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. 2008 Feb;3(3):18-28.

Richard III, Barer-Stoddart and the Daughter of Time

Robert G Evans  1 , Kimberlyn M McGrail
Affiliations

Richard III, Barer-Stoddart and the Daughter of Time

Robert G Evans et al. Healthc Policy. 2008 Feb.

Abstract
in English, French

"Truth is the daughter of Time," said mystery writer Josephine Tey. This point, illustrated in her rehabilitation of the "villainous" King Richard III, is equally apt for a reconsideration of the 1991 Barer-Stoddart report on medical personnel. Canadian physicians have reviled these authors for "creating" a physician shortage by encouraging provincial cuts to medical school enrolment. Yet, data pre- and post-1991 are quite clear: their report did not and could not have had this effect. The physician-to-population ratio has been stable since 1989. Average physician hours of work have fallen, but per capita expenditures on physicians' services (inflation-adjusted) are rising rapidly. A flood of physicians from the major expansion of enrolments now in place threatens serious fiscal trouble over the next two decades, and is likely to pre-empt any significant system reform.

《 La vérité est la fille du temps 》, soutient l'auteure de romans-mystère Josephine Tey. Cet argument, illustré par sa réhabilitation du 《 méchant 》 roi Richard III, vaut tout autant pour un réexamen du rapport de 1991 de Barer–Stoddart sur le personnel médical. Les médecins canadiens ont reproché aux auteurs du rapport d'avoir 《 créé 》 une pénurie de médecins en encourageant les gouvernements provinciaux à réduire le budget consacré aux inscriptions dans les écoles de médecine. Pourtant, les données recueillies avant et après 1991 sont très claires : leur rapport n'a pas eu et n'aurait pas pu avoir un tel effet. Le nombre de médecins par rapport à la population est stable depuis 1989. Le nombre moyen d'heures de travail des médecins a diminué, mais les dépenses par habitant en services médicaux (ajustées en fonction de l'inflation) augmentent rapidement. L'arrivée massive de médecins à la suite d'importantes initiatives mises de l'avant pour accroître le nombre d'inscriptions dans les écoles de médecine pourrait créer de graves problèmes fiscaux au cours des 20 prochaines années et risque d'entraver toute réforme significative du système.

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Figures

FIGURE 1.
FIGURE 1.
Canada, physicians per 10,000 population, 1968–2005
FIGURE 2.
FIGURE 2.
Canadian medical schools, 1960/61–2007/08
FIGURE 3.
FIGURE 3.
Canada, physician expenditures per capita, inflation-adjusted, 1975–2007
See this image and copyright information in PMC

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References

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