July/August 2009While I agree with Dr Murray’s basic assertion that BC could be graduating more MDs (“BC needs another medical school,” BCMJ 2009;51[4]:150), I would first suggest a recheck of the statistics. UBC will graduate approximately 256 medical students in 2010. With a population of roughly 4 400 000, that makes for a ratio of 5.8 MDs per 100 000 (not 2.8 MDs). Furthermore, Dr Murray speaks in broad strokes about Fraser Health having the courage to move ahead with a second “innovative” program. Is he talking about some odd notion to “fast track” a medical school de novo at SFU?
I would put it to you that patching together something resembling a medical school with no reference back to existing resources (i.e., UBC) makes little sense from a time or resource point of view. Our peak need for physicians will hit between 2010 and 2030 as the baby boom makes a transition from age 65 to 85. After that, the load on the health care system decreases. UBC is currently on track to local and distant expansion across the province. It is accredited and offers programs both through a traditional model and an apprenticeship-type model at sites in the Lower Mainland, Vancouver Island, Prince George, Chilliwack, and, coming very soon, Terrace, Kelowna, Kamloops, and Fort St. John.
You would have to build a massive infrastructure, both in terms of physical buildings and people, become accredited, get students through the system, and then have them qualified and licensed. The most optimistic forecast would have your first MDs operational in 10 years. That would give your medical school 10 more years of useful lifespan until the population bust removes the demand. It seems like a great waste of resources and money when UBC is able to quickly expand and contract its medical school offering with an infrastructure already built in. Don’t waste time and money re-inventing the wheel when you already live next to the world’s best wheel factory.
—Ari Giligson, MD
Delta
Competing interests
Dr Giligson earns a stipend as undergraduate program director for the Department of Ophthalmology at UBC.
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The popular cry these days from politicians and some bureaucrats is that there is a need for more doctors. As a retired MD who practised and taught in BC from 1954 until retirement in 1988, I am concerned about the under-utilization of our existing hospitals. They generally operate from 8 a.m. to 4 p.m., Monday through Friday, handling emergencies whenever they occur. Even with our newer and more efficient technologies the waiting lists continue.
In most industries, when needs increase, plants operate longer, producing more results at reduced per-unit costs—as well as providing more employment in a particular field.
Surely this approach could apply to our hospitals. Why not operate from 8 a.m. to midnight, two shifts per day, Monday through Saturday? More patients could be treated and more laboratory and investigative procedures (e.g., CAT scans) could be carried out. This would benefit patients and their attending physicians.
All too often we hear stories of newly trained MDs having to leave BC (and Canada) to practise their specialties because of time restrictions in our current hospital management. This has become more apparent recently with ill-timed and inappropriate hospital closures throughout BC.
The change I propose would require creation of a new payment formula for hospitals that rewards them for work done (the more the better) as compared to the archaic and old system of block payments per bed. So, while a new medical school might sound like a solution to our ever-changing needs, perhaps in the interim we could better utilize our facilities to enjoy the full potential of our present graduates.
—Al Boggie, MD
Delta