There is much to talk about this week, from staggering numbers of diabetes cases skyrocketing beyond all expectations, to new outbreaks of Clostridium difficile at a Toronto hospital and new requirements to report this disease along with others; even news from the Health Council of Canada that there is only a “scattering of achievements” in improving access to home care and primary care despite billions of additional health care dollars over the past five years.

More intriguing to me however, is the concept of private medical schools that is being floated out as reported by Christina Spencer in the Calgary Sun column June 4, 2008, “Private Practice-Can we train eager young doctors without government involvement?”.

Human resources are the underpinnings of the entire medical system. We can build many hospitals, buy expensive new equipment and adopt new reporting mechanisms but without understanding the impact of human resources our health care system is likely to continue to lag in many areas.

Certainly technology can play a role to assist our health care providers and globalization of some kinds of medical provision will occur but we need Canadians to direct the care and resources here and we need to be self-sufficient in producing doctors as competition for their services from other countries including the United States increases, particularly as it moves towards providing more universal care for the 45 million Americans who are reported to be uninsured. There are indications that the US will need approximately 200,000 more doctors in roughly the next decade.

More physicians and other providers will be needed here in the coming decades as well. How can they best be trained and what impact would private medical schools have on the public medical system here if any?

The Canadian Federation of Medical Students is reported to have two concerns about a private, non-profit school: that it could compete with public institutions for teachers and mentors and that tuitions would be higher at private schools, essentially restricting them to the rich.

Regarding the first concern is a vicious cycle that is created by not having enough physicians in the first place. Logically, it does not make sense to put off training more physicians because there are not enough teachers since this will only create greater shortages of teachers and physicians in the end. What is required is innovative and non-traditional ways of training that will evolve due to necessity.

In the second regard, with mounting tuition in the last decade, Canadian medical school graduates have significant debt which not only influences their career choices but which also may discourage some students with lesser financial backing from choosing medical training in the first place. Private medical schools would likely be costly and the argument is made that this would create an inequity, but the reality is that this inequity already exists despite the non-existence of private medical training in Canada.

Would private medical schools exacerbate this problem or have potential to improve it?

Clearly, there are many questions surrounding the medical workforce numbers that will be needed in the future and they must be considered in detail with both long term and short term repercussions in mind.