U of T rejects 2400+ people every year...

[lostintime]

The thing is: we have been proposing solutions, but none seem to work. It seems that the only way to get physicians in rural areas would be using force (not physical force). (no, I don't suggest some people should be stuck there, but it seems to be the only solution)

But the question will be: who will have to pay the price?

It seems the IMGs will be the best candidates, they are treated like second-class grad, they didn't study medicine in Canada so Canada has no obligation to them, and it's the most politically feasable because no one cares about them, and they are even despised.

 

Actually people do care about them. As an individual of course people care, they are very nice people and of course nice people have wishes of where they want to work and their own personal factors. However, at a system level, I agree that there is a bit of that and not everyone's personal wishes can be satisfied.

 

And on the system level, there are powerful physicians who care because their offsprings are IMG's and they want them back and have successfully pulled strings to get them back in the past. Who do you think a program will take all other things being equal ~ an IMG with no connections versus an IMG whose dad is chief of staff and best friends with the PD? Hmm.....

[Robin Hood]

Is it a kind of canadian pre-med arrogance that speaks out there?

 

Am I right, Robin Hood?

 

I'm not suggesting you should be stuck there, but with the rural shortage, may that's what the government will do.

Also, I have nothing to be arrogant since I'm being unlucky and life is not fair for me, and no one can guaranty I'll ever get it.

[dokrbb]

I'm not suggesting you should be stuck there, but with the rural shortage, may that's what the government will do.

Also, I have nothing to be arrogant since I'm being unlucky and life is not fair for me, and no one can guaranty I'll ever get it.

 

Well, you know, you are suggesting a lot of very interesting things, by the way:

- that the IMGs are treated as second-class grads, therefore they deserve nothing more than a rural area of practicing;

- Canada doesn't have any responsibilities toward IMGs, since they graduated elsewhere;

- and finaly, the most logic conclusion, since nobody cares about IMGs, this would be the most politically feasable solution,

 

Excuse me, but I find your comment completely incoherent, and your statements subjective and not sufficiently documented,

 

sorry, nothing personal...

[lostintime]

Lol this is where I think understanding of context and tone in written comments is kind of helpful....

[Robin Hood]

Well, you know, you are suggesting a lot of very interesting things, by the way:

- that the IMGs are treated as second-class grads, therefore they deserve nothing more than a rural area of practicing;

- Canada doesn't have any responsibilities toward IMGs, since they graduated elsewhere;

- and finaly, the most logic conclusion, since nobody cares about IMGs, this would be the most politically feasable solution,

 

Excuse me, but I find your comment completely incoherent, and your statements subjective and not sufficiently documented,

 

sorry, nothing personal...

 

Canada has obligations toward CMGs because the provinces spend a lot of money on them, so they expect this money to not be spent for nothing. Also, immigrant IMGs have access to residency spots in their countries, while here, it's very competitive, we don't have enough spost for everybody. Also, when I say you are perceived as second class, it's not because I think this, I'm just saying how Canada sees you (and you can see the despise you get from this forum, average people don't think differently). About sending IMGs to remote areas, it will be the most politically feasable because for the average Joe, the immigrant IMGs are immigrants taking jobs from Canadians, but that's not my perception.

[moo]

You cannot legislate where physicians will work. Back in the early 90s, the BC govt tried this by restricting the granting of licenses to new grads unless they worked in an undeserved area. BCMA sued and won

[dokrbb]

Lol this is where I think understanding of context and tone in written comments is kind of helpful....

 

may be you don't catch up with the thread, I quoted one post, still was reffering to the previous one...

 

hope this would be kind of helpful

[dokrbb]

Canada has obligations toward CMGs because the provinces spend a lot of money on them, so they expect this money to not be spent for nothing. Also, immigrant IMGs have access to residency spots in their countries, while here, it's very competitive, we don't have enough spost for everybody. Also, when I say you are perceived as second class, it's not because I think this, I'm just saying how Canada sees you (and you can see the despise you get from this forum, average people don't think differently). About sending IMGs to remote areas, it will be the most politically feasable because for the average Joe, the immigrant IMGs are immigrants taking jobs from Canadians, but that's not my perception.

 

I didn't say these are your perceptions, I said your statements are not sufficiently documented (which in not the same thing).

 

I will tell you a secret - the residency spots abroad are competitive too;

 

...and you are right, the attitude toward me and my comments is a kind of "special" on this forum, but I find that interesting, because in the real life all are politically correct and here is practically the only place where the canadians are "real", and it's OK. An educated society doesn't have to be honest and sincer, it has to be politically correct.

 

Peace,

[aaronjw]

You cannot legislate where physicians will work. Back in the early 90s, the BC govt tried this by restricting the granting of licenses to new grads unless they worked in an undeserved area. BCMA sued and won

 

I really don't understand why. Canada heavily subsidizes medical education and training. Why should gov't not be allowed to dictate where people work on some level?

 

If the military can do it...

[A-Stark]

I really don't understand why. Canada heavily subsidizes medical education and training. Why should gov't not be allowed to dictate where people work on some level?

 

If the military can do it...

 

Because medicine is not the ****ing military and we still pay thousands upon thousands for our education. Exactly how much more debt need I take on for the "privilege" of being able to live and work where I choose?

[aaronjw]

Because medicine is not the ****ing military and we still pay thousands upon thousands for our education. Exactly how much more debt need I take on for the "privilege" of being able to live and work where I choose?

 

That's not a valid argument. I'm not saying I'm in favour of what I suggested but I'd like to hear a valid argument as to why gov't shouldn't have some enforcement capabilities of where physicians practice (for a set period of time after graduation) given it's the taxpayer who helps fund their training.

 

There are no guarantees that prevent them from going abroad after receiving their training education and training in Canada thus preventing Canadians from reaping the benefit of subsidization.

[Kasiunut]

I really don't understand why. Canada heavily subsidizes medical education and training. Why should gov't not be allowed to dictate where people work on some level?

 

If the military can do it...

 

However using that argument, ALL university graduates could be told where to work as ALL university spots are subsidized by the government. Why should medicine be the exception?

[future_doc]

Why should gov't not be allowed to dictate where people work on some level?

 

If the military can do it...

 

We do not live in North Korea,nor in China where the government can wipe out villages and move a million people at a shot.

 

We live in Canada where there are no dictators in government, even if some act as if they are dictators, lol.

[aaronjw]

However using that argument, ALL university graduates could be told where to work as ALL university spots are subsidized by the government. Why should medicine be the exception?

 

Fair point and true. One could argue the difference being people will move to where there are jobs which isn't necessarily the case with physicians otherwise we wouldn't need to incentivize or use ROS methods to try and get physicians to practice in rural and under served areas.

[aaronjw]

We do not live in North Korea,nor in China where the government can wipe out villages and move a million people at a shot.

 

We live in Canada where there are no dictators in government, even if some act as if they are dictators, lol.

 

It's not about being dictatorial. It's about ensuring ALL Canadians have adequate access to health care regardless of location which is one of the 5 principals of the CHA. So if physicians won't go to where there is a NEED without a carrot (then leave once the carrot supply has diminished) then maybe It's time for some sticks to be involved?

[Kasiunut]

Fair point and true. One could argue the difference being people will move to where there are jobs which isn't necessarily the case with physicians otherwise we wouldn't need to incentivize or use ROS methods to try and get physicians to practice in rural and under served areas.

 

In Australia what they did is they established 3 different tuition schemes for med students:

 

1) commonwealth supported (ie subsidized like Canada) - student pay approx $10k per year. Can work anywhere after.

2) bonded spots where you pay less but have ROS requirement, not sure where

3) rural bonded where I think the student actually earns money to attend med school but then have to work off the "bond" by being sent to a specific rural location.

 

The number if each tier is established so say there are 50, 10 and 8 respectively. You choose when you apply if you want a bonded, rural bonded or commonwealth supported position.

 

That might work here for those who don't want to accumulate any debt and know in advance that they WILL be working in a rural location when they finish.

[moo]

That's not a valid argument. I'm not saying I'm in favour of what I suggested but I'd like to hear a valid argument as to why gov't shouldn't have some enforcement capabilities of where physicians practice (for a set period of time after graduation) given it's the taxpayer who helps fund their training.

 

There are no guarantees that prevent them from going abroad after receiving their training education and training in Canada thus preventing Canadians from reaping the benefit of subsidization.

 

I'm not a lawyer, but the Charter pretty much prevents that

[lostintime]

It's not really "forcing". This is not conscription, where people HAVE to go. The system is Australia is exactly what I am thinking of. I wonder how it works and if they have less issues with finding doctors in rural areas. If they don't want to apply to a bonded position and can't make the cut to another "Free to practice" position, then guess what, too bad tough luck.

[apache]

well, wouldn't the canadian students owe us, since we subsidized their education, while the Caribbean students payed it all on their own. what's so great about canada anyways, do you know how much cash you can make opening up a clinic of canadian trained docs near a resort in mexico… the taxes are lighter too, and i hear the weather is good.

 

The thing is: we have been proposing solutions, but none seem to work. It seems that the only way to get physicians in rural areas would be using force (not physical force). (no, I don't suggest some people should be stuck there, but it seems to be the only solution)

But the question will be: who will have to pay the price?

It seems the IMGs will be the best candidates, they are treated like second-class grad, they didn't study medicine in Canada so Canada has no obligation to them, and it's the most politically feasable because no one cares about them, and they are even despised.

[Kasiunut]

It's not really "forcing". This is not conscription, where people HAVE to go. The system is Australia is exactly what I am thinking of. I wonder how it works and if they have less issues with finding doctors in rural areas. If they don't want to apply to a bonded position and can't make the cut to another "Free to practice" position, then guess what, too bad tough luck.

 

To be honest I don't really know because I haven't really researched it. I just came across it when I was checking out the tuition at Aussie med schools(as I'm considering Australia as a back up) and came across these different tuition grades. I do now they are also complaining of a doctor shortage ( but don't know the details).

[apache]

meh, i'll just do medical ed in the states… pay 40 g a year… the last thing i'm ever doing is putting myself on some sort of leash for the country.

 

That's not a valid argument. I'm not saying I'm in favour of what I suggested but I'd like to hear a valid argument as to why gov't shouldn't have some enforcement capabilities of where physicians practice (for a set period of time after graduation) given it's the taxpayer who helps fund their training.

 

There are no guarantees that prevent them from going abroad after receiving their training education and training in Canada thus preventing Canadians from reaping the benefit of subsidization.

[Kasiunut]

Fair point and true. One could argue the difference being people will move to where there are jobs which isn't necessarily the case with physicians otherwise we wouldn't need to incentivize or use ROS methods to try and get physicians to practice in rural and under served areas.

 

Should we also require the same of nurses, teachers etc?

[Wayward son]

Rural physicians often work longer hours than non-rural physicians amd without sufficient backup which increases stress and pressure on them to provide for their patients jn an ever increasing manner especially since rural populations tend to have less healthy people than urban populations.

 

I think your second point is a major reason and one that is not often mentioned. Rural physicians often work without backup, and the more isolated the longer it will likely be until you get help. Many times we are talking about a FP (with no additional 1 yr ER) working their scheduled shift in the small ER dealing with a patient who has multiple very severe accute problems. In this sleepy little ER, the FP doesn't have a lot of experience with this kind of patient and neither does the nursing staff. The air ambulance could be an hour, or two, or six...better hope the weather does not deteriorate as that is exactly what the patient is doing. You are doing your best, but you know there has got to be some things you are forgetting. Are you being aggressive enough with the drugs? Too aggressive? Should you intubate now? You certainly would have long ago if you were at a larger center...but you have no vent, no RT, no second person who can intubate if you fail, and when was the last time you intubated someone?....and so on. Completely terrifying situation...and it is all on you. Then you think what if next time it is worse? An infant? Multiple patients from an MVC?

[A-Stark]

That's not a valid argument. I'm not saying I'm in favour of what I suggested but I'd like to hear a valid argument as to why gov't shouldn't have some enforcement capabilities of where physicians practice (for a set period of time after graduation) given it's the taxpayer who helps fund their training.

 

It is a perfectly valid argument because governments have no authority to impose implicit contracts on individuals by claiming they received "subsidies". More crucially, Section 6, Subsection (2) of the Constitution Act, 1982 states:

 

Every citizen of Canada and every person who has the status of a permanent resident of Canada has the right

 

(a) to move to and take up residence in any province; and

( to pursue the gaining of livelihood in any province.

 

If governments want new physicians to provide a Return-of-Service to a particular area they must obtain consent via explicit contract. There is no legal - nor moral - argument that justifies such draconian work requirements for any civilian occupation.

 

There are no guarantees that prevent them from going abroad after receiving their training education and training in Canada thus preventing Canadians from reaping the benefit of subsidization.

 

Well, you know what? That's the way a free society works. We can align appropriate incentives but we are ultimately free to make the choices we prefer. Canadian physicians do receive subsidized education, but I will assert without question that my six-figure debt gives me ample moral authority to live anywhere I please, grasping governments and venal "taxpaying" citizenry notwithstanding.

[aaronjw]

It's not really "forcing". This is not conscription, where people HAVE to go. The system is Australia is exactly what I am thinking of. I wonder how it works and if they have less issues with finding doctors in rural areas. If they don't want to apply to a bonded position and can't make the cut to another "Free to practice" position, then guess what, too bad tough luck.

 

Exactly, what I'm thinking isn't necessarily force but voluntary enforcement.

 

Med schools redirect a certain % of seats for people to practice in rural areas and because of this they are required to work in a rural or under serviced area for an extended period of time and should thry wish to cancel out of their this agreement then they are required to pay back the full cost of their medical duration and training.