Dr. Atul Kapur
1. Many associations face challenges engaging new and prospective members. How do you envision residents and first-fifteen physicians engaging with the CMA? What actions would you, as CMA President, take to accomplish this?
Residents’ primary affiliation is generally to their professional association; this speaks to the need for the CMA and RDoC to continue our strong relationship so that we can most effectively and efficiently meet the needs of our common members.
The transition from residency to practice is a time of great change, new responsibilities, and new obligations. It is also a time when a significant proportion of physicians question their memberships in various organizations, including the CMA. The CMA needs to make clear its relevance and usefulness to these members by recognizing and responding to their needs. This will require that we communicate better with members. This does not mean just sending out more e-mails, but rather inviting and creating more ways for members to give input and tell us what they need and want from their association.
Many physicians have particular interests that stem from personal experience and passions. Examples include environment and health, health of disadvantaged communities, and the social determinants of health. These members should see the CMA as their association which actively supports them in pursuing these interests. I will encourage the development of Communities of Interest as a mechanism to help members find like-minded colleagues and support them in achieving their goals.
2. In your view, what are the biggest challenges residents will face in the next 10 years? What are your proposed solutions to those challenges?
A major ongoing challenge will be maintaining an emphasis on education in the face of increasing service demands and continuation or worsening of the current restriction of resources. This combination of demands will also increase the risk of burnout, as described in another question. I will push the CMA to intervene where required to respond to this challenge.
The introduction of Competence by Design is an exciting shift in residency education, but also will inevitably raise implementation challenges. There will need to be monitoring and early intervention to ensure that there is a supportive culture in all environments and to avoid adding to resident stress. As a group independent of the residents, the educational colleges, and the schools, the CMA may be well placed to play an intermediary role and I will encourage this where appropriate.
The increased mismatch of resources, practice opportunities, and population needs may lead to increased stress and potential under- or un-employment. I will advocate for a national, data-driven physician human resource strategy to help resolve this stressor.
An ongoing challenge for residents is the debt load that many carry. I will advocate for a tuition freeze as first step to a reduction and will work with others to examine ways to implement more effective debt management and reduction strategies for residents.
3. An increasing lack of alignment between the Canadian medical workforce and the healthcare needs of the general population has been well documented. What do you believe is CMA’s role in advocating for better alignment?
The CMA should emphasize that population needs should be the compelling factor in determining allocation of residency positions, as opposed to other issues such as service requirements in teaching environments. The RDoC “Principles on Physician Health Human Resources to Better Serve Canadians” clearly show a broad perspective and will be a strong tool to use to convince governments of the benefits of working to implement the Calls to Action outlined in that document.
The CMA is also well placed to advocate to educational institutions the importance of needs-based allocation of residency positions. As well, it can partner on the development and refinement of tools for collection of Health Human Resource data and prediction of future needs (such as the work done by the Ontario Medical Association). As the voice of the entire profession, the CMA can work with Provincial/Territorial Medical Associations and Specialty Societies to remove barriers to recruitment & succession planning.
4. What do you perceive to be the main causes of burnout among residents, and what actions would you advocate for to correct them?
There are several causes of burnout that apply specifically to residents, which I will comment on below. However, many of the main causes are those that apply to all physicians, because residents work within the same system and are exposed to many of the same stressors, albeit in many cases to an elevated degree. Those include increasing clinical demands and the pressure of attempting to treat increasing numbers of patients with inadequate infrastructure support. Along with overwork there is also lack of control over assigned duties and an increasing amount of clerical work.
This is compounded for residents by the need to balance teaching responsibilities and patient care along with learning. Many residents are also burdened by concerns about debt and prospects for future positions that meet their needs and desires, and those of their families. More recently, we have seen more unfortunate situations of bullying, intimidation, and harassment of residents.
The work on physician human resource planning (see answer above) will help to avoid the stresses related to worries about future practice opportunities. I’m proud of the work I did leading my medical association in taking action to respond to intimidation of trainees and will bring the same attitude to the CMA. Many institutions and schools are developing and advancing wellness programs and I will advocate for these to include trainees, as well as for this to be a larger element of post-graduate curricula; solutions for faculty, such as time banking, should also be extended to residents.
5. Organizations involved in medical education are under increasing pressure to create efficiencies and share information. How would you approach the need to guarantee the legally protected privacy rights of learners within this context?
Learners should have control over their own information and not be coerced into giving up their privacy rights. I am particularly concerned to hear about learners’ self-evaluation information that is being used inappropriately. This will be even more important with the increasing use of ePortfolios.
I support RDoC’s “Data Collection and Learner Privacy Principles” and will work to generalize and integrate them with the CMA policy “Principles Concerning Physician Information” so that we can work together to promote them as the standard to be followed. The CMA and RDoC can be more effective with a united message and, together, should be able to achieve a consensus on these principles. This will include joint meetings to garner the support of the medical schools, educational colleges, Colleges of Physicians and Surgeons, the Medical Council of Canada, and governments.