Physician manpower study confluences with national review of demographic policy JIM GARNER
In one of his last speeches before moving on to graze in other pastures, former Immigration Minister Robert Andras declared: "To ignore controlling population trends is to foreclose the future... He was referring to the extensive review of demographic policy initiated by the Canadian government in the last couple of years, highlighted by a Green Paper presented to Parliament early last year. The Canadian government expects to come back to Parliament in the next month with a statement on population policy goals. It is against this background that Canadian physicians have been examining their resources of manpower and the needs of the population these resources must serve. The report of the requirements subcommittee of the National Committee on Physician Manpower has been reviewed by the CMA and its affiliated bodies (see page 787) and although the consensus is that the data are too soft for hard decisions, it can reasonably be said that Canadian medicine is not foreclosing its future by ignoring controlling population trends. The physician manpower studies d.d not evolve specifically as part of the government's overall review. Nevertheless, the national committee's work will inevitably become part of the input into demographic policy study. The Canadian government has, in the words of Mr. Andras, been moving to develop consciously a policy approach to population. There has been established within the federal government a demographic policy steering group of 14 deputy ministers. In addition, each provincial government has nominated a cabinet minister as lead minister for demographic policy. These ministers are consulting with the federal government, and the consultations extend to at least the deputy minister level. It has been somewhat overlooked that
the British North America Act does share authority to make immigration law between provincial and federal spheres. This is of importance to the studies on medical manpower, in that decisions on medical manpower have to be made by the provinces. A further important input into demographic policy was made in the form of a report on immigration by a joint committee of the Senate and House
of Commons, tabled last year. The indications are that the legislators' views have been well received. One innovation we may expect to see announced is an annual target immigration figure. The parliamentary committee favoured a minimum of 100 000 immigrants a year, and Mr. Andras translated this into a net migration inward of 50 000 to 100 000 a year. Given present low fertility levels, such a migration policy would produce a population in Canada of 28 to 30 million in the census year 2001. This in turn would give Canada a highly manageable growth rate of 1 % a year, compared to 1.6% in 1974. The relationship of immigration to physician manpower needs has not at all been adequately discussed. The overall impression left by the discussion at CMA House was that somewhere out there is a big pool of physicians who can be brought in or shut out according to how well the production lines in our medical schools function. This may be an unrealistic view. For instance, if Canada is committed to an immigration of 100 000 people a year and a physician to population
ratio of 1:600 (with apologies to the CMAJ contributor who challenged the validity of such an overall ratio), does this not suggest we need 166 new physicians a year to care for the immigrants, in addition to any increase in our stock of physicians required by the natural increase in population? These new physicians could no doubt be produced by Canadian medical schools, leaving no requirement for immigrant physicians. Any occupational group could, indeed, argue along these lines; the spool-winders could urge that we have enough spool-winders already, so let us admit no immigrant spool-winders. The same could be said by accountants, construction workers, ministers, truck drivers, even journalists and politicians. By restricting occupational categories where a surplus is already said to exist, we would end up with no immigrants at all. A possible compromise might be to admit immigrants in roughly the same proportion that is thought desirable in the whole population - say 166 physicians a year. The various official initiatives into development of demographic policy have not yet got into the nitty-gritty of what mix of skills the incomers might have. But certainly the proposed annual target figure would provide the opportunity of setting up a US-style waiting list, with a place on the list for each applicant according to how the authorities perceived his desirability. The system would, in the parliamentary committee's view, "provide the tools to manage immigration efficiently to serve Canada's population." It is obvious that the work of the National Committee on Physician Manpower and the review on demographic policy are coming to a confluence. Canadian medicine has the opportunity here to contribute to a process that can establish a good, economic, satisfying structure for the next two or three generations of practitioners. U
CMA JOURNAL/OCTOBER 23, 1976/VOL. 115 783
In one of his last speeches before moving on to graze in other pastures, former Immigration Minister Robert Andras declared: "To ignore controlling population trends is to foreclose the future... He was referring to the extensive review of demographic policy initiated by the Canadian government in the last couple of years, highlighted by a Green Paper presented to Parliament early last year. The Canadian government expects to come back to Parliament in the next month with a statement on population policy goals. It is against this background that Canadian physicians have been examining their resources of manpower and the needs of the population these resources must serve. The report of the requirements subcommittee of the National Committee on Physician Manpower has been reviewed by the CMA and its affiliated bodies (see page 787) and although the consensus is that the data are too soft for hard decisions, it can reasonably be said that Canadian medicine is not foreclosing its future by ignoring controlling population trends. The physician manpower studies d.d not evolve specifically as part of the government's overall review. Nevertheless, the national committee's work will inevitably become part of the input into demographic policy study. The Canadian government has, in the words of Mr. Andras, been moving to develop consciously a policy approach to population. There has been established within the federal government a demographic policy steering group of 14 deputy ministers. In addition, each provincial government has nominated a cabinet minister as lead minister for demographic policy. These ministers are consulting with the federal government, and the consultations extend to at least the deputy minister level. It has been somewhat overlooked that
the British North America Act does share authority to make immigration law between provincial and federal spheres. This is of importance to the studies on medical manpower, in that decisions on medical manpower have to be made by the provinces. A further important input into demographic policy was made in the form of a report on immigration by a joint committee of the Senate and House
of Commons, tabled last year. The indications are that the legislators' views have been well received. One innovation we may expect to see announced is an annual target immigration figure. The parliamentary committee favoured a minimum of 100 000 immigrants a year, and Mr. Andras translated this into a net migration inward of 50 000 to 100 000 a year. Given present low fertility levels, such a migration policy would produce a population in Canada of 28 to 30 million in the census year 2001. This in turn would give Canada a highly manageable growth rate of 1 % a year, compared to 1.6% in 1974. The relationship of immigration to physician manpower needs has not at all been adequately discussed. The overall impression left by the discussion at CMA House was that somewhere out there is a big pool of physicians who can be brought in or shut out according to how well the production lines in our medical schools function. This may be an unrealistic view. For instance, if Canada is committed to an immigration of 100 000 people a year and a physician to population
ratio of 1:600 (with apologies to the CMAJ contributor who challenged the validity of such an overall ratio), does this not suggest we need 166 new physicians a year to care for the immigrants, in addition to any increase in our stock of physicians required by the natural increase in population? These new physicians could no doubt be produced by Canadian medical schools, leaving no requirement for immigrant physicians. Any occupational group could, indeed, argue along these lines; the spool-winders could urge that we have enough spool-winders already, so let us admit no immigrant spool-winders. The same could be said by accountants, construction workers, ministers, truck drivers, even journalists and politicians. By restricting occupational categories where a surplus is already said to exist, we would end up with no immigrants at all. A possible compromise might be to admit immigrants in roughly the same proportion that is thought desirable in the whole population - say 166 physicians a year. The various official initiatives into development of demographic policy have not yet got into the nitty-gritty of what mix of skills the incomers might have. But certainly the proposed annual target figure would provide the opportunity of setting up a US-style waiting list, with a place on the list for each applicant according to how the authorities perceived his desirability. The system would, in the parliamentary committee's view, "provide the tools to manage immigration efficiently to serve Canada's population." It is obvious that the work of the National Committee on Physician Manpower and the review on demographic policy are coming to a confluence. Canadian medicine has the opportunity here to contribute to a process that can establish a good, economic, satisfying structure for the next two or three generations of practitioners. U
CMA JOURNAL/OCTOBER 23, 1976/VOL. 115 783
