The influence of governmental decision-making on academic medicine: the Quebec experience

Canadian medicine has achieved an appropriate balance between excellence in clinical practice and clinical investigation, making our academic system the best in the world. Adequately funded, universal medicine is the best and most equitable health care system ever devised. In Québec both systems are failing because we are not a participatory democracy in which providers are consulted on decisions involving health care and education. Governmental decisions are made undemocratically, are based on dubious assumptions, and do not ensure patient flow from primary to tertiary institutions. The reduction in quotas for subspecialty residency posts and the two-year family medicine training requirement to obtain a GP's licence threatens to destroy academic medicine because we will be unable to produce sufficient numbers of specialists to populate our medical faculties, let alone conduct research. Concerted action by the Canadian Institute of Academic Medicine is essential if this catastrophe is to be avoided.