I suspect I was as bewildered as anyone when I read an article from the Toronto Star this weekend outlining that the Ministry of Health and Long-term Care in Ontario intended to cut the number of residency positions in Ontario. http://www.thestar.com/life/health_wellness/2015/08/08/ministry-of-health-plans-to-cut-50-residency-places-angering-doctors-in-training.html Both Ali Damji, the Chair of the Ontario Medical Students Association, and Dr. Michael Toth, the President of the Ontario Medical Association (OMA), commented on the negative impact of the cuts. A Ministry spokesperson (not the Minister) outlined that the reductions are “intended to manage the risk of an oversupply of physicians in the future”.
No rationale has been provided for why 50 is the correct number of positions to cut. There is no indication as to whether research supports this measure, but I suspect that there is no reason based in health human resources data to substantiate it. In fact, if you think about it, if you want to control the supply of physicians, it might make more sense to cut medical student places first and then rationalize postgraduate training.
As to what evidence does exist that might support such a decision, the Ministry actually did participate in developing a forecasting model that was completed in late 2010, the Ontario Population Needs-Based Physician Simulation Model. https://www.healthforceontario.ca/UserFiles/file/PolicymakersResearchers/needs-based-model-report-oct-2010-en.pdf
This report was a joint effort of the OMA and the Ministry of Health and Long-term Care. Even a glance through the model is enough to demonstrate that, while some specialties may have adequate practitioners, there are shortages in other specialties that will not be addressed anytime in the next ten, even 15 years in the case of psychiatry. With this data available in a document developed in collaboration with the OMA, I wondered why the first consideration wasn’t to redistribute the residency spots instead of cutting them.
Examining the concern outlined by the Ministry’s spokesperson, that the government wants to “manage the risk of an oversupply of physicians”, consider the recent increase in the number of family physicians in the last ten years. Despite the increases, and even considering that family doctors are working in more efficient team-based models, there are still almost one million people in Ontario without a family physician. Redirecting a dozen more residency places to family medicine might help to address this shortage.
Finally, if one is not convinced by the facts, consider the human dimension. Most of Ontario’s medical students are from here. They were born here, raised here and would likely want to remain close to home. Not being able to find a training position close to home can have a significant impact on your life. There is very good data suggesting that doctors tend to practice where they train. Do we really not want these bright young people working here in Ontario?
All of these factors do tend to drive the best students away from a medical career, another outcome that ought to be considered before making such a decision. Ontario needs a permanent mechanism to consider physician human resources in the years to come. This was one of the recommendations of the Report of the Expert Panel on Health Professional Human Resources in 2000, another report still relevant and available to the government. This is a link to the report: http://www.health.gov.on.ca/en/common/ministry/publications/reports/workforce/workforce.aspx This is a link to my observations concerning the report: http://drgailbeck.com/2013/01/03/267/
Like most physicians, I am drawn to evidence-based decision making. It’s how most doctors aspire to practice. The best government decisions, like the best medical decisions, are based on evidence interpreted in collaboration with partners. The reports about how this decision were made do not say anything about the evidence used to make it. I guess we’ll see how that works out.