In my province, 35% of the practitioners currently in practice are within five years of retirement, if you take 65 as a retirement date. However, what is happening is that a significant number of those practitioners are not retiring in the way the generation before them did. They are altering the way they work. They still have a lot to contribute. They have skills that they want to pass on. So they move away from the more acute, physically demanding areas of their specialties into something a little less exciting, from a physical point of view. That's one factor.
The aim of this country should be that it should be self-sufficient in terms of physicians. That then leads to the question of what that means.
We have had a huge increase in the number of medical students in this country. There are still more Canadians studying medicine abroad than there are studying medicine in Canada. That then raises all sorts of issues about repatriation.
There have been a variety of arguments, both legal and otherwise, that say these people who have been trained abroad and who have taken the Canadian exam should be entered into the residency program, for example, at the same rate. That's resolved itself at the moment.
The issue in terms of residency posts is that there are an inadequate number. We probably need 1.2 residency posts for every Canadian graduate, but if you have 3,500 Canadians who have graduated elsewhere, those numbers don't match.
The other problem is that we really don't know what residency spots are entirely appropriate. How many family physicians as a percentage of the global output of medical schools, residency programs, do we actually need, or will we need? If chronic disease is going to be the new paradigm, and it is, do we need to focus more on those specialties and disciplines and residency programs that actually produce that kind of graduate, rather than the acute specialty programs such as general surgery?
In my case, for example, we don't have the data on that. That's come to light lately because residents have done training and then found difficulty getting employed.
That's the background. Then there is question about how you deal with those doctors who have trained overseas and may not actually be Canadians and want to emigrate. I know for a fact that FMRAC, the Federation of Medical Regulatory Authorities of Canada, is actually looking at a streamlined, common licensing process for physicians, whether they trained in this country or they trained abroad.
That might answer some of those issues. Then you've got capacity issues in terms of whether they're coming in for residency spots, again because that's going to be it. Again, it's not a simple answer, unfortunately. It illustrates the complexity of what is an adaptive complex system.