Friday, November 28, 2008 | Categories: Dr. Brian's Blog
Gerry Conetta sent us this:
"You asked about pet peeves. Here's mine: Most people make sympathetic clucking sounds when doctors sound off about the years of study and student debt load they suffer. I, on the other hand, while NOT trivialising their perseverance and hardship, think back on a study I read about perhaps fifteen years ago in which it was estimated that BACK THEN, it was costing society more than two million dollars to train a General Practitioner, that's right, $2 000 000 per GP. Do a bit of extrapolation to estimate what it must be now and that amount will seriously dwarf the doctors' claims of how much it has cost them. For this kind of societal outlay, I feel Ontario (and other provinces) should be imposing conditions on doctors. I would like to see new doctors contractually restricted to FIVE YEARS of assignment anywhere in the province they are sent dictated by provincial needs and a further FIVE YEARS in which they can decide where to practise IN ONTARIO. We should not allow them to leave practising in Ontario for a minimum of TEN YEARS to warrant our public investment in their training. If this sounds a little draconian, consider the military equivalent. The armed forces would never dream of providing you with a college education without the guarantee of a certain extended timeframe of enlistment. That, of course, is for a LOT LESS financial outlay. We, the taxpayers, need a greater return on investment."
Gerry, that's a great email. Here are some bottom lines. A number of studies have suggested that these days, the average med student racks up $80,000-100,000 in student debts by they time they graduate. Clearly, the cost has gone up considerably since my days in school. But even that amount of money does not reflect the true cost of medical education. A number of studies have pegged the 'real' cost to turn out one new MD at between half and three quarters of a million dollars.
The other part of your question is a philosophical one. Given the true cost, should cash-strapped provincial governments be permitted to take on some compulsory service in return for the fee? That's for our society to decide. I can tell you that the principle is not unheard of in Canada. Currently, there are 1500 Canadian students at med schools abroad. Many of them want to return to Canada to do their residency training and to set up practice here. The Ontario government has set up a program called "Return of Service." In return for being eligible for Canadian residencies on a level playing field with grads of Canadian med schools, these ex-pats have to sign a contract to work one year in an government-designated underserviced area for every year of residency training in Canada. Some ex-pats have said yes, while others have said no.
Check out White Coat, Black Art on Monday December 8 at 1130 (noon NT) and Saturday December 13 at 430 pm (5 pm NT) for my interview with two Canadians who studied medicine in Ireland and want to come back to Canada.