The Class of 1989 and physician supply in Canada.

BACKGROUND: "The Class of 1989" is a study of 1722 people who were awarded an MD degree by a Canadian university in 1989. This paper reports on migration, specialty choices and patterns of post-MD training in order to assess the contribution of the graduating cohort to the physician workforce of Canada. METHODS: A longitudinal study was conducted over 7 years after graduation to trace the current location, the post-MD training history and the professional activity of the graduating cohort. Several medical professional and educational associations in Canada and the United States provided year-by-year information on field and location of post-MD training, certification achieved, whether in practice and location of practice through to spring 1996. Information from all sources was linked to a list of 1989 medical school graduates. RESULTS: From entry to medical school through to 7 years after graduation the cohort was diminished by about 16%. The main reason for loss was migration to other countries: 193 graduates (11.2%) were outside Canada in 1995-96. Internal migration was extensive also; for example, by 1995-96 relatively few of the graduates were located in Newfoundland or Saskatchewan. Of the 1516 graduates active in Canada in 1995-96, 878 (57.9%) were in general practice/family medicine, and only 638 (42.1%) were practising or training in a specialty. INTERPRETATION: The "yield" of the Class of 1989 for Canada's physician workforce is insufficient to meet annual physician inflows from Canadian sources to serve population growth and to replace retiring or emigrating physicians. As output from Canada's medical schools drops even further, the gap between requirements and supply will grow even wider.

The Class of 1989 and post-MD training.

BACKGROUND: "The Class of 1989" is a longitudinal study of 1722 people who were awarded an MD degree by a Canadian university in 1989. This paper reports on the details of their post-MD training up to spring 1996. METHODS: Several medical professional and educational associations in Canada and the United States provided year-by-year information on field and location of post-MD training, certification achieved, whether in practice and location of practice through to spring 1996. Information from all sources was linked to a list of 1989 medical school graduates. RESULTS: Of the 1722 graduates 57 (3.3%) never entered post-MD training in Canada; 147 (8.5%) did 1 or more years of training in the United States. A total of 222 graduates (12.9%) took a break of at least 1 year from training, and 301 (17.5%) changed their choice of field or specialty after starting training. Substantial numbers took 1 or more years longer to complete training than would be expected based on the prescribed length of the training program chosen. The field or specialty choices of the cohort produced a generalist:specialist ratio of 58:42. The final numbers in several fields depended heavily on trainees changing their initial career choice. INTERPRETATION: The data point out widely differing and often very long lead times from start to completion of training. Since 1993, changes to licensure requirements have reduced opportunities for recent graduating cohorts to delay final career choices, take a break in training, prolong training or change initial career choices. Rigidities in the post-1993 training environment point to the emergence of a number of serious problems, such as dissatisfaction and high anxiety levels among residents, licensing authorities being faced with people who have not completed a training program to certification, and insufficient provision of positions for post-MD training because of underestimates of the time needed to complete training programs. The insights gained from this study lead to the recognition that planning the specialty distribution of the physician workforce is highly complex and difficult.

Physician-workforce and educational planning in Canada: has the pendulum swung too far?

Since the early '80s, and especially since the publication in 1991 of Toward Integrated Medical Resource Policies for Canada (the Barer-Stoddart Report), received wisdom has been that there is an oversupply of physicians in Canada and that medical school enrollment should be cut. In a CMAJ article published July 1, 1994, that described a computer program to forecast the supply and demand of health care resources, Denton, Gafni and Spencer projected a substantial physician surplus in Ontario in the years 2000 and 2010, despite substantial cuts in Ontario medical school enrollment. The author questions the data used in the forecasts and reaches different conclusions. She advances an alternative hypothesis that current medical school admission levels are, in fact, too low.

ACMC: past, present and future.

In this article, the president of the Association of Canadian Medical Colleges (ACMC) and its director of research review the issues that have confronted ACMC since its inception: the founding of ACMC; development of the clinical teaching unit; creation of the Medical Research Council and expansion of the research mission; the Royal Commission on Health Services and the founding of new faculties of medicine; ACMC's in-house research program; accreditation and ACMC's links with medical education in the United States; and French-language medical education in Canada. The review points out the perennial nature of many of these issues, and how often perceived solutions to the problems later become problems themselves. It ends on the optimistic note that ACMC can successfully meet the challenges of the future.