Few Canadians would have been paying attention to medical news of late, but they should have. March 1 was Match Day for Canadian medical students. That's the day thousands of Canada's future doctors find out where - and in some cases, if - they will train for their eventual careers, and in what specialty if they considered more than one. The Match is the single biggest source of emotional upheaval for a med student, and for many the pressure begins not long after learning where the closest bathrooms are. Angst, elation, rage, exuberance, despair, plus every gastrointestinal symptom under the sun...The Match brings on any and all of it.
For the overwhelming majority of med students, the Match works out just fine. They end up in the cities they want if not the program, or vice versa. About one in six will end up changing residency programs for one reason or another in a given year. As long the resident isn't reaching for an exceedingly competitive field - Ophthalmology, Plastics, etc. - they'll generally be accommodated.
This year, over 220 students failed to match to a program, or roughly 10% of this year's graduating class. Most will apply to the second round of the Match, where they'll compete with previously unmatched grads and international trainees for the spots that didn't fill in the first round. Some will not match, even after the second round, and what happens to these students from there is unpredictable. The worst imaginable outcome - a would-be doctor's death by suicide - is not at all unheard of.
It's too early to draw hard conclusions, because the selesai data won't be released until the spring. We do know that the majority of unfilled spots were in Family Medicine, with the remainder in programs that typically struggle to recruit: mostly Psychiatry and the lab disciplines, but there were a good number of unfilled Internal Medicine slots as well. We also know that residency spots have been cut, or are slated to be cut, with the ratio of residencies to graduates dropping lower than the sasaran of 1.2 to 1. That means less slack in the system for young doctors whose career goals or life circumstances change.
Many are expressing disgust and dismay, with good reason. Should we not guarantee every Canadian graduate a residency spot? Are we not facing a crisis of access to family doctors almost everywhere? And long waits for specialists? And idle surgeons without operating room time? How dare Canada invest a half-million dollars educating a medical student - who's near bankruptcy from student loans, by the way - and be willing to let them go untrained and jobless? Who benefits from this happening (except perhaps the banks vacuuming up interest payments)?
But enacting some sort of residency spot guarantee isn't a surefire fix, nor is shaking up the mechanics of the Match process. These surface solutions don't address the festering, intractable system problems that loom much larger.
Family Medicine remains unpopular, during and after training. Barring some freak change, 2018 will prove once again that the majority of med students don't want to train as family doctors, as has been the case for 20+ years. Comprehensive primary care - "classic" family practice - is even less popular than the residency, with many new grads focusing or restricting their practices out of the gate. Whatever the cause, and there are many, this remains our medical education system's proverbial elephant in the room.
Doctors' working conditions have deteriorated, and government responses have ranged from counterproductive to toxic. Fee cuts and legislated minimum wage increases are the most visible problems for doctors running a private office, but the work is increasing in complexity and bureaucratic demands have exploded for everybody. Increased service requirements are being foisted on doctors by governments, yet the doctors are expected to remain self-employed and cover their own expenses. And when things don't work out as planned? Governments invent ever more obnoxious micro-management schemes for community doctors, schemes that are really just end-runs around the logical (but prohibitively expensive) solution: expand government-funded clinics and put doctors on salary.
Doctors are fighting among themselves more than ever. There's nothing more comical than an op-ed blaming the medical profession for problems in health care, because the underlying assertion is that doctors speak with a monolithic voice. Nothing could be further from the truth. Medical associations these days resemble primitive tribal coalitions of single-specialty groups that hardly stomach one another, even in response to unilateral government action. Comprehensive family doctors dump on their colleagues with focused practices. Social media squabbles blow up into College complaints. The same Manichean left/right dichotomy that's poisoned political discourse now has done the same in the medical community.
In all of this, the public - as both taxpayer and patient - remains absent from the conversation. How does the public feel about limits on a doctors' practice autonomy, outside of College obligations (such as anti-discrimination rules)? Is the public entitled to a greater voice in the mix of doctors that are trained? What about doctors' geographic distribution? What about the expansion of the public service and growth of the bureaucracy without accountability?
Whether we call it the Gordian Knot or a Mexican Stalemate, clearly the medical pelatihan setup in Canada is broken, and in danger of doing harm to everybody involved. Yes, we must absolutely refuse to accept another Robert Chu. But we can't just guarantee a residency spot for every Canadian medical student and call it a day. It's past time to engage in a long, sincere conversation about the roles and expectations we place upon doctors, who calls the shots, who pays, and how much. Putting it off is only going to make matters worse.
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Saturday, March 3, 2018
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Canada,
doctors,
Family Medicine,
fee-for-service,
finance,
leadership,
medical education,
primary care
Belum ada tanggapan untuk "The Gordian Knot"
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