be based. I still contend that it is exaggerated by at least 35%. I agree with Mr. Mennie that the data on physicians in nonclinical roles are just as important as those on physicians in clinical practice, and that future needs must be met. My objection is to having the two mixed and the total figure interpreted as that for clinical practitioners. C.B. STEWART, MD Vice president Health sciences Daihousie University Halifax, NS
Physician manpower requirements To the editor: With reference to the Special Report by Milan Korcok and D.A. Geekie entitled "Report issued by requirements subcommittee of National Committee on Physician Manpower (Can Med Assoc J 115: 265, 1976), I call attention to the serious error in the data presented on ophthalmology. The last column of Table IV shows that 23 new ophthalmologists will be required in Canada; presumably this figure is for each year. However, Korcok and Geekie state that attrition is estimated at 3 % per year. Considering that there are 780 ophthalmologists in Canada now (Table III) the number 24 barely exceeds the yearly attrition and does not allow for the needs of an increasing population. The true figure for the number of ophthalmologists needed per year is about 45 to 50. An error of this magnitude in a publicly available medical publication is distressing, to say the least, as it is a potent source for mischief. It is well known that governments now, and possibly for. years to come, are on an "economy kick". Though in some areas of the country, such as British Columbia, there are nearly sufficient ophthalmologists, this is not true of Canada as a whole. Indeed in some areas there is a great deficiency. A further problem is that of distribution, which should improve with more ophthalmologists entering practice. Should the figure quoted in the Special Report be acted upon, the relative number of ophthalmologists will decrease and it will be impossible to improve matters. A shrinking population of ophthalmologists ought to comfort the optometrists who are laying claim to all primary eye care, medical and otherwise, in North America. Let no one think these ambitions are idle. Many people in government have been convinced that expansion of the optometrist's responsibilities is a logical step, and many of our medical confreres, owing to limited understanding of the factors involved, support it; if this should come to pass, the quality of eye care in Canada will take a serious downward step. Ophthalmologists must
remain the major providers of primary eye care. I believe I can speak of these matters with some authority. I was chairman of a committee instituted by the Council of Ontario Faculties of Medicine (COFM) in the spring of 1974 to study the present supply and future requirements for ophthalmologists in Ontario. The committee reported in September 1974 and found that this was a very difficult area upon which to pontificate as there were so many imponderables. Apparently these were recognized as well by the National Committee on Physician Manpower. Both groups agree in one area: under present conditions and modes of practice (which may well alter) the need is 1 ophthalmologist per 28 000 persons. However, the figure of 45 or more new ophthalmologists needed each year is more in keeping with the data presented in the report of the Ontario committee in 1974 and certainly is the valid one. One can only conjecture how those behind the Special Report fell into this error in the requirement for ophthalmologists. I cannot help wondering if there is not more here than meets the eye. I hope that members of other specialties will be alerted by this letter, for I suspect that the same type of error may have crept into their data. JOHN V.V. NICHOLLS, MD, FRCS[C] Clinical professor of ophthalmology University of Western Ontario London, Ont.
[This letter was referred to the chairman of the requirements subcommittee of the National Committee on Physician Manpower. - Ed.] To the editor: In their Special Report Korcok and Geekie condensed three volumes of reports into nine pages, yet conveyed many of the principal ideas, data and conclusions. As chairman of the requirements subcommittee I appreciate the quality of their report and the fair commentary. However, abridgement on this scale precludes consideration of many nonaverage data or atypical situations of potential significance. Anticipating that discussions might develop based on abridged versions of our report, the requirements subcommittee in the introduction to part III emphasized careful reading of the full texts of the 30 working party reports. In the working party report on ophthalmology, the full text of which was published as an annex to part III of our report, are tabulated data and discussion on the attrition rate of ophthalmologists in Canada. The data for 1969 through 1973, extracted from "Canadian Medical Directory" tapes,
indicated overall rates of 1.22% in 1973 to 2.31% in 1971. Hence an average figure of 1.75% compounded was applied in the formula for calculating the annual additions to the workforce needed to offset this attrition and to achieve by 1981 the target ratio of 1 ophthalmologist to 28 000 Canadians - the target on which the COFM study, the working party in ophthalmology and the requirements subcommittee found themselves in agreement. I have been reassured by more mathematically inclined resource persons that, given the foregoing and assuming medium fertility, the arithmetic was correct that indicated the need for an additional 24 ophthalmologists annually between 1972 and 1981. However, 3 % was the figure commonly applied by working parties lacking firmer data on attrition in their specialties and hence was cited by Korcok and Geekie as an average attrition rate. An example of the degree to which a small error in attrition rate can influence supply projections is given on page 83 of part III of our report. This is followed by the recommendation that "accurate determination of the rate of attrition in each discipline be calculated using demographic data and professional activity profiles". Because of remaining uncertainty whether available data would reliably reflect future attrition, the working party in ophthalmology stated in their report that "it is impossible at this stage to predict anything other than that attrition will continue to decrease the stock of ophthalmologists by somewhere between 7 and 22 per year over the next 5 years". Allowance for population growth based on the medium fertility assumption was consistently built into the requirements in all specialties. In ophthalmology it is reflected in the increment from an optimal present requirement of 780 to that of 887 by 1981. Comment on the statement that "the true figure for the number of ophthalmologists needed per year is about 45 to 50" must be limited in the absence of the evidence on which this estimate is based. However, the disparity between the figures 24 and 45 to 50 is great and deserves prompt efforts to gather and analyse whatever data are needed to resolve it. The implications of ongoing overproduction of specialists from unduly large training programs are serious - particularly for specialties such as ophthalmology that have limited prospects for retreading surplus physicians for other roles. J.B. RALPH MCKENDRY, MD Ottawa Civic Hospital 1053 Caning Ave. Ottawa, Oat.
CMA JOURNAL/NOVEMBER 20, 1976/VOL. 115 983