As Canadian medical colleges continue turning away applicants in the thousands, and a growing number of Caribbean Medical Schools open their doors to international students, inefficiencies of supply-and-demand in the medical provider marketplace continue to spark public debate. Both Canada and the United States project severe physician shortages in just a few years. Yet in these developed nations, thousands of well-trained medical students cannot obtain career advancement. Five trends bear watching:
1. The Law Controls
In the Canadian legal system, laws and not academic standards ultimately control the right to practice medicine. If the public voted to admit high school graduates with one year of training as licensed physicians, for instance, Canadian medical societies could do little about the situation except protest. Today, some Caribbean medical institutions find their medical board-passing graduates unable to obtain residencies in Canada or the USA, a practical necessity for employment in many jurisdictions. As the physician shortage increases, will public demand for qualified medical assistance ultimately produce a change in the laws governing licensing of Canadian physicians? Economists might answer in the affirmative. For example, perhaps legislators will eventually permit anyone passing medical boards to qualify for automatic volunteer residencies?
2. Flourishing Caribbean Medical Schools
Academic institutions in the Caribbean have benefited in recent decades from an influx of fee-paying students from Canada and other developed nations. The global physician shortage suggests this trend will continue, especially as more teaching hospitals arise in the region. Some established allopathic physicians in Canada could soon face competition from Canadian Caribbean-trained MDs.
3. Holistic Medicine
Holistic medical concepts have gained ground in North America since the 1980s. As Canadian physicians face greater competition from Caribbean-trained allopaths, licensing bodies in other under-served medically-related fields in Canada, such as Clinical Psychiatry and Veterinary Medicine, will face pressure to reduce barriers to entry into these professions.
4. Revamping Medical Training
As the University of the People has demonstrated, technology exists today to train remotely in a growing number of subjects. In the past, physical attendance at a University remained a prerequisite. Yet that situation no longer pertains. While considerable evidence supports the importance of clinical education in medicine, perhaps the arrival of more teaching hospitals in third world nations will offer opportunities for distance medical learners. Educators in North America might want to ponder that issue as tuition spirals upwards.
5. Inefficient Medical Markets
Ultimately, in a capitalist system, market forces of supply and demand will determine the allocation of physician resources. A sufficiently large contingent of qualified, unemployed Canadian Caribbean-trained School of Medicine graduates who have demonstrated the ability to pass medical boards will produce changes of some kind in the North American medical school system. Unfortunately, unless they begin implementing reforms soon, experienced medical educators might find that the momentum for making changes has passed from their professional organizations to legislatures.
Supply-and-demand will ultimately control the future of medical admissions policies in Canada. Inefficient markets eventually correct themselves.