UBC Faculty Research and Publications

Whether or wither some specialties: a survey of Canadian medical student career interest Scott, Ian M; Wright, Bruce J; Brenneis, Fraser R; Gowans, Margot C Sep 4, 2009

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
52383-12909_2009_Article_328.pdf [ 498.89kB ]
Metadata
JSON: 52383-1.0074640.json
JSON-LD: 52383-1.0074640-ld.json
RDF/XML (Pretty): 52383-1.0074640-rdf.xml
RDF/JSON: 52383-1.0074640-rdf.json
Turtle: 52383-1.0074640-turtle.txt
N-Triples: 52383-1.0074640-rdf-ntriples.txt
Original Record: 52383-1.0074640-source.json
Full Text
52383-1.0074640-fulltext.txt
Citation
52383-1.0074640.ris

Full Text

ralssBioMed CentBMC Medical EducationOpen AcceResearch articleWhether or wither some specialties: a survey of Canadian medical student career interestIan M Scott*1, Bruce J Wright2, Fraser R Brenneis3 and Margot C Gowans4Address: 1Department of Family Practice, University of British Columbia, 300-5950 niversity Boulevard, Vancouver, BC V6T 1Z3, Canada, 2Department of Family Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada, 3Department of Family Medicine, University of Alberta, 2-65 Zeidler Ledcor Building, University of Alberta Edmonton, Alberta, T6G 2X8, Canada  and 4Department of Family Practice, University of British Columbia, 300-5950 University Boulevard, Vancouver, BC V6T 1Z3, CanadaEmail: Ian M Scott* - ianscott@interchange.ubc.ca; Bruce J Wright - wrightb@ucalgary.ca; Fraser R Brenneis - fraser.brenneis@ualberta.ca; Margot C Gowans - mgowans@interchange.ubc.ca* Corresponding author    AbstractBackground: Given the looming shortage of physicians in Canada, we wished to determine howclosely the career preference of students entering Canadian medical schools was aligned with thecurrent physician mix in Canada.Methods: Career choice information was collected from a survey of 2,896 Canadian medicalstudents upon their entry to medical school. The distribution of career choices of surveyrespondents was compared to the current physician speciality mix in Canada.Results: We show that there is a clear mismatch between student career choice at medical schoolentry and the current specialty mix of physicians in Canada. This mismatch is greatest in UrbanFamily Medicine with far fewer students interested in this career at medical school entry comparedto the current proportion of practicing physicians. There are also fewer students interested inPsychiatry than the current proportion of practicing physicians.Conclusion: This mismatch between the student interest and the current proportion of practicingphysicians in the various specialities in Canada is particularly disturbing in the face of the currentsub-optimal distribution of physicians. If nothing is done to correct this mismatch of studentinterest in certain specialities, shortages and misdistributions of physicians will be further amplified.Studies such as this can give a window into the future health human resources challenges for anation.BackgroundEven though Canada has more physicians per capita thanmany nations, reductions in the ratio of physicians topatients combined with an aging population is expectedto have implications for the health care system.[1]ers, even if we were to maintain the same number of phy-sicians, there would be fewer doctor-hours to provide careto patients. [2-6]In Canada, the number and specialty of physicians isPublished: 4 September 2009BMC Medical Education 2009, 9:57 doi:10.1186/1472-6920-9-57Received: 19 February 2009Accepted: 4 September 2009This article is available from: http://www.biomedcentral.com/1472-6920/9/57© 2009 Scott et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 6(page number not for citation purposes)Between 1993 and 2000 alone, the physician to popula-tion ratio dropped by 5.1%.[1] Because of the changingdemographics and practice patterns of physician provid-determined by numerous factors including governmentpolicies, undergraduate and postgraduate training oppor-tunities, immigration and emigration of providers, genderBMC Medical Education 2009, 9:57 http://www.biomedcentral.com/1472-6920/9/57and age distribution of providers, remuneration incen-tives and disincentives and the work life cycle of physi-cians among a host of factors. [7-14] A significantcomponent of the Canadian medical education system isthe Canadian Residency Matching Service--CaRMS.CaRMS is a not-for-profit organization that works withthe medical education community, medical schools andstudents, to provide an electronic application service anda computer match for entry into postgraduate medicaltraining that serves all medical students and all postgrad-uate programs throughout Canada.[15] Canadian medi-cal school training is 4 years at all schools in Canadaexcept two schools where the training lasts 3 years. Stu-dents then enter the CaRMS match at the end of thisundergraduate medical training. Residencies in Canadafor Family Medicine are typically 2 years and for the otherspecialties they range from 4-5 years. All Canadian medi-cal graduates wishing to enter a residency in Canada par-ticipate in CaRMS. The residency match is viewed bymedical students as a high stakes activity and studentsdevote significant attention to ensuring that they receivetheir top choice in the CaRMS match.[16] In 2008, 91%of Canadian medical graduates were matched to their topdiscipline at the end of the first round of the match.[17]At present, there is an over-supply of postgraduate medi-cal training positions in Canada for Canadian medicalgraduates. Even with the inclusion of international medi-cal graduates (IMGs) into the CaRMS process, there were121 unfilled residency spots in Canada at the end of thesecond CaRMS match in 2008.[18] As a result, the careerpreference of Canadian medical graduates has an impor-tant impact on the mix of practicing physicians.[19] Thereis currently no clear national strategy in Canada for dis-cussing the mix of residency positions that should bemade available to medical students. This lack of a nationalstrategy at the post-graduate training level coupled withan excess of residency positions means that medical stu-dents have a significant role in determining the future mixof providers. Canada is not unique in having a matchingservice nor an oversupply of postgraduate positions forstudents which places student choice as an important fac-tor in the mix of future providers. [20,21] Other regionsare also moving towards a coordinated nationalmatch.[22]While students do not apply for residency positions untiltheir final year of medical school, for many, the choicebetween primary care and specialty medicine has beenmade prior to commencement of or early in medicalschool. [23-26] For some students, they already have aspecific specialty firmly in mind prior to medical schoolentry.[27] While career choices at medical school entry areWhile the current mix of physician providers may not beoptimal for our health care system needs, it nonethelessrepresents the structure and function of our current sys-tem. To further understand what influence student choicewill have on the future of the Canadian Health Care Sys-tem, we wished to determine how closely the career pref-erence of students entering medical school was alignedwith the current physician mix in Canada.MethodsSettingAs part of multi-year, multi-centre investigation [28-30]into medical student career choice, we have been survey-ing student career aspirations at eight Canadian medicalschools. Students were surveyed at the University of Brit-ish Columbia, University of Calgary, University ofAlberta, University of Ottawa, University of Toronto, Uni-versity of Western Ontario, Queen's University andMcMaster University. These Universities volunteered fromamong 13 English speaking medical schools operating atthe beginning of this study.SubjectsInternational students were excluded from the study.From the remaining students, a cohort of 3,225 studentsentering the above schools between 2002 and 2005(depending on the school over a one to four year period),were asked to complete a survey on career choice.Procedure and InstrumentDuring the first few weeks of medical school, studentswere asked to identify and rank their top three careerchoices. Students were offered the following list of possi-ble career choices: Emergency, Urban Family Medicine,Rural Family Medicine, Internal Medicine, Obstetrics andGynaecology, Paediatrics, Psychiatry, Surgery, and Other(a write in option). These career choices were pre-selectedas it was felt they would be clear and distinct for most stu-dents in their first few weeks of medical studies. Urbanand Rural Family Medicine was chosen to further under-stand the issue of the future of primary health care in ruraland remote communities. A series of other attitudinal anddemographic questions were asked that are not includedin this study. Two reminders were sent by email to stu-dents who did not respond. For the purposes of this study,only the students' top career choice was considered.Data analysis was performed using SPSS version.14.0(SPSS Inc. Chicago, USA). Descriptive analysis was used topresent student career interest on entry to medical school.Comparisons between the proportion of students indicat-ing each major career choice and the proportion of Cana-dian physicians currently practicing in that specialty [31]Page 2 of 6(page number not for citation purposes)clearly mutable, it is clear that these early choices are pre-dictive of ultimate career direction.were made using the chi-square test statistic. In all cases, aresult was considered significant for p < 0.05.BMC Medical Education 2009, 9:57 http://www.biomedcentral.com/1472-6920/9/57Ethical approval was received by the appropriate univer-sity ethics boards at all participating schools.ResultsThe overall response rate on this entry survey was 89.8%(2,896/3,225). Eighteen students (0.6%) were excludedfrom analyses due to our inability to classify their write incareer choice (i.e. sports medicine, interpretive medicine,performance art medicine). In addition, 139 students(4.8%) failed to specify their top career choice or statedthat they did not have a top career choice and were thusexcluded from analysis. A final sample of 2,739 studentswith valid responses was analyzed.Valid survey respondents ranged in age from 19 to 49years, with a median of 23.0 years and a mean of 24.0years. A majority of responents were female (56.7%) andsingle (71.1%) and had entered medical school from a sci-ence background (91.7%). Most (75.7%) came from fam-ilies where their most educated parent had a universityeducation, 41.2% having close family or friends practicingmedicine and 20.4% having spent a majority of theirchildhood living in a rural community (self defined).The most popular career choice among students at medi-cal school entry was internal medicine and associatedmedical subspecialties (28.9%), closely followed by fam-ily medicine (rural and urban combined, 25.9%). Theleast popular career choice amongst those listed was psy-chiatry (2.9%) (See Table 1).The career interests expressed by students differed signifi-cantly from the current mix of full time equivalent physi-cians for all specialties (p < 0.005) (Table 2).DiscussionAccording to the Canadian Institute for Health Informa-tion (CIHI), the number of active physicians in Canada is60,612. [31] It is apparent in comparing student careerchoice at medical school entry with the current mix ofactive physicians that there is mismatch between studentinterest and the current physician workforce (See table 2).While career interest at entry to medical school does notdefinitively indicate career choice on graduation, there isincreasing evidence of a strong association. Studies havedemonstrated that from 45% to 70% of students predicttheir ultimate specialty choice at medical school entry.[23-26]This mismatch is greatest for Urban Family Medicine forwhich the proportion of students interested in this careerchoice at medical school entry is 28.1% points below thecurrent proportion of physicians practicing in this disci-pline. There is also discordance between student careerchoice and the current workforce mix in Psychiatry withstudent interest 3.7% points below the current proportionof physicians practicing in this discipline. There is agreater interest among entering medical students in thecareers of Emergency Medicine (5.0% points greater inter-est), Internal Medicine and medical subspecialties (4.2%points greater interest), Surgery (7.4% points greater inter-est) and Paediatrics (11.7% points greater interest) com-pared to the current proportion of physicians practicing inthese areas. There is a near match of the student interest inObstetrics and Gynaecology (1.2% points greater interest)and Rural Family Medicine (2.4% points greater interest)compared to the current proportion of physicians practic-ing in these disciplines.Table 1: Interest of Medical Students in Specific Careers at MD school EntrySpecialty n % 95% CIInternal Medicine and Medical subspecialties 791 28.9 27.2 - 30.6Surgery and Surgical subspecialties 478 17.5 16.1 - 18.9Pediatrics 418 15.3 14.0 - 16.6Urban Family Medicine 420 15.3 14.0 - 16.0Rural Family Medicine 291 10.6 9.4 - 11.8Emergency 158 5.8 4.9 - 6.7Obstetrics and Gynecology 103 3.8 3.1 - 4.5Psychiatry 80 2.9 2.3 - 3.5Page 3 of 6(page number not for citation purposes)TOTAL 2739 100.0BMC Medical Education 2009, 9:57 http://www.biomedcentral.com/1472-6920/9/57It is likely that the 5% surplus interest in emergency med-icine is not an accurate representation of excess interestcompared to the current workforce of emergency provid-ers in Canada. CIHI classifies all certificants of the Collegeof Family Physicians of Canada as Family Physicians{both CCFP and CCFP (EM)}. As of May 9 2008, therewere 1,796 physicians with a CCFP (EM) designation inthe College of Family Physicians of Canada MembershipDatabase. [Personal Communication from Sarah Scottsscott@cfpc.ca, National Physician Survey & Janus ProjectCoordinator, College of Family Physicians of Canada toIan Scott, May 9, 2008)] Chan [32] estimates that 50% ofphysicians with CCFP (EM) designation practice primarilyemergency medicine. Others have found even highernumbers CCFP (EM) physicians practicing primarilyemergency medicine with less than 20% engaged in ablended family/emergency medicine practice.[33] Inaddition, in many rural or remote jurisdictions physicianspractice emergency medicine without any form of certifi-cation. Thus, the actual excess interest in emergency med-icine compared to actual providers of emergency care maybe smaller than is observed if one were able to comparestudent interest with the actual numbers of physiciansproviding emergency care across Canada.The impact of the number of international medical grad-uates (IMGs) who enter the system at the level of theCaRMS match is modest but growing. During the 2008nication email from Jim Boone jboone@carms.ca GeneralManager and COO, CaRMS to Ian Scott January 22, 2009]Overall the national percentage of IMGs within the Cana-dian medical workforce has declined slightly from 23.1%in 2000 to 22.3% in 2004.[34]Our study shows nearly the same proportion of graduatesinterested in practicing rural family medicine as are cur-rently providing service in rural communities. However,this is already an under-serviced geographical area.Rourke estimates that an additional 1175 family physi-cians are required to bring the family physician-popula-tion ratio to the same level as the Canadian average.[35]This study begs the question: "What is the appropriate mixof physician specialities for Canada?". While a number oforganizations, commissions and reports [36-41] havelooked at this issue, there are as yet no clear recommenda-tions. There have been calls for greater systematic central-ized physician data collection but these calls have not yetbeen heeded.[42] Recently the Canadian Medical Associa-tion Journal requested human resources data from theCollege of Family Physicians of Canada and all 47 spe-cialty groups registered with the Royal College of Physi-cians and Surgeons of Canada.[43] Only 27 groupsresponded to the request and of those who responded,only 13 had done studies over the last decade on thehealth human resources issues in their discipline.[43] OfTable 2: Current Physician Mix in 2003-2004 compared to MD Student InterestDiscipline Current Physicians Entering MD studentsn % %Urban Family Medicine 26324 43.4 15.3 X2 = 878.30, df = 1 p < 0.001Internal Medicine and medical subspecialties 14969 24.7 28.9 X2 = 25.72, df = 1 p < 0.001Surgery andsurgical subspecialties6131 10.1 17.5 X2 = 163.03, df = 1 p < 0.001Rural Family Medicine 4962 8.2 10.6 X2 = 21.39, df = 1 p < 0.001Psychiatry 4,014 6.6 2.9 X2 = 60.15, df = 1 p < 0.001Pediatrics 2,152 3.6 15.3 X2 = 1073.22, df = 1 p < 0.001Obstetrics and Gynecology 1,593 2.6 3.8 X2 = 14.57, df = 1 p < 0.001Emergency Medicine 467 0.8 5.8 X2 = 852.01, df = 1 p < 0.001Total 60612 100 100http://www.physicianhr.ca/reports/default-e.phpPage 4 of 6(page number not for citation purposes)CaRMS match, IMGs (who were Canadian Citizens orLanded Immigrants) accounted for 14.2% (353) of thetotal residency positions filled (2478). [Personal Commu-those that had done studies, only six could quantify exist-ing shortages of physicians in their specific discipline.With over 4,000 physicians planning to retire or leaveBMC Medical Education 2009, 9:57 http://www.biomedcentral.com/1472-6920/9/57practice in the next 2 years, the current number of Cana-dian medical graduates barely fills this void particularlygiven the entering cohort's career intentions.[8]Given that there is evidence that student interest at careerentry is associated with a student's ultimate career choice[23-27], this data gives insight into not only the futurecareer aspirations of medical students but the possiblefuture structure and function of the Canadian Health CareSystem. This study therefore heralds a future CanadianHealth Care system populated by increasing numbers ofspecialists, decreasing numbers of urban family physi-cians and the on-going insufficient number of rural familyphysicians.Since medical educators have a social responsibility to beaccountable for the health care needs of the populationthey serve [44], it may be time to selectively recruit stu-dents and to modify medical school curricula in such away as to better meet the future needs of Canada's popu-lation. An alternative solution would be to limit thenumber of postgraduate positions in certain disciplines todrive students towards the required career choices. Such astrategy may result in many students finding themselvesin careers they are not suited for or students choosing tomove to other jurisdictions for postgraduate training toachieve their desired career choices. Both of these out-comes could have negative implications for the CanadianHealth Care System.This study is limited by not including all medical schoolsin Canada and while it has surveyed nearly 3000 studentsfrom eight Canadian medical schools over a time periodof up to 4 years, the results might not be generalizable tothe entire country. We will be following these studentsforward to determine what their ultimate career choiceand career matches is. In addition we will seek to under-stand what factors at medical school entry predict a stu-dent's ultimate career choice beyond their stated careerinterest at the beginning of medical school.ConclusionIn light of expected shortages of physicians in Canada andother countries, the career desires of entering medical stu-dents can provide insight into the future structure of thehealth care system. Health planners should heed thesestudent desires and take proactive action in planning thehealth care system, otherwise countries may get a healthcare system that medical students have defined for them.Competing interestsThe authors declare no financial or non-financial compet-ing interests other than they are members of departmentsply of family physicians for the Canadian health care sys-tem.Authors' contributionsIS, BW and FB contributed to the study conception anddesign. MG developed the approach to the statistical anal-yses of the data. IS wrote the first draft of the manuscriptwith all authors contributing to the revisions. All authorsread and approved the final manuscript.Authors' InformationIan Scott is the Undergraduate Director of Family Practiceat the University of British Columbia. Bruce Wright is theAssociate Dean Undergraduate Medical Education at theUniversity of Calgary. Fraser Brenneis is the Senior Associ-ate Dean, Education for the Faculty of Medicine & Den-tistry at the University of Alberta. Margot Gowans is asocial sciences researcher in the Department of FamilyPractice at the University of British Columbia.AcknowledgementsFunding was provided by the Council of Ontario Universities.References1. Chan B: From Perceived Surplus to Perceived Shortage:What Happened to Canada's Physician Workforce in the1990's?  2002 [http://secure.cihi.ca/cihiweb/products/chanjun02.pdf].Ottawa, Ontario, Canadian Institute for Health Information2. Martin S: Family matter.  CMAJ 2003, 168(9):1174.3. Association of Faculties of Medicine of Canada (AFMC): CanadianMedical Education Statistics 2007 Table 8 Enrolment inCanadian Faculties of Medical by Sex 1968/67-2006/07 (page10).   [http://www.afmc.ca/pdf/CanadianMedicalEducationStatistics2007.pdf].4. Jeon S, Hurley J: The relationship between physician hours ofwork, service volume and service intensity.  Canadian Public Pol-icy 2007, 33(Suppl 1):17-30.5. Watson DE, Slade S, Buske L, Tepper J: Intergenerational differ-ences in workloads among primary care physicians: a ten-year, population-based study.  Health Aff (Millwood) 2006,25(6):1620-1628.6. Herbert C, Whiteside C, McKnight D, Verma S, Wilson L, Hebert PC,et al.: Ending the sexist blame game.  CMAJ 2008,178(6):659-661.7. Shuchman M: Searching for docs on foreign shores.  CMAJ 2008,178(4):379-380.8. Collier R: Doctors call for plan to curb physician shortage.CMAJ 2008, 178(4):384.9. Kondro W: Generational attitudes and attributes to affectphysician workforce.  CMAJ 2007, 177(10):1172.10. Senf JH, Campos-Outcalt D, Kutob R: Factors related to thechoice of family medicine: a reassessment and literaturereview.  J Am Board Fam Pract 2003, 16(6):502-512.11. Rabinowitz HK: The role of the medical school admission proc-ess in the production of generalist physicians.  Acad Med 1999,74(1 Suppl):S39-S44.12. Moss PJ, Lambert TW, Goldacre MJ, Lee P: Reasons for consider-ing leaving UK medicine: questionnaire study of junior doc-tors' comments.  BMJ 2004, 329(7477):1263.13. Watanabe M, Comeau M, Byske L: Analysis of InternationalMigration Patterns Affecting Physician Supply in Canada.Healthcare Policy 2008, 3(4):e129-e137.14. U.S. Department of Health and Human Services: Physician Supplyand Demand: Projections to 2020.   [http://bhpr.hrsa.gov/healthworkforce/reports/physiciansupplydemand/default.htm].Page 5 of 6(page number not for citation purposes)of family physicians and wish to ensure a sustainable sup- 15. CaRMS: About CaRMS.   [http://www.carms.ca/eng/index.shtml].Publish with BioMed Central   and  every scientist can read your work free of charge"BioMed Central will be the most significant development for disseminating the results of biomedical research in our lifetime."Sir Paul Nurse, Cancer Research UKYour research papers will be:available free of charge to the entire biomedical communitypeer reviewed and published immediately upon acceptancecited in PubMed and archived on PubMed Central BMC Medical Education 2009, 9:57 http://www.biomedcentral.com/1472-6920/9/5716. Young TA: Teaching medical students to lie.  Can Med Assoc J1997, 156(2):219-222.17. CaRMS: Canadian Graduates Match Results by Choice Disci-pline and Medical School 2008 First Iteration R-1 Match.[http://www.carms.ca/pdfs/2008R1_MatchResults/13Canadian%20Graduates%20Match%20Results%20by%20Choice%20Discipline%20and%20Medical%20School_en.pdf].18. CaRMS: Unfilled Positions by Discipline and Medical School2008 Second Iteration R-1 Match.   [http://www.carms.ca/pdfs/2008R1_MatchResults/45Unfilled%20Positions%20by%20Discipline%20and%20Medical%20School2nd_en.pdf].19. CaRMS: Discipline Choices of Canadian Applicants 2008 FirstIteration R-1 Match.   [http://www.carms.ca/pdfs/2008R1_MatchResults/10Discipline%20Choice%20of%20Canadian%20Applicants_en.pdf].20. National Resident Matching Program: Medical Schools, Students,Teaching Hospitals Celebrate Biggest "Match Day" ever onRecord.   [http://www.nrmp.org/pressrelease2009.pdf].21. National Resident Matching Program: Advance Data Tables 2009Main Residency Match--Table 1 Match Summary 2009.[http://www.nrmp.org/data/advancedatatables2009.pdf].22. Jefferis T: Selection for specialist training: what can we learnfrom other countries?  BMJ 2007, 334:1302-1304.23. Zeldow PB, Preston RC, Daugherty SR: The decision to enter amedical specialty: timing and stability.  Med Educ 1992,26(4):327-332.24. Carline JD, Greer T: Comparing physicians' specialty interestsupon entering medical school with their eventual practicespecialties.  Acad Med 1991, 66(1):44-46.25. Kassebaum DG, Szenas PL, Schuchert MK: Determinants of thegeneralist career intentions of 1995 graduating medical stu-dents.  Acad Med 1996, 71(2):198-209.26. Kassebaum DG, Szenas PL: Medical students' career indecisionand specialty rejection: roads not taken.  Acad Med 1995,70(10):937-943.27. Kozar RA, Anderson KD, Escobar-Chaves SL, Thiel MA, Brundage SI:Preclinical students: who are surgeons?  J Surg Res 2004,119(2):113-116.28. Scott I, Wright B, Brenneis F, Brett-Maclean P, McCaffrey L: Whywould I choose a career in family medicine?: Reflections ofmedical students at 3 universities.  Can Fam Physician 2007,53(11):1956-1957.29. Wright B, Scott I, Woloschuk W, Brenneis F, Bradley J: Careerchoice of new medical students at three Canadian universi-ties: family medicine versus specialty medicine.  CMAJ 2004,170(13):1920-1924.30. Scott I, Gowans MC, Wright B, Brenneis F: Why medical studentsswitch careers: changing course during the preclinical yearsof medical school.  Can Fam Physician 2007, 53(1):. 95, 95-5, 94.31. Canadian Institute for Health Information: Full-Time EquivalentPhysicians Report, Canada 2002-2003 and 2003-2004.National Physicians Database. 1, i-E-2 2006 [http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_17_E].32. Chan BT: Do family physicians with emergency medicine cer-tification actually practice family medicine?  CMAJ 2002,167(8):869-870.33. Shepherd LG, Burden JK: A survey of one CCFP-EM program'sgraduates: their background, intended type of practice andactual practice.  CJEM 2005, 7(5):315-320.34. Pong R, Pitblado J: Geographic Distribution of Physicians inCanada: Beyond How Many and Where.   [http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_1346_E&cw_topic=1346]. Cana-dian Institute for Health Information35. Rourke J, Dewar D, Harris K, Hutten-Czapski P, Johnston M, KlassenD, et al.: Strategies to increase the enrollment of students ofrural origin in medical school: recommendations from theSociety of Rural Physicians of Canada.  CMAJ 2005,172(1):62-65.36. Romanow , Roy J: Building on Values: The Future of HealthCare in Canada - Final Report.   [http://www.hc-sc.gc.ca/english/pdf/romanow/pdfs/HCC_Final_Report.pdf]. Commission on theFuture of Health Care in Canada37. Kirby , Michael : Reforming Health Protection and Promotionbus/commbus/senate/com-e/soci-e/rep-e/repfinnov03-e.pdf]. Stand-ing Senate Committee on Social Affairs, Science and Technology38. Canadian Health Services Research Foundation   [http://www.chsrf.ca/home_e.php]39. Health Canada: Advisory Committee on Health Delivery andHuman Resources.   [http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/plan/credentials-criteres_e.html].40. Health Canada: Pan-Canadian Health Human Resource Plan-ning Initiative.   [http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/plan/index_e.html].41. Kondro W: Task Force Two calls for pan-Canadian approachto physician resources.  CMAJ 2006, 174(13):1827.42. Howell E: National wait times database needed.  CMAJ 2008,178(2):139.43. Howell E: Physician, count thyself.  CMAJ 2008, 178(4):381-384.44. Health Canada: Social accountability: a vision for Canadianmedical schools.  Ottawa 2001.Pre-publication historyThe pre-publication history for this paper can be accessedhere:http://www.biomedcentral.com/1472-6920/9/57/prepubyours — you keep the copyrightSubmit your manuscript here:http://www.biomedcentral.com/info/publishing_adv.aspBioMedcentralPage 6 of 6(page number not for citation purposes)in Canada: Time to Act. 2003.   [http://www.parl.gc.ca/37/2/parl

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.52383.1-0074640/manifest

Comment

Related Items