Generalism versus subspecialization: changes necessary in medical education.

© 2006 Society of Rural Physicians of Canada 126 O ver 600 participants listened to data from the National Physician Survey (NPS), the Canadian Post-M.D. Education Registry (CAPER), and a debate on the issues that influence and determine career choices by medical students and residents during the inaugural Partners Meeting. This document focuses on the key issues raised during the presentations and the debate, the audience comments (both oral and written), and recommended directions for change in educational approaches. Although the ratio of practising family/general physicians to specialists has remained relatively constant over the last decade (52:48), the number of medical students making Family Medicine their first career choice match has declined from 44% in 1992 to about 25% in 2003, with some improvement in 2004. Practice entry into generalist specialties that serve a critical role in the provision of medical care in rural communities, including General Internal Medicine, General Surgery, Obstetrics and Gynecology, Pediatrics and Psychiatry, has dropped from 35% of all Royal College-registered residents certified in 1995 to 25% in 2004. Why is this a concern? Generalist physicians, including both family physicians and generalist specialists, deliver an enlarged scope of practice, covering health needs of populations in rural and remote parts of Canada as well as defined urban communities. A generalized care model has health care providers who have a better understanding of the community context, the patient’s total health status, and options to respond to current patient needs. Services are generally accessible, particularly in smaller communities, and there is greater likelihood of a longterm relationship between health care provider and patient. A specialized care model is characterized by more highly concentrated expertise available to address rare or complex problems, with service access concentrated in larger communities, resulting in greater fragmentation of care and a higher incidence of short-term relationships between health care providers and their patients. The subspecialist has a substantial depth of knowledge about spePodium: Doctors Speak Out La parole aux medecins