This past week has been a remarkable one. I believe I have grown in my understanding of the responsibilities of the CoM with regards to Aboriginal communities.

On Wednesday and Thursday, I had the good fortune of participating in Building Reconciliation: Universities Answering the TRC’s Calls to Action. Our chancellor Blaine Favel and our new president Peter Stoicheff demonstrated great leadership in initiating this important national forum at the University of Saskatchewan. Representatives from more than 50 universities in Canada—including 14 presidents—were here to learn, exchange ideas and set collective goals for responding to the recommendations of the TRC.  There were also Aboriginal student leaders, faculty and staff from the University of Saskatchewan who contributed valuable local knowledge to the TRC conversations.

In fact, three of those recommendations are specifically directed at medical schools.

20. We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.
21. We call upon all levels of government to:
    1. Increase the number of Aboriginal professionals working in the health-care field.
    2. Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
    3. Provide cultural competency training for all health- care professionals.

22. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.

Saturday night I attended the meeting of the Indigenous Physicians Association of Canada (IPAC) and brought greetings on behalf of the CoM. The president of IPAC is Dr. Alika Lafontaine, an alumnus of the CoM and anesthetist in Edmonton. I also had the pleasure of listening to the keynote speech by Dr. James Makosis, a family doctor from Alberta who also has a Master’s degree in Public Health. Dr. Makosis spoke eloquently about issues of reconciliation, aboriginal history and aboriginal health.

I learned many things from Aboriginal and university leaders this week. In the summation on Thursday at noon, a panel of university presidents and an active audience developed some great take-home messages. Dr. Ralph Nilson of Vancouver Island University emphasized the importance of seeing each other as equals and learning to respect different ways of knowing. Dr. William Robins of University of Victoria at University of Toronto said that he learned: stories matter, naming the problem matters, and relationships matter. An Aboriginal leader, Leroy Little Bear, stated that presidents can help change the conversation, and Dr. Vianne Timmons of University Regina extended that responsibility to all leaders at universities.

Peter Stoicheff emphasized again if not here, where and if not now, when? He also stressed that we all should feel a sense of urgency and impatience but should set a tone of hope and enthusiasm. In terms of our obligation to do research that benefits Aboriginal communities, he reiterated the principal that Aboriginal people stress: nothing about us, without us.

Aboriginal leaders included our students, Chancellor Blaine Favel, Chief Perry Bellegarde, National Chief of the Assembly of First Nations (and from Saskatchewan) and Honourable Justice Murray Sinclair, Commissioner of the Truth and Reconciliation Commission of Canada. Justice Sinclair had, for me, the most important insight for the College of Medicine: education is the key to reconciliation.  Justice Sinclair also said: “By including teaching around residential schools in Canadian curriculum, we are not only opening the door to having Aboriginal people become part of the circle, we are also opening the eyes of Canadians to the fact that they have been educated in the public schools about Aboriginals historically, and even today, in (a way) that is simply wrong and doesn’t contain accurate information.”

With 63 self-identified Aboriginal graduates and 31 Aboriginal students here at the College of Medicine, it could be easy to sit back and say we’re doing pretty good. I came away from this week learning we have so much more to do.  Demographic projections for Saskatchewan now show the population is more than 15 per cent Aboriginal people and suggest that by 2030 this number will be more than 25 per cent. Our current enrolment target of 10 seats for Aboriginal students is inadequate.

I ask what our collective responsibility is in ensuring Aboriginal communities, families, and students feel comfortable to bring their cultures and traditions into our University and College of Medicine environment?  How do we continue to work with Aboriginal students so they feel they don’t have to hide their identity and ways of being in order to fit into the “culture of Medicine”?

While visiting Île-à-la-Crosse this summer, I saw the abandoned building that formally housed sequentially both the residential school and the drug and alcohol treatment facility. I’m sure we fail to teach all of our students the health legacies of colonization, residential schools and current inequities faced by our Aboriginal people and communities.

Yes, we have much work still to do but to paraphrase President Stoicheff: what medical school in Canada is better poised to lead in responding to the TRC recommendations 20, 21 and 22? And if so, why not now?

As always I look for your feedback, welcome your comments on the blog and invite face-to-face conversations. I’m happy to meet anyone anytime on this or any other issue of importance to you. My door is always open…

Saskatchewan—like my first province of practice, New Brunswick—is under-doctored. Moving to Nova Scotia I discovered a province that had the highest per capita rate of physicians in the country (this despite one of the lower-pay schedules in the country but that is an entirely different discussion!).  For the first time I encountered signs outside clinics advertising that they were accepting walk-ins and new patients!

So what was the difference between New Brunswick and Nova Scotia? I believe it was, of course, the presences of a long-standing, highly successful medical school that resulted in the dramatic difference in the number of doctors in both provinces. This explains my passion to establish Dalhousie Medicine New Brunswick in the five years before I came to Saskatchewan. It also explains my belief that a vibrant college of medicine distributed throughout the province is key to having sufficient physicians and a high quality healthcare system for the people of Saskatchewan.

However, the world of physician employment is changing rapidly. Medical students’ seats in Canada nearly doubled between 1995 and 2008 and residency positions increased correspondingly. As a result, nationally we are now seeing physicians in some specialties and sub-specialties having difficulty finding employment. The reasons for this are multiple and complex. Certainly manpower planning for healthcare has been a challenge with a long history of boom and bust cycles in nursing and more recently in medicine.

Various agencies and jurisdictions have taken action in recent years in an attempt to resolve this issue. Some provinces, such as Nova Scotia, have implemented a structured physician resource plan that manages both the recruitment of replacement and new physicians, as well as the mix of residency positions across the specialties.

FMEC PG (Future of Medical Education in Canada – Postgraduate) has as its first recommendation: “Ensure the right mix, distribution and number of physicians to meet societal needs.” The Physician Resource Planning Task Force has been established by the deputy ministers of health in collaboration with the deans of medicine. That group has a mandate as follows:

• A pan-Canadian physician resource planning tool to better understand the complexities of physician supply;
• A process for addressing physician imbalances across identified specialties; and
• Accurate information to support decision-making by those considering and currently pursuing medical education, both in Canada and abroad.

The Royal College of Physicians and Surgeons has shown leadership in this regard having produced a study in 2013 entitled “What is really behind Canada’s Unemployed Specialists” and at that time they reported that 16 per cent of new specialists and sub-specialist positions couldn’t find work and 31 per cent were pursuing additional training to become more employable.

In 2014, the Royal College organized a national summit on physician employment. I attended a follow up meeting in the first week of November. While overall the numbers showed a possible slight improvement, there continues to be a substantial number of new physicians that are having challenges finding employment. What is also of further note is that the number of specialties involved seems to be growing quite considerably. Whereas the original data seemed to focus on three or four specialties there are now more than 12 that are reported to have graduates experiencing difficulty finding employment.

This year’s meeting was very educational and a great opportunity to learn the diverse views on this challenging problem. Some were very frustrated at the lack of hospital resources, which was the real limit, rather than patient needs. Some resident groups feel their specialty is training too many. There is generational conflict as some young specialists feel senior colleagues are taking advantage of this situation. In one study, 35 per cent of residents don’t know enough about employment prospects and 25 per cent are not confident about finding a job. Surprisingly, there were some at this year’s meeting that challenged the idea that all physicians should be gainfully employed. This was not the consensus of the meeting and was certainly not my opinion.

SaskDocs organized a recent panel discussion before medical students and residents that consisted of myself, Dustin Duncan, Minister of Health; Greg Ottenbreit, Minister Responsible for Rural and Remote Health; Dan Florizone, CEO Saskatoon Health Region; Dr. Mark Brown, President Saskatchewan Medical Association and Dr. Dennis Kendel, CEO SaskDocs. The panel listened to the concerns of the students and residents, and chief among those was the plans for the province on its physician manpower plan.

I do know that CaRMS and the issue of physician employment are among the greatest concerns facing our students and our residents. I think that one of the key things we can do as a medical school is ensure we have excellent career counselling as our students progress through medical school and residency. I also believe that as a province we need do our best to inform our students of the predicted future manpower needs in Saskatchewan so they can make informed choices.

I think this challenge of physician employment across the country has many aspects. One beneficial to Saskatchewan is that over the next 10 years we have a superb opportunity to recruit excellent doctors and, in particular, excellent academic physicians who would make major contributions to the College of Medicine. In addition, we have already seen an improvement in the retention of U of S medicine graduates in Saskatchewan. I think we need to do our best to see these national challenges around physician employment as an opportunity for us here in Saskatchewan.

I sit on the Board of CaRMS and am very interested on feedback that can assist CaRMS in helping us “ensure the right mix, distribution and number of physicians to meet societal needs.”  As always, I look forward to discussion and debate on these and other issues impacting our college and my door is always open.

A lot has gone on this fall at the College of Medicine. Most exciting is of course the news that we have come off probation with the Committee on the Accreditation of Canadian Medical Schools (CACMS) and its American equivalent, the Liaison Committee on Medical Education (LCME), and have had our accreditation extended until the spring of 2018. Thanks to all. This now gives our Vice-Dean Education Dr. Kent Stobart and his team in UGME two years to prepare for a successful accreditation in the fall of 2017, a process on which we are committed to keeping you updated.

I am currently away at meetings of the American Association of Medical Colleges in Baltimore. Last week I attended the Treasury Board meeting with our new president, Peter Stoicheff and the vice-presidents to present on the U of S and the renewal at the CoM, attended the board meeting of the Association of Faculties of Medicine of Canada and attended a RCPSC Summit on Physician Employment in Ottawa.

Another significant change in the college was the progress on the faculty transition to a “one-faculty” model. As many know, our MD faculty association members were offered an incentive package to transition to a new model of faculty engagement. The outcome is that 114/130 members expressed interest in the transition as of the deadline of October 31.

I know for many this was a complex and personally challenging decision. I spoke to at least 100 of the faculty association members to better understand their concerns. I also tried to call everyone individually and offer my apologies to the few I did not get to before the deadline. This transition is one that is a priority to me, and will continue to be a decision I’m open to feedback on as we move forward.

While this direction was established before I joined the CoM, the plan makes sense to me as I have repeatedly emphasized the biggest challenge faced by the CoM is the amount of MD time devoted to academic and scholarly pursuits compared to our medical school peers. We are moving to a model of physician engagement that is used at all Canadian medical schools and our goal is to retain all faculty members who are committed to an academic career and engage more fully MDs already in the province and newcomers to Saskatchewan.

While we tried to address many concerns, such as holding research grants, supervising grad students etc., the concern about the system’s (CoM, HRs, Gov’t) capacity to develop sufficient ACFPs and contracts prior to the end of March was heard loud and clear. To address this concern, we put together a CoM team to work with Tammy Goebel (SHR) and Ministry of Health officials. Sherry Peters, an HR professional from U of S experienced in change management, and Erin Roach, an experienced physician services administrator from RQHR, have been seconded to this team and will assist with these arrangements. They are supported by Dr. Gill White, who has been involved in the ACFP development from the start. The team is backed up by Brad Steeves and our financial team in the Dean’s Office. They are already hard at work.

In terms of the CoM team, this has been a busy fall. I am certainly thankful for the energy and dedication Brad Steeves has devoted to acting COO, while the search for a full-time replacement is proceeding quickly. We have a new director of finance, Shaz Azam. I have an acceptance for our vice-dean of research who will be announced shortly. We have completed the pathology unified head search and we are meeting final candidates in obstetrics/gynecology and medicine and have had first visits from superb candidates for the chair in MS Research. Finally, I am committed to transforming the college’s record in fund raising and in that regard I am absolutely delighted to have recruited Gail Shivak, a very experienced and highly regarded fundraiser, as our director of advancement.

Another major event this fall was an intensive financial planning exercise to provide the university and the government with a five-year projection for the CoM budget. This culminated in a two-week, all-hands-on-deck exercise that converted the plans in The Way Forward and the needs I have articulated for more MD faculty, biomedical sciences reform, distributed medical education and growing research into a comprehensive financial projection. This will be an essential piece of work as we continue on our journey to be one of the best medical schools in Canada.

Intense work continues in preparation for the PGME accreditation in December and I look forward to that opportunity to interact with our peers. There is lots to talk about in PGME with the movements towards competency-based education, social accountability in PGME and the recent concerns about the right mix of programs and positions across the country—a topic I will investigate further in the upcoming blog about the recent Summit on Physician Employment.

Finally, yesterday was an important time to reflect on the contributions made by our members of the Armed Forces—past and present. My uncle of the same name was a casualty of the Second World War. I remember many a cold day standing at Remembrance Day ceremonies as a Boy Scout and Air Cadet. I took an afternoon last week in Ottawa to visit the Aviation Museum and was reminded again of the huge contribution by the Prairies in the aviation training programs for allied air forces during the Second World War. This example took particular advantage of the Prairie landscape and weather, and is only one of many efforts and sacrifices by Canadians. I am always struck by the names of U of S casualties engraved on the stairwell wall outside the President’s Office in the Peter MacKinnon Building. If you have not seen it, I suggest you search it out someday.

As always please engage in discussion. This blog is a great place for discourse on important topics affecting the CoM. And my door is always open!