‘Big changes’ may be in store for med schools in wake of U.S. health reform legislation

U.S. Health Reform, May 2010Raids of Canadian doctors possible in wake of U.S. health reformImmigration hoops face southbound Canadian docsANALYSIS: Canada needs political will for meaningful health reformOTTAWA | Canadian medical educators are confident their graduates will stay home to practise rather than be enticed south by provisions of U.S. health-care reform legislation.There’s very little product differentiation between Canada’s 17 medical schools and the 131 schools now operating in the U.S.In fact, during an interview with the Medical Post, Dr. Nick Busing, president and CEO of the Association of Faculties of Medicine of Canada called accreditation of both schools and hospitals “North American” in process and standards.You might expect this to result in an almost free-flow of personnel across the border, and, in many ways you’d be right. However, other contextual factors also need to be considered, he added, including the fact that licensing requirements are not North American. They’re determined by individual provinces and states.“People have the impression that there’s been a constantly significant brain drain to the south,” Dr. Busing said. “In reality, the numbers indicate there aren’t as many going as returning.”Indeed, according to a recent “Mythbusters” analysis, published by the Canadian Health Services Research Foundation, emigration of Canadian doctors to the U.S. “represents a loss.”“However, when it comes to the brain drain, it’s nowhere near a mass exodus. At worst, it’s more a trickle than a flood,” stated the June, 2008 issue. “In recent years, not only has the brain drain trend slowed, it has actually reversed,” state the Mythbusters authors.In 2004, there was a net brain gain of 85 doctors. Although this gain has decreased as of late—a net gain of 61 in 2005, 31 in 2006 and just 20 in 2007—“the data still counters popular perceptions that Canadian doctors are leaving in droves.”Those who have been around for a while, though, also know there have indeed been “flood” years when the numbers leaving the country were troubling. In 1994, for instance, Canada lost 777 physicians, notes Canadian Medical Association statistics. In that year, and the three years following, there was a net migration of more than 400 doctors.Some argue that was a different time.“A variety of other contextual factors may motivate physicians, and graduating medical residents alike, to look at practise outside Canada,” wrote CMA director of workforce research Lynda Buske and AFMC vice-president of research and analysis Steve Slade in the AFMC’s DataPoint! series a year ago.“Income caps, clawbacks and mobility restrictions may have prompted out-migration during the 1990s,” they added. More recently, provincial government-sponsored alternative payment plans, recruitment strategies and other incentives “may be fuelling higher physician retention rates.”U.S. shortages of 90,000 doctors or more have been predicted by 2020, coupled with health system improvements that will cover more than 30 million new patients.“It comes as no surprise that Canadian physicians are seeing increased activity by U.S. recruiters,” the pair also noted. “Time will tell if these forces reverse the gains we’ve made retaining Canada’s physicians.”Dr. Busing also referred to the near-certainty U.S. health reforms will accentuate the dire need for newcomers and that Canada will be the first place U.S. health administrators will look, particularly for family doctors. But he also believes they’ll be less inclined to leave than in the mid-‘90s.“The community of family physicians in Canada is in a better state now than five years ago,” noted the former president of the College of Family Physicians of Canada. “It’s still not perfect, but it’s better. A number of concerns have been dealt with.”The AFMC’s recently-issued national strategy, The Future of Medical Education in Canada, calls for more attention to generalist training for all MD graduates, he also noted.Further, the AFMC is studying the post-graduate sector, which Dr. Busing expects will “also shine light on the need to refine how we educate our physicians.”“Changes may be needed as a result of U.S. reform,” he predicted.Meanwhile, U.S. schools are projected to dramatically increase enrolments as much as 30% as part of an initiative that began a few years ago and continues today.The Association of American Medical Colleges, AFMC’s sister group, which includes 400 teaching hospitals as members, has called for the elimination of caps on residency positions at 1997 levels funded by Medicare, the national program covering the elderly, “so future physicians can finish their training,” noted AAMC president and CEO Dr. Darrell Kirch in a response to the legislation.The reform bill includes incentives for physicians to pursue primary care but does not deal with concerns about potential shortages overall, AAMC officials added.Teaching hospitals are able to create more residency slots on their own, but government won’t reimburse them.

‘Big changes’ may be in store for med schools in wake of U.S. health reform legislation

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