CASE STUDY

A view into our medical future two leaders and resident physicians, one the president of the Fdration des mdecinsrsidents du Qubec, and the other, vice-president of FMRQ and president of the McGill Residents Association. He is a francophone cardiology fellow; she is an anglophone pathology resident in the McGill training programs. They are both fluently bilingual, bright, engaging and dedicated to careers in medicine in Montreal. Theyrepresent possibilities -- they are the future of medicine in Canada.

These young physicians' career paths are in stark contrast to those described in a study in the Canadian Medical Association Journal that has revived the public debate about how to blunt the reported migration of medical school graduates and physicians southward to the United States. The CMAJ study, conducted by a team of Canadian and American researchers, found that one in nine Canadian-educated physicians practises in the United States and nearly half of those graduated from the University of Manitoba (8 per cent), the University of Toronto (15.2) or McGill University (24.7).

The numbers give you pause, but there is nothing simple about their meaning. McGill enjoys a reputation internationally that continues to draw exceptional students and members of the faculty from around the world, the United States included. The numbers are somewhat less surprising in the report. Anyone working in the health education or health service sectors in the United States works side-by-side with Canadian graduates.

There is a justifiable affront to nationalism that comes from the notion that Canadian-educated doctors are beating a path to the U.S.That concern is made worse by the knowledge that Canada's increasingly overburdened health system is further stretched by a shortage of physicians, and that the 10 to 30 U.S. graduates who cross the border the other way each year do little to balance the deficit.

On top of that, the cost of medical education is high - about $50,000 per student per year. While it is true that tuition for medical school is high relative to many other programs, we also have to keep in mind that more than 70 per cent of the cost of each year of medical school is actually subsidized. Therefore, over $30,000 per year of a medical student's education is paid for by Canadian government sources and a good number of these graduates never practice medicine here in Canada.

In McGill's case, there is no doubt that local work-force conditions play a role in their ability to compete with the lure of the newer, better-funded facilities, the higher salaries and the more flexible working conditions offered by many U.S. institutions. And, as the Association of Faculties of Medicine of Canada reports, it is important to remember that the United States faces a daunting doctor shortage as well. So the pressure will not lessen.

For more than a decade, the core teaching hospitals of the McGill University Health Centre network (the Royal Victoria, the Montreal General, the Montreal Children's, the Montreal Neurological Institute and the Montreal Chest Institute) have operated at best in a state of suspended development due to the delays surrounding construction of a new MUHC hospital project.

As long as the status quo in Canada maintains, we will continue to produce exceptional doctors who have to choose between treating patients in superb, modern conditions elsewhere and delivering excellent care locally in lesser surroundings.

You are the federal Minister of Health and you are tasked with solving this problem!

QUESTIONS

II. Statement of the Problem (2-3 sentences)

This section should start by presenting a concise statement of the major problem or problems. Remember, the more problems

you identify, the more solutions will be necessary or the more complex a given solution is likely to be. Some questions to ask when you formulate your definition of the problem are:

1. Have I identified the basic problem(s) or am I dealing with the symptoms?

2. If I have identified more than one problem, are they separate or related?

3. Am I putting myself in the company's shoes and looking towards the future?

III. Problem Analysis (1/2 page)

The PROBLEM ANALYSIS is the most crucial segment in the development of a case. It should be a detailed analysis, leading to your alternatives and recommendations. Concentrate on issues discussed in the unit that have caused the problems or managerial concepts that may be used to solve the problems. It should organize the basic issues or factors in the case.Do not reiterate the case-- this is a waste of time and space.

The analysis should incorporate all relevant material discussed in class and the text. Analytical arguments should be based upon the facts of the case, as well as upon logical and clear-cut reasoning. Use an objective unemotional approach in your analysis. This does not mean that you may not be persuasive in your methods of presentation. A logical grouping of related points will help, as will full development of each point. Give your analysis depth, as well as breadth; substantiate major points with minor points. Be sure that you cover each point adequately be explanation or evidence. Look at concepts like the differing parties affected by the situation.

IV. Evaluation of Alternatives (1- 2 pages)

This section should indicate 3 possible solutions. Each solution should include at least three pros and three cons (strong and

weak points) that relate to it. Based on your analysis, develop a list of alternatives for resolving the issues or problems you observed in the case. Some alternatives clearly not feasible could be omitted. All other alternatives must be formally evaluated. Determine the yardsticks to measure their feasibility, utility, and risk. It is not enough that a given action will reduce costs. There may be other offsetting disadvantages. For example, lack of capital might prohibit its use.

This section of your analysis should, using course concepts, tell why your solution(s) will work. A major objective of this section is to show clearly how you are applying course concepts to arrive at a workable solution and implementation to the problem you have identified. Be sure to stress the application of course concepts, and underline any course concepts applied during this section.

V. Recommendations (1/2-3/4 page)

Logical reasoning and evaluations will eventually narrow the several feasible alternatives to the ONE with the least

risk and/or the greatest potential reward. This recommendation must solve the problem identified, tend to optimize profits and minimize costs, and be feasible in terms of satisfying personnel, existing functional relationships, and resources available. Explain which alternative you recommend and why?

Explaining why you did NOT pick the other alternatives is also a good idea.

VI. Implementation (~ 1/2 page)

Draw up a plan for HOW you will implement your recommendation. Include dates, names and specific actions that must be

performed to accomplish or achieve your objectives. The plan should be divided into

short term(< 1yr) and long term(>5yr)

plans (timeline).