The Canadian Medical Association's Policy on Physician Health and Well-being.

BACKGROUND Canada has seen its health care system undergo significant reorganization over the past decade. In the mid to late 1990s, Canadian physicians identified 4 pressures that were contributing to the strain on the system. The greatest pressure was fiscal as the federal government withdrew large amounts of funding for health. A second major pressure came from the dwindling pool of physician resources. Canada cut down on the number of students permitted entry into medical school, withdrew funding for postgraduate training slots, decreased funding for physicians who wished to return for a second residency, and limited the ability of international medical graduates to enter the country. Many physicians left Canada to practice in other countries. A third pressure came from serious divides within the profession. Established physicians reached agreements with several provincial governments that directly discriminated against new graduates. Further pressure came from changes in the education and training system, including dramatic increases in tuition fees for medical students, attempts by universities to impose tuition fees on postgraduate trainees, and the requirement by medical students to choose their specialty at a much earlier phase of training. In this context, physicians began to slowly report growing problems managing stress. In 1997, one local headline quickly became national news: “Doctor Suicide Soaring: HSC Resident’s Death Significant Wake Up Call” ..................