About every decade, the province goes through a cycle of readdressing the number of physicians needed to be trained and they “never get it right,” said Schulich School of Medicine & Dentistry Dean Michael Strong.
Announced last month, the Ontario Ministry of Health and Long Term Care plans to cut 50 residency spots in the province, 25 in each of the next two years. Schulich alone will lose eight spots over two years.
Despite the fact Strong feels the province has been on the right track lately, as far as ensuring there are ample physicians for Ontarians, this latest move seems to be heading in the wrong direction. “So it takes 10 years before you can correct it again,” he said. “Now, we have an aging population, the Baby Boomers are going to hit, one in four are going to have a dementia of some sort. So, now is not the time.
“We can handle that,” Strong continued. “At the end of the day, the discussion we really need to have is, ‘Are there, across Canada, areas that are deficits that we really need to work carefully with?’ The answer would be ‘yes.’ In Ontario, we train a lot of Canadian specialists. Changes we make in Ontario are a Canadian change. That discussion needs to be in much greater depth.”
According to a spokesperson for the Ontario Health Minister, the number of first-year residency spaces has gone from 639 in 2003 to more than 1,200 today. As a result, 94 per cent of Ontarians currently have a family doctor.
“Overall, the number of physicians in Ontario will grow 13 per cent by 2021, which is almost triple the rate of Ontario’s population growth,” wrote a spokesperson for Eric Hoskins, Minister of Health and Long Term Care. “This year alone, Ontario will add 700 net new doctors – 250 of them in family medicine. After a decade of growth, it is prudent to review the residency spaces in this province to ensure we have the right mix and number.”
Last year, 55 graduating medical students couldn’t find residency spot, according to the Canada Residency Matching Service, despite Ontario having the fewest family doctors per capita in Canada at 103 per 100,000 people, tying them with Saskatchewan. The national average is 111 per 100,000; Nova Scotia is the highest at 133 per 100,000.
Currently, 800,000 Ontarians don’t have a family doctor. When you combine that with the fact the province is adding 140,000 new people each year, Mike Toth, Ontario Medical Association president, sees the residency cuts leading to fewer physicians trained in Ontario to meet current – and future – needs.
“In the early 1990s, medical school enrolment was cut. As a result, we began this century with a doctor shortage in Ontario where hundreds of thousands of people didn’t have a family doctor, and wait times to see a specialist or for surgery were far too long,” said Toth, calling the cuts “irresponsible” and “unacceptable.” “Ontarians can expect more of the same as a result of this action.
“We believe this move is based purely on fiscal considerations and not the health-care needs of Ontarians. Ontario’s doctors put patients first – it’s time the government did the same.”
It’s a complex issue, Strong said, especially with regards to everything from the selection of what specialty areas are deemed necessary, and selected, for residency spots by the province, to the non-availability of the operative resources required for other speciality areas in medicine.
“We have to be really careful. A lot of the areas, for instance orthopaedics, went unfilled in some areas,” he said. “We have a real need for orthopaedic surgeons, but we need more operative resources.”
The ministry, he said, is working with medical schools to determine what specialties will be hit with the cuts.
Chris Watling, Associate Dean of Postgraduate Medical Education at Schulich, appreciates the concerns of the students who have a significant stake in any changes that are made to residency training in Ontario. But he is confident Schulich can weather the storm.
“The reductions in residency training positions that have been mandated will have a modest impact at Western,” he said. “For the 2016 residency match, the ministry has required us to cut four Canadian Medical Graduate residency positions, and then in 2017 we have been required to cut an additional four International Medical Graduate positions. The loss of eight positions over the next two years represents less than 5 per cent of our total residency positions.”
Watling added Schulich would ensure these reductions not adversely impact the quality of the affected programs.
“Even after the planned cuts have been made, there will remain more available residency positions in Ontario and in Canada than there are graduating medical students in Canada,” he said. “At Western, we are committed to helping our graduates to prepare as well as possible for the match process in order that they have the best chance of matching to their desired specialty.”
Strong, along with other medical school deans, is in the midst of discussions with the province to ensure the residency spots cuts are taken from the proper areas
“Most of us are saying, ‘Let’s just step back for a moment, finish what we’re doing in trying to get this manpower correct and then let’s make the appropriate changes,’” Strong said. “I get it, we all get it, it’s tight, finances are tight, but it’s not the time to do this.”
Hoskins’s spokesperson said this decision is not based on achieving cost savings and has been arrived at through a “collaborative, evidence-based process,” which takes into account Ontario’s current and future needs.
“Even after this recalibration, we will still have more residency spaces than medical students graduating from Ontario schools each year. We have been working closely with our medical schools to determine where changes need to be made based on evidence and will be consulting with students and other stakeholders before any changes are implemented.”