Dr. Sandy Buchman

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?

To engage Residents and First-fifteen (R & F15) physicians with the CMA, one must demonstrate attention to their concerns and connect with them on shared values that are relevant to the reasons that attracted them to become physicians in the first place.

As CMA president, I would ensure that the issues that concern R & F15 physicians are front and centre. I would create the space so that this group feels a sense of belonging to an organization that advocates on their behalf. The Ambassador program is an example of an entity for advocacy within the CMA for this cohort. I would seek to strengthen and enhance it. I would listen to learn all I can to prove that the CMA provides good value for their membership dollar in advocating for the issues that they care about.

One issue that I have long espoused that in my experience appeals to R & F15 physicians is that of the social accountability of the medical profession. What is Medicine’s social mandate? Do we contribute our expertise to advocate for system change that improves clinical population outcomes especially for vulnerable and marginalized populations by addressing the SDOH? Can the CMA help fulfill the CanMeds role of advocacy at a national system level? I believe that the CMA must fulfill this role and that the majority R & F15 physicians become inspired and engaged with an organization that lives the values of equity and fairness in health care.

Major challenges residents (and Medicine) will face in the next 10 years:

1) No job guarantees: For decades, medical students could choose any specialty they wanted and for the most part would be guaranteed a job in the specialty and location of their choice. There were never enough physicians and there were always jobs especially if one was willing to go a little further afield. This world no longer exists. Highly trained residents are now continuing fellowships as they are unable to find suitable positions. This is neither right nor fair to physicians who have trained so long nor to patients who require their expertise and service.

Potential solution? Develop a national Health Human Resource Entity to gather data on community demographics/healthcare needs so that adequate planning and budgets can be allocated to training the appropriate number and type of physicians (and other healthcare providers) to meet community needs.

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?

Advancing medical technology, artificial intelligence, instant access to online medical information by patients is changing the face of medicine and the role of physicians. The physician’s role in diagnosis and management will be altered in ways that we can’t even conceive. Physician educators must determine how undergraduate, postgraduate and continuing medical education can address this rapidly changing practice environment. We are in transition. Medical graduates will not be adequately trained to be able to practice in this new world unless we plan better now.

But be reassured: professionalism, maintaining competency and caring will never change.

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?

As already alluded to in Question 2, I strongly believe it is within the CMA’s mandate to advocate for national Health Human Resource Planning to correct the misalignment between the Canadian medical workforce and the healthcare needs of people in Canada. We need data to not only train the correct number of physicians to meet Canada’s needs, but to determine the number within each specialty, the correct ratio of generalist family physicians to other specialties, and in particular to address the maldistribution of physicians across the country. Training an adequate physician workforce would also help address and hopefully reduce the workload issues of individual physicians and contribute to decreasing burnout and stress, which in turn also would lead to improved population health.

As CMA president, I would advocate for the CMA to be involved in physician (and general health) human resource planning (HHR) using these need-based projections. In addition, this data would be a huge asset to medical students in guiding their career choices.

Another potential area of advocacy for the CMA with the objective of improving alignment that needs to be explored is establishing partnership with patient organizations to collaborate and co-design the healthcare system (including HHR planning). There is emerging evidence that doing so leads to better and safer population health outcomes. The CMA would certainly have a leadership role as the major medical organization in Canada to work with patient organizations which would strengthen our advocacy for improved resources with government.

4. What do you perceive to be the main causes of burnout among residents, and what actions would you advocate for to correct them?

Anecdotally, many residents report that the administrative burden they face is a common cause of burnout and stress. Another area is “call violations” meaning that the frequency of call – such as 1 in 2 or 1 in 3 – has become routine in surgical specialties. Unfortunately, it seems to persist as it is framed as a “choice’ by the resident. But many share that the culture of the hospital and the training which encourages the demonstration of commitment to the specialty and hard work is really at fault.

As we do for most treatments we seek the evidence for the claims being made in order to develop the evidence-based solutions that will be effective. Resident burnout and stress is a serious problem. How well has it been studied? Do we have adequate information/data from a large enough sample of residents from all programs that can inform us as to the correct solutions? For example, as stress-inducing as too frequent call is, does this impact educational opportunities and competence? Do more frequent hand-offs in order to have less call impact patient safety? Or does fatigue from too much call? Another question is whether burnout is gender or age specific? Specialty or location specific? In other words, more detailed research into this issue is needed. The CMA can advocate for updating the data base to make evidence- informed decisions to improve the context and culture in which residents work. This is no longer optional. It is imperative that it get done urgently.

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 protection of the privacy rights of residents/learners should be no different than the privacy rights and confidentiality protections we have for patients. Finding efficiencies in sharing necessary information is laudable but not if it violates a resident’s right to confidentiality and privacy.

I would approach the solution to this problem by working with other medical organizations with similar concerns such as the CFPC, RCPSC, CMQ and AFMC etc. in the context of the Canadian Medical Forum. The CMF exists specifically to address these types of problem that we are all trying to solve. Policy around the creation of a common standard of exactly what information is needed to be shared and what might be acceptable to all parties could certainly be developed within the CMF.

I believe that there must be technological software program solutions to solve this problem of maintaining privacy while necessary demographic and other relevant information is shared between institutions. The healthcare system appears to have competently protected patient privacy. Why is it that resident /learner privacy is any different?

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