Dr. Darren Larsen
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?
This is a question that means different things to different people. Gone are the days when doctors join their associations because they see it as a duty. The new generation of physicians is choosing to associate based on values. How does the CMA reflect their shared values and beliefs? How does it represent their point of view? How does being a CMA member enhance their practices, careers and lives? I believe that changes coming to CMA involving creating a modern dynamic Association will be key. There are new policies on physician health and wellness, a modernized code of ethics and a new Charter of Shared Values that reflect this view.
By 2025 half of CMA members will be millennials. As President, I will ensure that the Association reflects the changing perspectives of its new physicians. I would encourage innovation, as with Joule. We must find, promote and sponsor physician-led innovation in policy, social and technological domains. I will promote local communities of action that define the work to be done by the CMA and which can be spread nationally. I would promote education and leadership to produce a diverse cadre of physicians who want to step up to face tough medical issues facing the nation. I will encourage robust respectful dialogue that embraces differing opinions. CMA needs to go where its members are. It needs to be relevant to the issues of the day. And it must reflect the values of new physicians.
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?
The biggest challenges affecting residents in the next 10 years, in my opinion, will have to do with four things:
- The mismatch between medical specialties needed by our population and the types of doctors being trained. This will lead to oversupply in some areas and undersupply in others. I would work now, as President, to ensure that a robust health human resources plan is created that looks ahead at least eight years and models supply and demand using real data and supporting changes in physician demographics, projected work hours and regionality. This can be finely tuned to ensure we are training exactly what Canada needs. This should not be subject to political whimsy and random quotas.
- Servicing educational debt for the 80% of graduates who have it. Some students have accumulated over $300k of student loans. Repayment models must be created that allow servicing this while also growing a professional and personal life. Novel repayment structures are required. CMA should champion this.
- Loss of physician autonomy. Most provinces are moving toward new models of care that no longer put the physician in the centre. We will have to respond to this cultural change in ways that encourage collaboration and integration as part of a team. This is not just the case for primary care, but also for specialists.
- The rise of artificial intelligence and machine learning that will threaten the current monopoly physicians have on skills and knowledge. Dr. Watson will be much smarter than us. Computers will read X-rays and cytology slides better than radiologists and pathologists. Robots will do surgery more precisely. Our unique value to patients and the health system based on relationships and trust will be fundamental to our survival. I want to start the conversations now on how we will adapt.
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?
CMA has a huge role to play in this regard. Planning for matching health resource needs, training and population demands will need to be done nationally, not province by province. CMA can take this on as one of its core responsibilities. It can influence choices and planning from the first admissions to medical school right to the highest of fellowships, using national data in near real time. This data can be used to plan 8 to 10 years out and match supply and demand with models for both rural and urban care. It can take into account changes in technology, patient demographics and funding to make planning scientific and evidence based rather than politically driven. It can do this best through partnerships that are strong and proactive rather than reactive.
These partnerships can hold joint accountability for making the correct decision and can include federal and provincial agencies, regulatory bodies, governments and patients. Fixing this problem and avoiding a health human resources crisis will take real vision and bold leadership. It will involve making difficult choices. It will require spreading the policy and workload amongst many different players. CMA is well suited to lead this on behalf of all of us.
4. What do you perceive to be the main causes of burnout among residents, and what actions would you advocate for to correct them?
Physician burnout is a complex issue and it is different for residents and new doctors than it is for long established ones. The causes cannot be seen in isolation. They must be viewed in total and personalized as each of us reacts differently to each one. I would advocate for the following:
- Reconnecting to the joy in Medicine again – We are besieged by bad new stories about reduced incomes, battles with government and a health system pushed to the brink. This creates a sense of hopelessness and helplessness in young physicians. We can reorient some of the conversations that create our culture to focus on the connection we have with our patients and each other. We can focus on the relationships that give us lift. We can take pride in our hard work and outcomes in patients lives.
- Support our residents in their desire to learn and do things differently – We can create space for diverse modes of practice. We can even accept that some residents will never want to practice, opting for careers in administration, health policy or even tech startups. I would advocate strongly for the strength in supporting different practice models that generate balance in life between career, family and recreation. I would point out the “hidden curriculum” and fight for its end.
- Unsupported workloads and downloading in a stressed system are an issue for many – Learners become the shoulders on which much of the active work in hospitals and teaching centres falls. As the complexity of care and the need to support patients holistically becomes the norm, our institutions need to be aware of the effect of downloading upon our younger doctors. Their capacities are wondrous but not limitless. Their energy is unbridled but not infinite. And they need to feel appreciated. I want to make this happen through dialogue and sponsorship of ideas for change that come from residents themselves.
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?
The privacy rights of learners are to be as respected as the rights of practicing established physicians as well as patients. Information on patient care must be shared across the health system to ensure that nothing falls between the cracks when they change hospitals or are transferred back to the community. Our thoughts, actions and medical opinions form part of the patient story whether created by a resident or a staff person. This detail has rules surrounding it as set out in HIPA and PHIPA and institutions must be monitored and audited for adherence. When breaches occur the usual standards of reporting and disclosure apply.
In terms of personal information collected about students and residents by the institutions they are working in, RDoC has created some insightful policy to be used when advancing thought in this area. I believe it should be referenced when having conversations about consent for sharing between organizations that may be involved in the training, matching or future employment of the learner.