Letters Establishing goals and setting priorities References dian physicians ending up paying taxes 1. Stevens KD. Stemming needless deaths: “med- at different stages of life should be the icalizing” the problem of injection drug use to Uncle Sam after having had several objective. The rise in the number of [commentary]. CMAJ 2000;162(12):1688-9. hundred thousand taxpayer dollars 2. Wanger K, Brough L, Macmillan I, Goulding J, 3 female physicians has forced the impor- MacPhail I, Christenson JM. Intravenous vs sub- spent training them in Canada. tance of parenting responsibilities to cutaneous naloxone for out-of-hospital manage- Instead of seeing such programs as surface. These issues are of equal im- ment of presumed opioid overdose. Acad Emerg cost-effective, short-term solutions to Med 1998;5:293-9. portance to men. Flexibility in practice 3. Darke S, Hall W. The distribution of naloxone the oft-reported Canadian physician settings and training programs is helpful to heroin users. Addiction 1997;92:1195-9. shortage,4 people quibble about the 4. Strang J, Powis B, Best D, Vingoe L, Griffiths P, to all physicians — parents or not. Taylor C, et al. Preventing opiate overdose fatal- “significant cost” or about whether ities with take-home naloxone: pre-launch study such programs really meet the needs of of possible impact and acceptability. Addiction Bibiana Cujec 1999;94:199-204. all IMGs in Canada. Department of Medicine When faced with the possibility that University of Alberta IMGs might have to be considered for Edmonton, Alta. practice in Canada, Canadian doctors David Johnson You can’t have one without — at least the ones who have written to Departments of Medicine, Anesthesia, the other CMA publications — react by enacting and Community Health and rules to exclude them5 or faulting them Epidemiology id anyone else note the rather for having to study abroad.6 This is University of Saskatchewan bizarre, if not macabre, juxtaposi- done despite reports about the need for Saskatoon, Sask. D tion of 2 articles in the July 11 issue?1,2 more physicians7 and about how hard it One dealt with the prevention of motor is to get into medical school in Canada.8 References 1. Carr P, Ash AS, Friedman RH, Scaramucci A, vehicle injuries, whereas the other con- Being a Canadian citizen and an Barnett RC, Szalacha L, et al. Relation of family cerned improvements in organ dona- IMG who has at least US$400 000 responsibities and gender to the productivity and career satisfaction of medical faculty. Ann Intern tion rates. Seems to me you can’t have worth of postgraduate medical training Med 1998;129:532-8. it both ways! in the United States, I find myself hav- 2. Cujec B, Oancia T, Bohm C, Johnson D. Career and parenting satisfaction among medical stu- ing to head back to the United States to dents, residents and physician teachers at a Hugh M. Scott join other Canadian citizens who are Canadian medical school. CMAJ 2000;162(5): Director General also IMGs, after being unsuccessful in 637-40. McGill University Health Centre my attempts to obtain licensure here. I Montreal, Que. knew I would have a hard time trying to get medical training here but I didn’t Battling opiate overdoses References know how hard it would still be after I 1. Kent H. Combating car accidents by examining the causes. CMAJ 2000;163(1):75. received accredited training in the thoroughly enjoyed your recent arti- 2. Moulton D. NB launches ambitious Organ Do- United States. I cles on substance abuse in the June nation Network. CMAJ 2000;163(1):75. Canadians deserve the best medical 13 issue of CMAJ, especially Kyle care in the world, but are they getting it Stevens’ essay.1 I cannot help but think when doctors feel so overworked they that if the narcotic antagonist naloxone Attitudinal problems facing take job action to get funding for addi- was made readily available to heroin ad- international medical tional manpower, as physicians have dicts and others as a harm reduction graduates done in British Columbia? measure (perhaps as an expansion of a needle exchange program) there would David Roy M. Evangelista be fewer deaths from opiate overdose. .B. MacLachlan’s recent letter il- Physician After all, most addicts would have little T lustrates the attitudinal problems Lethbridge, Alta. trouble subcutaneously or intravenously Canadian citizens who graduate from injecting naloxone into an unresponsive schools outside Canada face when they References 1. MacLachlan TB. Licensing international med- 2 1 friend while awaiting a 911 response, attempt to obtain licensure in Canada. ical graduates [letter]. CMAJ 2000;163(3):260-1. and the drug would certainly not be The article on British Columbia’s 2. Andrew R, Bates J. Program for licensure for in- ternational medical graduates in British Columbia: used for recreational purposes. Indeed, experience with the licensing program 7 years’ experience. CMAJ 2000;162(6):801-3. this idea is being seriously explored in for international medical graduates 3. Andrew R, Bates J. Licensing international med- 3,4 ical graduates [letter]. CMAJ 2000;163(3):261. the addiction literature. (IMGs) showed that the program had a 4. Sullivan P. Concerns about size of MD work- 100% licensure and in-country reten- force, medicine’s future dominate CMA annual meeting. CMAJ 1999;161(5):561-2. D. John Doyle tion rate at a much lower cost than that 5. Mador ML. History lesson. CMA News 2000; Department of Anesthesia of training a physician from scratch.2 10(7):2. 6. Milburn C. Is medical school only for the rich? Toronto General Hospital The program also eliminates the possi- [letter]. CMAJ 2000;163(1):13. Toronto, Ont. bility of having newly minted, Cana- 7. Sibbald B. Southern Ontario towns hang out CMAJ • SEPT. 19, 2000; 163 (6) 697 Correspondance MD-wanted signs. CMAJ 1998;159(10):1292. gram directors thought job opportuni- Reference 8. Sullivan P. Shut out at home, Canadians flocking 1. Buske L. Where do medicine’s job opportunities to Ireland’s medical schools — and to an uncer- ties would deteriorate over the next 5 lie? CMAJ 2000;162(13):1865. tain future. CMAJ 2000;162(6):868-71. years. In the other 3 the survey results indicate that opportunities are expected [The author responds:] to either remain constant (occupational Be careful how you report medicine) or actually improve (pedi- art Harvey’s points are well taken. survey results atrics and community medicine) over BThe detailed results of the survey that time period. of program directors conducted by the Unfortunately, this article has misin- Canadian Resident Matching Service in read with great interest a recent formed the journal’s readers, particu- 1999 are shown in Table 1. I hope this 1 I Pulse column in CMAJ. However, I larly medical students who depend on will clear up the confusion caused by have several major concerns with sources such as CMAJ to make difficult the presentation of the survey results in Lynda Buske’s reporting of the survey career decisions. my CMAJ Pulse column.1 of residency program directors con- cerning job opportunities in their spe- Bart Harvey cialties over the next 5 years. Lynda Buske Assistant Professor and Community Canadian Medical Association While the statement that a majority Medicine Residency Program Director of program directors in 4 specialties Department of Public Health Sciences Reference (occupational medicine, neurosurgery, University of Toronto 1. Buske L. Where do medicine’s job opportunities pediatrics and community medicine) Toronto, Ont. lie? CMAJ 2000;162(13):1865. thought that job opportunities in their specialties would either remain constant or deteriorate over the next 5 years is Table 1: Responses of Canadian program directors surveyed by the Canadian technically correct, it is misleading. Resident Matching Service to the following question: Please speculate as to how job A detailed review of the CaRMS opportunities in your specialty will change in the next 5 years survey report shows that respondents Response (%) were asked to specify if they believed Remain job opportunities in their specialty Increase constant Decrease would (1) improve, (2) remain constant or (3) deteriorate over the next 5 years. Family medicine 73 27 0 For these 4 specialties the results of the Internal medicine 92 8 0 survey were as follows: 100% (2/2) of Obstetrics and gynecology 83 8 8 occupational medicine program direc- Anesthesia 77 23 0 tors felt that job opportunities would Radiology 100 0 0 remain constant; 22% (2/9) of neuro- Psychiatry 62 38 0 surgery program directors felt that job Pediatrics 46 54 0 opportunites would improve, 44% (4/9) Laboratory medicine 82 9 9 felt that they would remain constant Dermatology 75 25 0 Emergency medicine 70 30 0 and 33% (3/9) felt that they would de- Neurology 85 15 0 teriorate; 46% (6/13) of pediatrics pro- Physical medicine and rehabilitation 67 33 0 gram directors felt that job opportuni- Community medicine 50 50 0 ties would improve and 54% (7/13) felt Medical genetics 100 0 0 that they would remain constant; and Nuclear medicine 50 25 25 50% (2/4) of community medicine pro- Occupational medicine 0 100 0 gram directors felt that job opportu- General surgery 100 0 0 nites would improve and 50% (2/4) felt Cardiac surgery 71 29 0 that they would remain constant. Neurosurgery 22 44 33 By choosing to group “remain con- Opthalmology 67 33 0 stant” and “deteriorate” together, Buske Orthopedic surgery 67 25 8 presented a distorted view of the results. Otolaryngology 86 14 0 Imagine how the article would have Plastic surgery 86 14 0 read if she had chosen to group “con- Thoracic surgery 100 0 0 stant” and “improve” together.