Guest UWOMED2005 Posted September 20, 2003 Report Share Posted September 20, 2003 Part of the problem there as well is that some family physicians, for whatever reason, sometimes refer things they should deal with themselves. For example, I know of one case of a family doc in T.O. referring a patient to an ENT to remove impacted wax from their ear. It's not all family physicians, but many could be dealing with some "specialized" cases themselves. Theoretically, the whole system depends on family physicians. They (NOT emerg) are supposed to be the entry point into the health care system, and are supposed to be the generals coordinating all the soldiers (lab tests, specialty consults.) But if a patient doesn't have a family doctor, or that family physician doesn't have the time to take a step back, make sure all the labs/tests/consults have been noted and put together the pieces, then it's much more likely that those expensive MRIs, specialty consults, and tests will go to waste, lost in some Radiology library. I've seen it happen - someone had a test (path report) three years back that confirmed a Dx (celiac disease) but it was misplaced by the health care system. Their celiac went on for three more years uncontrolled and had numerous more tests and hospital visits, until a 3rd year clerk happened to find that result when he went through the entire patient's file. Link to comment Share on other sites More sharing options...
Guest notold Posted September 20, 2003 Report Share Posted September 20, 2003 Phil, i absolutely agree that "force" is not the answer. I would not consider it to be "force" if it was presented as a "condition". For example, they take in the regular number of students and add 10 spots per school for "conditional" acceptance. No one would 'force" you to practice rural/remote but if you were in agreement to doing so you would be granted a "special" spot. It would be a condition of acceptance that you practice x# of years in an underserviced or rural/remote location. I see nothing wrong with that whatsoever. Its as equally valid as volunteer/and other "desirable" background qualifications. notold Link to comment Share on other sites More sharing options...
Guest aneliz Posted September 20, 2003 Report Share Posted September 20, 2003 A potentially workable solution...but the logistics from the admissions angle would be ugly.... would those extra ten spots go to the first ten people on the wait list that said they would agree to the conditions? Or would you apply in a separate applicant pool (ie apply twice - once for regular seats and once for special seats)? Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted September 20, 2003 Report Share Posted September 20, 2003 A potentially workable solution...but the logistics from the admissions angle would be ugly....I'd go a step further and say "untenable". The real problem is that after you have accepted these students, how do you guarantee that they will follow through with their pledge to go rural? I've met many residents who have spouses who simply could not find work in their profession in a small town; try being a PhD researcher in Prince Rupert. Many other people become acclimatized to the large city environment where they've studied med school, or become reliant on the technology, tools, and ready pool of specialists that are so prevalent in the larger teaching centers. The final point perhaps is that with the huge disparity between med school applicant numbers and available seats, you are going to see students using this "rural route" as a gateway into med school. There's not much benefit expending resources in recruiting a rural doctor if he/she bails for Toronto the minute his/her contract is up. Ian Link to comment Share on other sites More sharing options...
Guest notold Posted September 21, 2003 Report Share Posted September 21, 2003 .. I'd go a step further and say "untenable". The real problem is that after you have accepted these students, how do you guarantee that they will follow through with their pledge to go rural? .......... Of course any contract is open to breach but I would suggest one where they are given a reduction in tuition upfront and assistance relocating. If they break the contract a large penalty is built in along with reimbursing the tuition. Or they could call it a "Rural/Remote Residency" and if the person ditched before their 3 years were up everyone else would also know it. Of course there are always legit/valid reasons why this might happen but if all this was known and conditional at the time of entry i think they might end up with a pool that "wanted" to do it. Not all are entirely averse to the idea. Part of the selection process would be those candidates who would be most likely to fullfil their obligation. i.e already living rural, mature and no dependents, foreign trained, and certain other qualities. For example I would think a young person who was born/raised in toronto and never set foot on a farm or travelled anywhere would be a less likely candidate than someone who lived rurally, raised poultry, travelled to third world countries etc. I would use the same application process but have a special section: "Are you applying for the Rural/Remote program." yes please go to Section D They would be assessed by the same general criteria with their "special" qualities given added weight for special acceptance. This way they take no seats from the general pool tho I'm not so sure that might not change. I think they would see quite a few applicants in this area. notold Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted September 21, 2003 Report Share Posted September 21, 2003 Excellent points raised by everyone, and I guess this proves why there is no easy solution! One thing is for sure though, that the Ministry of Health and Ministry of Education better put their heads together so we don't have MD grads unable to enter a residency position because of lack of space! That whole concept is so absurd it is beyond words. Link to comment Share on other sites More sharing options...
Guest macdaddyeh Posted October 3, 2003 Report Share Posted October 3, 2003 I thought I would revisit this topic after the Liberal landslide yesterday in Ontario. As McGuinty promises more seats for medical schools I began myself to ponder this dilemma. I realized that even though he may promise to provide funds for the increased seats (which will likely only cover tuition etc) that does not account for extra resources and space/infrastructure. In other words, the schools may be willing to take the money, but can't increase their seats because of space and faculty limitations etc. And on top of that, say schools do increase their enrollment, as has been mentioned before there is no concomitant increase in residency spots. Any further thoughts? Link to comment Share on other sites More sharing options...
Guest aneliz Posted October 3, 2003 Report Share Posted October 3, 2003 Interesting side note on that subject: Current UWO class size = 133 seats Largest lecture hall in Med sci building = 145 seats (after they renovated to pack more seats into the room!) Promised Liberal increase in med school seats = 15% 15% of 133 = ~20 additional seats current class size + 15% = > largest lecture hall seating capacity.... Link to comment Share on other sites More sharing options...
Guest bruhaha Posted October 3, 2003 Report Share Posted October 3, 2003 Won't med school seats shoot up by more then 15% with the addition of NOMS next year? Maybe he meant on top of NOMS, but it seems rather disingenuous to be making promises that keep themselves. Link to comment Share on other sites More sharing options...
Guest aneliz Posted October 3, 2003 Report Share Posted October 3, 2003 NOMS is supposed to have 40 spots... There are currently ~700 seats in the five Ontario schools...so to live up to promises, the liberals are going to have to find space in for an additional 60ish spots in the existing schools in addition to opening NOMS to increase seats by 15%.... Apart from the physical space issues, there are also instructor availability and resource issues too... Anatomy dissection groups have increased from 6 to 8 or 9 people... Clinical methods groups have increased from 4 to 6 people... "Small" group learning is often 1/4 of the class or ~35 people due to the relative lack of instructors... Lines for computer access and printing can be very long.... People are going to Stratford and St Thomas for clinical teaching sessions because there aren't enough instructors in London... 24 people from my class HAVE to go to Windsor for clerkship because there is already not enough space for everyone in the London hospitals.... Link to comment Share on other sites More sharing options...
Guest everyoneloveschem Posted October 5, 2003 Report Share Posted October 5, 2003 Here's an even crazier, harder to work idea: The gov't makes scholarships for certain uber-excellent students to get their residencies in the U.S., then brings em back to Canada to work (like how they have a couple foreign country NSERCs). The Americans use us (steal some of our best grads), why not use them back? Link to comment Share on other sites More sharing options...
Guest aneliz Posted October 5, 2003 Report Share Posted October 5, 2003 A good idea...but an expensive one! Med school tuition in the states is MUCH higher than it is here (usually at least the equivalent dollar numbers but in USD instead of CAD). And, once people went to the states to go to school, and made contacts in the states, got married, etc, how exactly do we guarantee they are coming back? It would be much cheaper/cost effective to use the money that would be spent sponsoring students to study in the states to pay docs to teach here (would greatly increase the number of instructors!) and put the resources into Canadian programs. Link to comment Share on other sites More sharing options...
Guest strider2004 Posted October 5, 2003 Report Share Posted October 5, 2003 And, once people went to the states to go to school, and made contacts in the states, got married, etc, how exactly do we guarantee they are coming back? This part is easy. If you are a foreign student doing residency in the states, they usually give you a J visa with requires you to return to your home country after training. This is similar to a student visa. That way, the newly graduated residents are forced out of the states and back into Canada. As for the idea of having a special "rural applicant" section on the OMSAS, I think it would severly limit students' choices. They should be going into rural medicine because they are making an informed decision, not because they were streamed into it before they knew what options they had. It has to be done at the medical school and clerkship education part of med school, where rural docs have the ability to directly impress upon students what the life is really like. Another option is the rotating internship that was taken away about 10 years ago. It allowed docs to work right after 1 year of internship. It allowed new graduates to explore their options a bit more and decide later what the wanted to do. The current situtation forces med students to decide early on what they want to do and more often than not, they take the 'safe' bet. It's a lot easier to pick a competitive specialty and transfer to family med if your choose than the other way around. When the rotating internship year was taken away, the percentage of applicants choosing family med took a nosedive. Link to comment Share on other sites More sharing options...
Guest notold Posted October 9, 2003 Report Share Posted October 9, 2003 As for the idea of having a special "rural applicant" section on the OMSAS, I think it would severly limit students' choices. They should be going into rural medicine because they are making an informed decision, not because they were streamed into it before they knew what options they had. It has to be done at the medical school and clerkship education part of med school, where rural docs have the ability to directly impress upon students what the life is really like. ............................. From my perspective this more or less demonstrates my point that there are a number who already have a good idea what it would be like because they live rurally/ northern and have had exposure to that way of life...like myself..I KNOW that is what I want to do. I know I also like pathology and family medicine. Not everyone is the typical med school applicant:p There are a number who have had enough life experience to make these decisions "ahead of time". A young med student has years to "go rural" at any point in their career with any (other)speciality they choose. For those who already know they welcome the rural opportunity, I would think it a wise way to go from an admissions perspective. Why not let all us old donkeys take the North?!:smokin notold Link to comment Share on other sites More sharing options...
Guest macdaddyeh Posted October 9, 2003 Report Share Posted October 9, 2003 Notold: I hear what you are saying, and I too am a die-hard northerner, but let me play the devil's advocate by presenting one futher simple dilemma. Say there is a northern stream box on the application, What if you want to change your mind during med school or residency? Or what if you do all the training and THEN change your mind? There are serious ethical and legal (not just financial) implications to *not* being able to change one's mind. There are just too many problems with the northern-only option, one primarily being that people could lie just to get in. But as I just noted, the government or school etc. is not in a position to *force* you to practice there, *unless* you sign some specific clause that says you are willing to practice in X northern community and they will pay for it, or some such scenario...in which case I can see why you really want that option made available to you. I think the current underserviced area program (as illogical or ill-funded as it is) is at least a step in the right direction. You pay for school up front, then they forgive a significant (but not all) portion of your loans in exchange for x years of service. They pay in installments I believe to prevent people from going up north, doing a quick cash-grab and running back south! I believe in free or subsidized education but there has to be a trade-off with responsibility and accountability (specifically with reference to demonstrating a legitimate interest in serving in the north). On an interesting side-note an old pal of mine is a Danish doctor who lives in Copenhagen. He only recently graduated and the government PAYED HIM to go to school; in fact they even gave him a housing allowance! (with no limitation on where to practice). Now there is a lesson we can learn from other northern countries! Education is an investment in the future; particularly for health care professionals! Further interesting dilemma which no one adressed is...nobody has defined what "north" means!!!! For example people in Iqaluit would likely laugh at someone who said "Thunder Bay" was north, who would likely laugh at someone who said Sault Ste. Marie was north who would likely laugh at someone who said Barrie was north. Do you get my point? That's also my bone with the upcoming Northern Ontario Med School; they consider people from Sudbury notherners! What a joke! Sudbury is ~4 hour drive from Toronto. by the same logic, why is Ottawa not North? Just food for thought, Notold. Best wishes on your application! Link to comment Share on other sites More sharing options...
Guest notold Posted October 11, 2003 Report Share Posted October 11, 2003 okay Macdaddeyah, I'll play along with you. This is a stretch for a comparison..but what happens when you join the military? Do you for sure know you will love it? Not in all cases I'm sure, but there is a commitment and you pretty much have a good idea of what is expected and what the rules are. Yes you can quit either after you serve your time or sooner with a "penalty". The rules are up front although I'm sure many are surprised by the reality:lol As for moral and ethical question/implications..what has happened to commitment and personal accountability? If someone commits to something then that is a commitment..is it not? Who then is behaving unethically? That all said I do not agree with "force" and also would not see it as force....just as you can leave the military before you put in your compulsory time you could also leave the Northern program, but with a "penalty" unless an exceptional reason was given. There could be a process(long and arduous) for those who wanted to change streams -midstream...like you have to reapply to be accepted in the regular stream. Perhaps that would be a deterent. I'm sure no process would be or could be perfect, just as in medicine in general there are those who enter for status and income reasons. I think that would weed out those who "lied" just to get in and for them I'd say "too bad for you" :hat for a taking a spot from someone who really wanted it...they "should" be penalized IMHO. I'm not sure why their seems to be this undercurrent that med students/doctors should only do what they want to do when it comes to this, yet there are all kinds of other pre reqs and requirements that no one complains about because they are the rules. As far as defining the North ( in Ontario) if you go to NOMP (http://www.nomp.on.ca) and some other sites they have fairly distinct definitions for undeserviced/northern and rural. From what i can gather although Laurentian is one of the hosting universities for NOMS, Sudbury is not considered north in NOMP definitions. This is likely a strategic move, encouraging people to the "mid' north while having T.O close. Like a stepping stone to the real North and it certaily falls within their rural and underserviced areas. I agree the current program is a step in the right direction, and there other recruitment incentives as well. It seems to be clear that even financial incentive is not high enough. Perhaps a whole other animal is required for northern/rural medicine? Indeed I think you are not looking at your "typical" med student.:smokin notold Link to comment Share on other sites More sharing options...
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