According to both administrators and recent graduates of the Queen’s School of Medicine, the Ontario government’s decision to expand medical school enrollment is an important step towards ensuring that physician services are more accessible to Ontarians in the future. However, critics say this undertaking is only a small part of the larger solution required to satisfy this goal.
Health and Long-Term Care Minister Elizabeth Witmer, announced on August 23 that the government would invest $975,800 to expand undergraduate enrollment by 40 positions at the province’s five medical schools this coming school year. Of the 40 new undergraduate positions, 13 have gone to the University of Toronto, 8 to McMaster University, seven each to the University of Ottawa and the University of Western and the remaining five to Queen’s.
The move to expand enrollment is based on an interim recommendation from the government’s Expert Panel on Health Professional Human Resources that found that the Ontario health care system was short 1,000 physicians. According to Witmer, the expansion in enrollment is to meet this need in medical service in Ontario.
“We are expanding enrollment immediately to ensure that all Ontarians have better access to physician services in the future,” she said.
Dean of Health Sciences and Director of the Queen’s School of Medicine Dr. D.M.C. Walker says that the expansion in enrollment is a necessary action on the part of the Ontario government to reverse the effects of previous reductions in enrollment (In 1992, former NDP premier Bob Rae imposed a cap on medical student enrollment). “The governments in Canada reduced the number of medical students eight years ago so that the number leaving has become greater than the number entering [with the result that] Canada is in a net loss position”.
Kingston General Hospital resident and recent Queen’s School of Medicine graduate Dr. Michael Feldman commented that the government’s action to expand enrollment was critical not only to ensure that the physician supply match the increasing demands placed by an aging population but also to account for the evolving nature of of work done by doctors.
“The complexity of medicine is continually increasing as science and the courts require evidence-based justification for treatment of illnesses or injuries. This type of medical care requires more time to get the same amount of work done,” he said.
“[Also], physician practice patterns are changing such that more doctors work part-time or take time for raising families. An increased number of physicians may be required to do the same amount of work.”
While the increase in five medical student positions at the Queen’s school of medicine may not seem like a significant expansion, Walker thinks that the change in enrollment will have a positive effect in the long-term.
“Four years from now there will be 40 doctors more than there would have been before,” says Walker.
“We think it will make a difference because Queen’s makes good doctors and if we can get more out there it’s a good thing”.
While Walker admits that expanding enrollment in medical programs can have a negative effect on the quality of the program, he emphasizes that Queen’s School of Medicine will not be adversely affected by this recent enrollment openings.
“It’s always a worry... but none of Ontario’s medical schools are at full capacity so its not an issue at the moment,” he explained.
Walker stresses, however, that if the enrollment expansion project is to be effective in improving accessibility to physician services in Ontario the future, it must be accompanied by the success of several other related measures designed to target the problem of inaccessibility.
“It is not the sole solution to a perceived doctor shortage. It has to be wrapped up with other solutions which I think the government are employing”.
A related step in the government’s comprehensive plan to address physician supply and distribution throughout the province is the Tuition Grant Program and Location Incentive Funds which are designed to attract new physicians to under serviced areas in the province. This project will provide students with $10,000 for each year of undergraduate medical training and in exchange, graduates will be required to practice in an approved under serviced area for the same number of years they received the grant. The length of the service required is a minimum of three years and a maximum of four years. “The experience in other jurisdictions is that this can be effective,” said Walker of the location incentive plans.
He explains, however, that it remains to be seen if the program will attract Queen’s grads, as undergraduate medical students will only be able to apply to the program when starting their final year of medical school. As a recent medical school graduate, Feldman was skeptical about the potential effectiveness of the tuition incentives.
“I think offering financial incentives to medical students who commit to working in under-serviced areas is an insufficient response to the problems of working in remote areas”, he comments.
“I think the main problem in remote areas is not one of financial compensation but rather professional isolation... How can a doctor take any time off if there are only a couple of physicians in your town? How can the physician stay in touch with medical trends and breakthroughs if they have to travel great distances to attend conferences and seminars?”
Aware of the many concerns involved in the issue of accessibility to physicians in all areas of Ontario, Walker concludes that improvement in this area remains an intricate puzzle, yet he expresses confidence in the government’s efforts to address the issue.
“When a problem is multifaceted it requires a complex solution... many governments have tried to solve it in the past and this government has been quite dedicated in trying to achieve that”.