CFMS Lobby Day Ask 2012

Canadian Federation of Medical Students Fédération des étudiants et des étudiantes en médecine du Canada www.cfms.org

EXECUTIVE SUMMARY In Budget 2011, the Government of Canada announced a program to improve access to primary health care in rural and remote regions.1 The Canadian Federation of Medical Students (CFMS) believes that all Canadians - regardless of location – deserve adequate, quality care. In turn, the CFMS hopes to work with the Canadian Government to strengthen health care in underserved areas across the country.

This year, as policy-makers consider health care transformation options, the CFMS is focusing on measures that could more effectively attract doctors to rural and remote regions. Whereas economic and structural barriers hamper efforts to attract primary health care professions to underserved areas, the CFMS proposes two courses of action: (a) The federal government should defer repayment of the principal of, and interest on, the federal portion of Canada Student Loan Program (CSLP) loans until the end of students' residency training; and, (b) Health Canada should allocate $50,000 per year to each medical school for the purpose of recruiting candidates from rural and remote communities.

DEFERRING LOAN REPAYMENT As of 2012-2013, the Government of Canada will forgive a fraction of the federal portion of the Canada Student Loans for new family physicians who practice in a rural or remote community up to $8,000 per year, to a maximum of $40,000 over five years. This program will provide financial relief for recent medical graduates while boosting primary care in underserved areas.

However, the CSLP will still require medical residents to make payments on both the principal of the undergraduate loan and interest accrued during postgraduate residency training. Many primary care physicians pay off a large portion of their federal loan prior to completing their postgraduate medical education, or residency; these physicians would not benefit from the new CSLP relief program. Consequently, the incentive to practice in a rural or remote community is considerably diminished.

British Columbia, Alberta, Manitoba, Ontario and Prince Edward Island already offer medical residents loan- and interest-relief on the provincial-territorial portion of the Canada Student Loan during residency training. Likewise, it would be advantageous for the federal government to offer the same loan- and –interest relief on the federal portion of the Canada Student Loan for medical trainees. In addition to aligning federal and provincial-territorial policies, this would more effectively attract primary care physicians to rural and remote areas.

The CFMS calls upon the Government of Canada to defer repayment of the principal and interest accrued on the federal portion of medical graduates’ Canada Student Loans until the completion of their residency training.

PROVIDING UNIVERSITIES RECRUITMENT ASSISTANCE Although 22 percent of Canadians live in a rural or remote area, only 17 percent of family doctors and three percent of specialists practice rurally.2 This mismatch leads to decreased access to health care for rural Canadians and has negative health implications. Students from rural backgrounds are 2.5 times more likely to practice rural family medicine,3 but are underrepresented in medical school classes.4 This is partially due to the absence of mentors, inadequate preparation during pre-medical years and a lack of knowledge about educational opportunities.

Many “pipeline programs� in the United States and Australia have tried to remedy such barriers through a combination of academic tutoring, mentorship, career exposure, research opportunities, and admissions preparation. These programs work. Since the start of the Australian Rural Undergraduate Support and Coordination Program in 1994, the proportion of medical students of rural origin has increased from 10 percent in 1989 to 25 percent in 2000.5 The CFMS proposes that the federal government support such initiatives in Canada through start-up and operating grants for medical schools to implement mentorship programs that meet the following criteria: (a) Be affiliated with a Canadian medical school; (b) Targets a defined group currently under-represented in Canadian medical schools (e.g. rural, aboriginal); (c) Provides, free of charge, some combination of academic tutoring, mentorship, career exposure, research opportunities and admissions preparation; and, (d) Includes longitudinal follow-up and monitoring metrics to gauge the success of the program.

Whereas mentorship programs could benefit the Canadian medical community, the CFMS calls upon Health Canada to allocate $50,000 per year to each medical school for the purpose of establishing mentorship programs that recruit medical school candidates from rural and remote communities.

References 1. Government of Canada. The Next Phase of Canada's Economic Action Plan: A Low-Tax Plan for Jobs and Growth. Ottawa, ON: 2011.

2. Society of Rural Physicians of Canada. Admission of Rural Origin Students to Medical School: Recommended Strategies. Shawville, QC: 2004.

3. Rourke J, Dewar D, Harris K, Hutten-Czapski P, Johnston M, Klassen D, Konkin J, Morwood C, Rowntree C, Stobbe K, Young T; Task Force of the Society of Rural Physicians of Canada. Strategies to increase the enrolment of students of rural origin in medical school: recommendations from the Society of Rural Physicians of Canada. CMAJ. 2005; 172(1): 62-5.

4. Kwong JC, Dhalla IA, Streiner DL, Baddour RE, Waddell AE, Johnson IL. A comparison of Canadian medical students from rural and non-rural backgrounds. Can J Rural Med. 2005 Winter; 10(1): 36-42.

5. Dunbabin JS, Levitt L. Rural origin and rural medical exposure: their impact on the rural and remote medical workforce in Australia. Rural and Remote Health 3 (online). 2003; 1-17.

ENDORSEMENTS

The Canadian Federation of Medical Students (CFMS) is the representative voice of Canadian medical students to the federal government, to the public, and to the national medical organizations. We are a group representing over 7,500 medical students at 14 Canadian medical schools from coast to coast. It is our mission to provide representation, services and communication within our membership and to the world at large. We are an ever expanding organization which continually strives to meet the needs of Canadian medical students.

CFMS MEMBER SCHOOLS University of British Columbia University of Alberta University of Calgary University of Saskatchewan University of Manitoba Northern Ontario School of Medicine University of Western Ontario

McMaster University University of Toronto Queen’s University University of Ottawa McGill University Dalhousie University Memorial University of Newfoundland

FOR FURTHER INFORMATION Noura Hassan, CFMS President ChloĂŠ Ward, CFMS Vice-President Advocacy Matthew Tenenbaum, CFMS Vice-President Communications

Canadian Federation of Medical Students 324 Somerset Street West, Suite 300 Ottawa, ON K2P 0J9 Phone: (613) 565-7740 Fax: (613) 288-0524 www.cfms.org

president@cfms.org vpadvocacy@cfms.org vpcommunications@cfms.org