lence on the evaluating examina- tion of the Medical Council of. Canada. According ... procity between the Canadian and US ... graphically described by an Irish.
requirements are affected by the medical school from which one graduated. Medical schools in the countries Dr. Bose lists are considered "category I", since graduates have a proven record of excellence on the evaluating examination of the Medical Council of Canada. According to the registrar of the College of Physicians and Surgeons of Alberta, Dr. L.H. LeRiche (personal communication, 1988), graduates from these schools generally have fewer requirements to meet to be able to practise in Alberta than graduates from other schools. Graduation from accredited US medical schools is considered equal to graduation from a Canadian medical school because of reciprocity between the Canadian and US accreditation systems maintained by the Committee on Accreditation of Canadian Medical Schools. Dr. LeRiche noted that in Alberta graduates of all medical schools, Canadian and foreign, must have 2 years of postgraduate clinical training (internship) either in Canada or, for category I graduates, in a category I country and that temporary licences are granted to category I graduates in situations of demonstrated need - for example, when a medical school or a nonurban practice has difficulty recruiting a Canadian graduate. Information on category I schools or on the practice of medicine in Canada may be obtained from the registrar of the College of Physicians and Surgeons of the appropriate province. As to the licensing examination, graduates of foreign medical schools in many circumstances are required to write the evaluating examination of the Medical Council of Canada; only if they are successful may they write the qualifying examination, which graduates of all schools, Canadian and foreign, are required to take in Alberta. Alexandra Harrison Director of educational services Canadian Medical Association 996
CMAJ, VOL. 138, JUNE 1, 1988
"Servicing specks of pepper"S D_ r. D.C. McCaffrey's despair over the percentage of non-Canadians licensed to practise medicine in Saskatchewan in 1987 (Can Med Assoc J 1988; 138: 300) should perhaps be balanced with the associated figures. The annual graduating class in medicine at the University of Saskatchewan numbers 60. Thus, even if all of the graduates obtained a licence in their province of graduation (an unlikely event for any province), they would still represent less than half of the 159 new registrants. In the face of a perceived physician surplus worldwide (ibid: 62 and 63-64) it is unrealistic to consider expanding the number of places in Canadian medical schools despite the very real difficulties faced by Canadian applicants (ibid: 304). Rather, I suggest that distribution remains the critical issue: it is difficult to provide acceptable medical care to regions where 60% of the population live in communities of less than 50 000 people; this was graphically described by an Irish colleague in practice in western Canada as "servicing specks of pepper scattered on the floor of a refrigerator". In this light the CMA is to be applauded for starting programs to encourage rural students to pursue medical careers. Data from Manitoba have clearly indicated that this approach is more likely than financial incentives or bursary programs to result in more Canadian graduates entering rural practice (ibid: 347). Michael J. Rieder, MD, FRCPC Department of Paediatrics Hospital for Sick Children Toronto, Ont.
[Dr. McCaffrey responds:] I find incredible Dr. Rieder's contention that because there is a worldwide surplus of physicians Canada should make no effort to
educate her own young people. There is a world surplus of wheat, yet no one would contemplate importing wheat to Saskatchewan to meet domestic demand. Having worked in Moose Factory, Ont., I would wholeheartedly agree with Rieder that distribution is a major problem. Previously we tried to take physicians to every small community. This did not work. Now we must try to bring the people to centralized clinics such as the successful Lac La Ronge Clinic in Saskatchewan. We have centralized education. Why not centralized health care? D.C. McCaffrey, MD, FRCPC Chairman Department of Anaesthesia Ottawa General Hospital Ottawa, Ont.
Illicit pleasure O ne might think, judging by the smooth flow of Dr. Douglas Waugh's article in the Feb. 1, 1988, issue of CMAJ (138: 248) that Dr. Waugh has spent much of his life feeling guilty. How sad that we should consider the practice of medicine a trade rather than a profession. "Medical education" becomes an oxymoron equivalent to "military intelligence". How refreshing it would be if we allowed ourselves to be socialized to enrich and enlarge our understanding of the world without guilt. Is it not necessary to study the human condition in order to understand the medical condition? We should be encouraged to make time to read novels, biography and philosophy to become not illiterate polymaths but educated people who can understand and be empathic with the ways of the common man, a condition that perforce we must share with our patients. Dody Bienenstock, MB, BS, FRCPC Department of Psychiatry McMaster University Hamilton, Ont.
