What does Brian Day say (or not) about privatized medical education?

In August, the Canadian Medical Association passed a resolution during its annual meeting in Montreal calling for “public-private partnerships to facilitate the expansion of medical school capacity.” According to Brian Day, an orthopaedic surgeon and immediate past president of the Canadian Medical Association, Canada has a single-payer problem in medical education and in payment for physician services, which he said means “splitting up a pie that’s not big enough” resulting in a “rationing of resources.” During a talk to the University of British Columbia Clinical Faculty Association in October, he emphasized that Canadian health care is underfunded, and he predicted that, consequent to the Chaoulli decision, all provinces will follow Quebec`s lead to allow private funding of medically necessary services.

According to Dr. Day, private funding is needed: “That’s the way we’re going to get better health care for more people and how we’re going to get better funding for medical education.” He gave examples of private funding for medical infrastructure in Vancouver: the Jack Bell Research Centre, the Pattison Pavilion of the Vancouver General Hospital, and the Gordon and Leslie Diamond Health Care Centre. “This is all private money going into ‘public health care,’” he said, but if he meant to illustrate how the profit motive can enhance health care, his examples failed him. All three of these buildings, which are part of the Vancouver General Hospital clinical, education, and research campus, were named for prominent BC philanthropists.

I join Dr. Day in applauding the generosity of these donors, and I hope that wealthy people will continue to enhance medical research and education in Canada through charitable giving. But donation is not the same as investing in health care funding and delivery in order to generate profit. Surely the distinction does not escape Day, so his confusion is puzzling. Furthermore, he mentioned none of the problems that commercial health care can bring, which Dr. Marcia Angell presents in a recent Canadian Medical Association Journal essay. You can read more about peer-reviewed research on the downside of privatization on the CDM Web site.

As the meeting drew to a close, Day pointed out that Canada has too few physicians. Given a physician density of 2.1/1000 compared with a mean of 3.1/1000 among OECD countries, few would argue that Canada should not train more doctors. Day then brought up the proposal of a new medical school situated in BC’s Fraser Valley and affiliated with Simon Fraser University. This is the best thing that could happen to the UBC clinical faculty, he said, because UBC has a monopoly. He suggested that clinical faculty, some of whom are unhappy about UBC’s unwillingness to bargain with them collectively, would be better off if another institution provided competition. When an audience member asked about the role of a public-private partnership in the venture, he said the medical school would likely be in Surrey, BC and added, “I know more than I can tell you.”

According to two members of the SFU Faculty of Health Sciences, the medical school they and their peers envision would promote primary care and community medicine. Brian Day is not known as a champion of these issues. He founded a private surgical clinic, and during his remarks, he said that once Canada eliminates wait lists, medical tourism can develop as a “big industry” to provide procedures for well-off foreigners. This would be a source of funding for domestic health care, but he didn`t go so far as to say it could also create profit for investors and clinic proprietors, such as himself. Before the meeting ended, Day and some supporters obtained a hasty vote, with as many abstentions and nays as yeas, in support of the concept of a second medical school in BC.

Do we need more medical graduates? Yes, and UBC has just expanded its entering medical class to 256 students. It’s unlikely that the province will support another medical school right away, given the establishment of campuses in Prince George, Victoria, and Kelowna. Private money may be necessary to open a second faculty of medicine, but private-school graduates would come away with high debt, and if Day’s vision of commercialized payment and delivery prevails, perhaps an indoctrination.

Randall F. White, MD