Steven Lewis: New Canadian medical schools will fail to solve issues (2024)

Simon Fraser University, Toronto Metropolitan University and the University of Prince Edward Island are getting new medical schools to train more family doctors.

The first graduates of the new schools will be practice-ready six years after their doors open. By then, the six million-plus Canadians who now lack a regular source of care will be eight million? Ten?

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I hope the new schools teach math.

And then there’s this: Medical education is obsolete. Artificial intelligence is already better than psychiatrists at diagnosing depression, radiologists and pathologists at detecting some cancers, and family doctors at controlling high blood pressure.

Robotic surgery is more precise and steady than the most gifted surgeon. ChatGPT, barely a year old, has passed medical licensure exams. The butterflies have flapped their wings, and the hurricane is here.

Unless the graduates of the new schools are forbidden to go on to specialties — only 30 per cent of today’s medical students aspire to family medicine — most of the training will be wasted.

The general medical knowledge essential to specialists focused on a particular body part, organ or disease will be reinforced in residency training and practice. Most of what they learned in pre-med and undergraduate medical school will be used about as much as a home treadmill after January.

Forgive the rudeness in pointing out that nurse practitioners are just as good as (often better than) family doctors at primary care. It takes far less time and money to train them.

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Medical education needs more than a new paint job; it is arguably a tear-down. Educational programs, structures and standards — especially those run by universities and professions — change slowly by design. They’re already laps behind in the race to the future.

Primary care is much more than medicine. The population is older and people most at risk have complex conditions and needs that no family doctor can master alone.

The calls for team-based care are decades old. Yet health professionals are silo-trained, inclined to protect practice turf and celebrate their differences. Patients are caught in the crossfire.

To succeed, the new schools can’t be medical schools. They should be four-year schools of primary care that provide team-based training in a wide range of disciplines.

Admit students with a year of post-secondary education, like medical schools used to do. Keep tuition low or even free for students from less advantaged backgrounds.

The classroom portion of the first two years should teach the science essential to primary care, the basics of teamwork, how health systems function and the non-medical factors that account for 80 per cent of the health of individuals and populations.

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Rotate students through primary care clinics, nursing homes and other community settings to see this knowledge in action and to glimpse the practice roles that suit them best.

In years three and four, students would branch off into primary care disciplines, now called family medicine, nursing, pharmacy, the rehabilitation therapies, mental health, midwifery, etc. (Over time occupational identities may blur.)

The curriculum should be geared to population needs, not the exotic interests of specialists or professional associations. Some graduates will be immediately job-ready for certain roles; others will move on to residency training for more independent and advanced practice.

The schools should offer modular, convenient and inexpensive up-skilling courses to respond rapidly to personnel shortages and allow experienced health-care workers to retool and recharge their careers.

Scope of practice should be based on providers’ certified competencies, not lifelong, static occupational identities, decades-old training or arbitrary monopolies, regulations and accreditation standards.

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No one can foresee all future needs or the promise and limits of science and technology. That’s why the new schools should train team-oriented generalists who can thrive in and adapt to a constantly changing landscape. Career-long reinvention will be the new normal.

Education as usual will not begin to fix primary care. The new schools must break the mould to make good on the vision so often articulated, but never achieved. Bring the primary care disciplines together and give them a year to design a new approach.

Universities planning medical schools: the crystal ball is in your court.

Steven Lewis spent 45 years as a health policy analyst and health researcher in Saskatchewan and is currently adjunct professor of health policy at Simon Fraser University. He can be reached at[email protected].

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