Dear Editor:
I believe that I have some insights regarding the issue of the Practice Ready Ontario, foreign-trained doctors, the shortage of family physicians, NOSM, and Canadian medical schools. I should point out that I'm one of the extremely fortunate people in the area and I have a phenomenal family physician, Dr. Brian Shaw (the last of a generation of doctors).
I grew up in a medical family (in which we received fairly crappy medical care unless we were extremely ill - my dad would say "I deal with sick people all day long, go see a doctor."). My grandfather, Dr. K. Y. Sinclair was a general surgeon who would remove an appendix on a dining room table. He, eventually, settled in North Bay where he acted as a general surgeon and general practitioner. My father, Dr. R. A. Sinclair, took over my grandfather's practice when he retired (that retirement lasted 2 days - he became the admissions physician at the Ontario Hospital and worked there until he died).
My father, as a general practitioner, could do pretty much anything. Minor surgeries were routine in his office. He performed anesthesia at the hospitals. He'd be at the hospitals by 6:00 am to do rounds, come home to have breakfast with the family, go to his office to see patients, come home for lunch with the family, go back to his office, come home for dinner with the family at about 7:00 pm, go to the hospitals and do rounds again, come home and go to sleep. He, effectively, worked from 6:00 am to 10:00 pm or 11:00 pm or 12:00 am..... and would be called to the hospitals throughout the night. I wouldn't want that job.
I've watched the practice of medicine change. Doctors still have stressful jobs but, fortunately, they've learned to strike a much better work-life balance. Sadly, though, the general practitioner doesn't exist anymore. Bringing them back might be worthwhile and help ease some of the stress on the system.
I spent several months in the Philippines. I was impressed with the skills of the doctors in Manila. We might consider recruiting family practitioners from the Philippines and several other countries around the world that are producing good doctors (I expect that this is being done). We must be accrediting them exponentially faster than we are now. Much of this could be done online in order to streamline the process. Effectively, they should be able to be accredited as soon as they walk off the plane. This is also a very effective recruiting tool: It's pretty attractive when you know that you can work immediately.
Medical school in Canada is quite expensive. New doctors have accumulated much debt. However, medical schools in Canada are heavily subsidized: The same degree in the U.S. would cost about 4 times as much. Because of this, I believe that Canadian graduates should be contractually obligated to practice in Canada for an amount of time equal to the money they would have paid if they were educated in the U.S. minus what they paid in Canada (before, for example, moving to the U.S. where they would make much more money).
The same approach should be used for NOSM graduates except that they must practice in Northern Ontario. I doubt that I'm the first person to suggest this (I've been out of the loop for several months). My excellent cardiologist in the Philippines, Dr. M. Alegre, won't like that suggestion: She wouldn't ever be able to leave the county.
Just a bit of history. My opinions. My suggestions.
Best wishes,
Bob Sinclair
North Bay
