Dr. Michael Dickinson
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?
Engaging and supporting medical students and residents have long been an interest and passion of mine. I hold faculty appointments at two universities and earned clinical teaching awards at both the undergraduate and postgraduate levels. I also presented at our national pediatrics conference on the topic of transition to practice and co-developed a website on this topic with my colleague, Dr. Sarah Gander. All this to say that I believe that residents and new grads need to be a high priority group at the CMA; after all, you are the future of the profession!
I would support the development of an annual meeting or conference for early career physicians to share ideas and discuss challenges. This would not only provide a forum to assist young physicians, but it would also be an opportunity to engage residents and the first-fifteen in the broader activities of the CMA. The CMA could facilitate connecting young physicians with mentors who are 5-10 years into practice who could provide some guidance and advice based on their own recent experience.
I believe that member discounts like the Goodlife gym memberships and Telus phone plans are particularly helpful and appealing to young physicians, and I would encourage the CMA to increase the repertoire of offerings with an appeal to early career doctors.
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?
After discussions with many trainees, I understand that residents have significant anxiety about finding employment after graduation. It is challenging for residents who complete most of their training in one academic center to be fully aware of all the job and locum opportunities that exist across the country, but this need not be the case. I believe that the CMA could do more to build and develop an online resource that would help link senior residents with both vacant positions and locums available. Ensuring that our residents have opportunities to complete rotations outside the academic centers will also help trainees better understand the full range of employment options that exist.
Another challenge for residents over the next decade will be the transition to competency-based training and evaluation. While I support the concept of competency by design, there will no doubt be growing, and teething pains as residency programs transition to the new system and this may be stressful for residents. While this transition is more the domain of the Royal College, the CMA needs to be aware that this is a potential source of stress for trainees and make sure that we support residents as best we can through the transition phase.
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 is uniquely poised, because of it’s broad membership, to comment and inform policy on the national health care needs of the country. This will require collaboration with medical schools, residency programs, the Royal College, and the Canadian College of Family Physicians. We must ensure that the number of medical school positions and residency positions are aligned to meet the needs of our population. Physicians recognize that when one physician retires, it often takes two physicians or more to replace them. This is currently not accounted for in our medical training. I also worry that our smaller, more rural communities are particularly at risk of being in crisis as large numbers of physicians reach retirement age over the next decade. The CMA could play a valuable role in monitoring this situation and providing the information and data needed to policymakers and advocating for funding to ensure that we have sufficient medical school seats and residency positions to meet our human health care resource needs. Advocating for rural training opportunities for residents will also encourage young physicians to consider doing locums or establishing a practice in a smaller community or province.
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 wellness is currently a strategic priority of the CMA, and this applies to residents and students as much as it does to practising physicians. I believe that the on-call demands that are frequently placed on residents are the main drivers of burnout. This is particularly problematic in smaller programs where residents may be doing 1 in 4 call consistently for long periods of time. The perpetual sleep deprivation in combination with the known health risk of shift work makes the residency period very high risk for burnout and other physical and mental health problems. Also contributing to resident stress is the lack of control over schedules and a lack of recognition and appreciation for the significant work provided. Oh, and did I mention exams?!?
As advocates for physician wellness, the CMA must continue to shed light on this issue that traditionally has been underappreciated. We must work together with resident associations and program directors to ensure that on-call schedules are humane and that our trainees have the opportunity for rest, recovery, and leisure activities and studying. While prevention of burnout is the goal, we must also strive and advocate for the provision of confidential, quality support services to provide treatment for physicians, including residents, who suffer from burnout.
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?
Currently, the CMA is advocating strongly for the implementation of a national licensure system. These advocacy efforts do seem to be making an impact, and I am cautiously optimistic that we are moving towards such a system in the near future. For physicians, especially early career physicians, to have to apply for a new licence in every province is a waste of both time and money for the physician and limits employment opportunities. I think that a national licence system would be even more powerful if combined with a national locum service, housed by the CMA, that would help connect physicians looking for employment with nationwide locum opportunities.