Three months after an election campaign promise by British Columbia’s Health Minister Adrian Dix to launch a new medical school, plans have yet to be announced.
Details of financing and accreditation are still uncertain and now University of British Columbia (UBC) medical students are voicing concerns about how a second medical school might negatively affect their education and careers.
“It sort of came out of nowhere,” says Billy Zhao, president of the UBC Medical Undergraduate Society. “The timeline is really surprising because a new medical school requires accreditation and approval from national regulatory bodies.”
During the NDP re-election campaign, Dix said the new school would be located at the Surrey campus of Simon Fraser University (SFU), with a first class starting as early as 2023. As Metro Vancouver’s second most populated municipality, the suburb of Surrey has a rapidly growing population of more than 517,000.
Franco Rizzuti, former president of the Canadian Federation of Medical Students and student lead for the University of Calgary’s 2016 accreditation, says launching a new medical school by 2023 is “potentially doable” but “would be incredibly pressured.”
“I think a new accreditation of a school would take, at a minimum, two years. The last new medical school was NOSM (Northern Ontario School of Medicine), and it was years in the making,” Rizzuti says.
A spokesperson for the Association of Faculties of Medicine of Canada, which accredits medical schools, says it has no update to provide.
As the province’s only medical school, UBC runs medical programs in four locations around the province – Victoria, Kelowna, Prince George and Vancouver-Fraser, where two-thirds of the 288 students enrolled each year are concentrated.
It is this Lower Mainland location that has drawn most of the medical students’ concerns. The students already rotate through Surrey Memorial Hospital, one of the Fraser Health Authority’s main teaching centres, and worry that adding hundreds more into the area will make it difficult to find sufficient clinical learning opportunities and educators.
“I rotated through Surrey for my urology rotation,” says Zhao. “My learning was really great there because I had a lot of one-on-one time with preceptors (supervising physicians). It is a concern that if there’s more medical students rotating through, there might not be enough clinical time for each student and the quality of education might go down.”
Zhao’s concerns about student saturation in the Lower Mainland are founded. Recently, a fire at Burnaby Hospital forced medical students to transfer to another Fraser Health Authority site: the Royal Columbian Hospital in New Westminster. As a result, says Zhao, preceptor time and opportunities to practise must-learn procedures were reduced for each student.
“I can’t begin to imagine if we added – I don’t even know how many – new students; it will be very difficult,” says Zhao.
Moreover, UBC students are anxious about increased competition for the bottleneck that comes after graduation: residency programs. Without completing a residency specialization, no Canadian medical graduate can practice medicine.
UBC’s Faculty of Medicine and SFU Surrey representatives have so far not explained how they plan to mitigate these concerns.
“It’s a two-step process to train a doctor,” says Zhao. “If you don’t fund additional residency spots, you won’t address the doctor shortage. You’ll just get more unmatched medical students. A lot of students are anxious.”
Matching is the algorithmic process by which medical students are contracted to a multi-year specialty and specific city placement. In the 2020 matching process, 67 Canadian medical graduates were left without a residency.
“Every year, those unmatched students get added back into the pool of applicants, exacerbating the problem,” says Zhao.
John Liu, a UBC graduate who was left unmatched this year, says the entire experience was “very stressful.”
“This one decision determines your career and where you live for two to five years or longer,” he says. “Going unmatched has a stigma to it – it gives the impression that you are undesirable. There’s still a real fear that I won’t match to anything.”
Liu says he would be happy to match to Surrey’s family medicine residency program but that “across B.C., family medicine spots are filled quickly.”
There are only 11 family medicine residency spots in Surrey available for Canadian medical graduates. Across the rest of Metro Vancouver, there are only 12 spots in downtown Vancouver and 11 in New Westminster.
Dix has remained silent on whether the province will be able to fund additional residency spots to accommodate the proposed increase in medical students. If not, each unmatched medical student will represent a lot of wasted taxpayer money. According to Rizzuti, it can cost as much as $250,000 in tuition and government-paid grants to universities to train a medical student until graduation.
“The figure comes from the annual per-medical-student loss to both faculties of medicine in Alberta when the Alberta government cut medical school enrolment in the early 2010s,” Rizzuti says, adding that there is “tremendous variability between provinces.”
Duncan Sinclair, former dean of medicine at Queen’s University in Kingston and member of the Canadian Medical Hall of Fame, says it remains unclear how B.C. will find the means to fund an undoubtedly expensive new school with hundreds of students.
“We’re going into a very difficult economic decade where most economists foresee tough financial times,” he says. “Where’s the funding for a new school going to come from? The government will have to deal with COVID-related deficit and debt.”
Given the rarity of launching medical schools, Sinclair says it is difficult to forecast how the process will play out.
“The idea of a new school in B.C. is not describable in ‘usual’ terms because new medical schools are not usual,” he says. Almost all of Canada’s medical schools were established before 1970 with the exception of NOSM, which was established in 2005.
Ake Blomqvist, an economics professor at Western University in London, Ont., says: “It’s all taxpayer funded; it’s all politics. You’re talking about very large amounts of money when talking about operating costs.”
If increasing local access to primary care practitioners is Dix’s goal, says Blomqvist, there are other options to consider that would be more economically feasible, such as importing internationally trained graduates or training less costly alternatives such as nurse practitioners.
For now, Sinclair says, he is not surprised with the media silence from provincial universities and the B.C. government.
“I think what is very likely is that all of the players are anxious to get all their ducks in a row,” he says. “I suspect negotiations are still at a relatively delicate stage.”