Dr. Dharm Singh
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 are the future of the Canadian Medical Association (CMA). Increasing engagement and collaboration with Residents and Resident Doctors of Canada (RDoC) will be my key priority. We need to understand the issues residents are encountering during the training period. To improve engagement with residents, CMA needs to become a partner in solving issues residents are facing. I will work hard so that National Licensure becomes a reality in Canada. National License and increasing residency positions are my priorities. This will require enhanced cooperation with other stakeholders. Helping residents during the transition from training to practice will also make residents more engaged with CMA. I will create a liaison committee comprising of both RDoC and CMA members for enhanced collaboration between two organizations. Expanding the CMA Ambassadors program is essential. CMA presence during RDoC annual meetings will give a chance to hear from residents and learn about the issues that matter. Improved communications and regular update about CMA activities using various social media platforms is needed.
Communications and engagements should always include receiving inputs from residents directly. This not only helps in understanding the issue but also helps in making action plans for solution. CMA advocacy activities should help in improving the day-to-day working conditions of residents. Social determinants of health, mental health and climate changes affecting health are some of the topics that matter to our future physicians. CMA working groups and committees should include residents in these issues.
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?
Increasing systemic pressures, including bureaucratic, political and hospital management-related are and will be causing clinicians to spend a significant amount of time in non-clinical work. Furthermore, increased expectations from physicians who are encountering patients with multiple and complex medical issues will be challenging in the future. This is taking a toll on the physical, mental, emotional and financial well-being of residents and physicians across the country. Burnout and mental health issues (including anxiety, stress, depression and job dissatisfaction) rates are increasing. Complex medical needs, increasing expectations and systemic factors causing physician’s burnout are going to cause the medical profession to be less attractive for younger generations. I will start province-wise summits of multiple stakeholders (including Governments, Health authorities, Hospital management, Regulatory bodies, Medical Universities, and Medical associations) to find solutions. My priority will be to increase autonomy to physicians.
In the absence of any national physician human resource planning and data, I expect there will be more demand and supply mismatch across the country. Residents may not be able to find suitable jobs according to their training and qualifications. I will advocate for data collection and increase residency positions by the Universities and Governments as per demand.
Technological advancements (AI, Robotics, mobile apps, virtual medicine, etc.) will become more and more popular in the future. CMA needs to advocate for adequate training in medical school and residency period so that our future physicians are ready to incorporate technology into clinical practice.
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?
At present, there is a mismatch between demand and supply of physicians. This is happening because there is no physician human resource data collection and analysis. We do not know how many family physicians and specialists are needed in 5 or 10 years from now. This is causing recruitment/retention problems and creating difficulties in the allocation of residency positions in universities and teaching institutions.
CMA should play a leadership role in physicians human resource planning on a national basis and share this data with various stakeholders in healthcare like governments, health authorities and medical universities. This planning should be done for family physicians, specialists, rural, remote and urban areas. Human resource planning should help in better distribution of physicians as well as resources across the country. It will also help medical students and residents in better career planning. National physician resource planning will ultimately lead to better health for Canadian and better health for physicians (due to less burnout).
4. What do you perceive to be the main causes of burnout among residents, and what actions would you advocate for to correct them?
Burnout is one of the most important issues the medical profession is facing right now. Various systemic factors are causing higher burnout, higher anxiety, and depression among residents and physicians. Residents are experiencing high workload and less job satisfaction. They are losing control, flexibility and decision making in their hospitals and other health institutions. It is getting difficult for them to have work life balance and above all, they are not finding much meaning in work. A national physician health survey conducted by the Canadian Medical Association last year showed higher rates of anxiety, depression and suicidal ideation among residents and physicians. Physician health should be one of the essential quality indicators of public health because poor physician health leads to poor population health.
As the CMA President, I have a plan to call a province-wide summit of various stakeholders in healthcare. They include Government, health authorities, regulatory bodies, universities/medical schools, and provincial medical associations. We need to acknowledge higher burnout and promote existing physician health programs. Better data collection is needed about the prevalence of burnout with respect to speciality, gender, the location of work, and years of work. We need to provide an optimal environment for physicians and residents to excel in their profession. Promoting flexibility, better work-life balance and rewards/incentives are some of the things which should be encouraged. Education about how to improve resilience and self-care in medical school is also a necessary step. Choosing local leadership which can make a decision and implement it locally will make residents and physicians feel more empowered. It will also help in improving organizational culture.
5. More than half of surveyed residents would locum outside of their primary province or territory of practice if no additional license applications were required. What steps would you take to create a licensing system that improves physician mobility and allows physicians to respond to dynamic patient care needs?
In Canada, provincial regulatory organizations are responsible for giving licences to physicians and residents to work. Every time physicians move from one province to another province, they have to apply all over again to get the license. The application process can be lengthy, involved extensive paper works and often expensive. The method of obtaining provincial licences may delay the start of work (Locum, Elective or Permanent) and furthermore it is causing a financial burden on residents and physicians. It is also causing problems for residents and physicians to work in rural and remote areas of the country. Relocations of physicians are not seamless because of extensive paperwork involved in obtaining a license. With the advancement of technology, virtual care will be more and more popular in the future. Provincial licensing restrictions are also causing restrictions in providing virtual care.
In collaboration with Resident Doctors of Canada and the Canadian Federation of Medical Students, I will lead CMA in a constructive and results-oriented dialogue with provincial regulatory bodies. Emphasis should be given to finding a solution in the near future. I will also propose starting the provision of National Locum License. Depending on the outcome and feedback from this initiative, there should be a National Medical Licence proposal. Creating a National Regulatory body should also be part of the discussion.