constructive criticisms should be forwarded to Dr. N.P. DaSylva, CMA director of medical services, at CMA House, P0 Box 8650, Ottawa, ON KiG 0G8. A limited supply of single copies of the 2000-plus page report, in its entirety, are available from Dr. Derek Geliman, director general, Health programs branch, Health and Welfare Canada, Ottawa, ON KlA 1B4.
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