With respect to rural and urban, we have a strategy on that. In British Columbia, for example, and elsewhere, it's been shown that if you have students from rural areas going to medical school, they're more likely to practise in a rural setting. In fact, the data on that in British Columbia is very positive. Those from the rural centres tend to want to go back. Of course, the crisis in medical manpower is at its greatest in rural Canada.
In terms of capacity, the theme I talked about in my remarks was about empowering the patient, not focusing on the system, which is what some people here want to do. Put the patient at the centre and not the system at the centre, and have everyone revolve around the patient. One of those means is to attach the funding to patients so that when patients go to an institution they are a value, not a cost.
We are the last OECD country that block-funds our hospitals. When you say there's no capacity.... There is no incentive in our system for a hospital to be efficient, to be effective in admitting and discharging a patient. We've seen a situation in Britain, which had a national health service and has universal health care, where in three and a half years wait lists have gone down and capacity has increased, because there's more.... For example, if I have an operation that takes one and a half hours and it's 3:30 in the afternoon, they won't let me do that operation because I might go overtime. That's because the patient is using up the hospital's money. So it's inefficient, and it's not putting the patient at the centre of the system.
On recruitment, 1,500 medical students are going to foreign medical schools, and many of them are very, very bright. In fact, there are over 200 Canadians in Australia and over 300 in Ireland. At one of the Australian universities, four of the top five students in the graduating class were Canadians. So they're not B students.
I think, again, we have a problem with recruitment and retention. Yet we have a situation in which 50% of newly trained orthopedic surgeons--some of the biggest wait lists in the country are for orthopedic surgery--leave within five years of graduation because we can't give them operating room time.
So the word that defines our approach to our health system is rationing. We're rationing access. The way we can break that is by attaching the funding to the patient, and then the vicious circle will be broken.