physicians in canada physicians in canada physicians and surgeons play an important role in the provision of health care in canada. they are responsible for the promotion, maintenance, and restoration of health through the study, diagnosis, prognosis, and treatment of disease, injury, and other physical and mental impairments. as canadian medical schools solely offer the doctor of medicine (m.d.) or doctor of medicine and master of surgery (m.d., c.m.) degrees, these represent the degrees held by the vast majority of physicians and surgeons in canada, though some have a doctor of osteopathic medicine (d.o.) from the united states or bachelor of medicine, bachelor of surgery (m.b., b.s.) from europe. part of a series onhealthcare in canada health canada minister of health health act medicare health transfer non-insured health benefits controlled drugs and substances act history of medicine physicians nursing father of medicare comparison with the us indian hospital hids act topics abortion drug policy euthanasia refugees hiv/aids smoking suicide obesity canada portal physicianthe doctor by luke fildes (detail)occupationnamesphysician, medical practitioner, medical doctor or simply doctoroccupation typeprofessionalactivity sectorsmedicine, health caredescriptioncompetenciesthe ethics, art and science of medicine, analytical skills, critical thinkingeducation requiredmbbs, md, mdcm, or dofields ofemploymentclinics, hospitals, governmentrelated jobsgeneral practitionerfamily physiciansurgeonspecialist physician in order to practice in a canadian province or territory, physicians and surgeons must obtain certification from either the college of family physicians of canada (cfpc) or the royal college of physicians and surgeons of canada (rcpsc), as well as become members of the provincial or territorial medical professional regulatory authority. history hospitals were initially places which cared for the poor as those with higher socioeconomic status were cared for at home. in quebec during the 18th century, a series of charitable institutions, many set up by catholic religious orders, provided such care. the first medical schools were established in lower canada in the 1820s. these included the montreal medical institution, which is the mcgill university faculty of medicine today. in the mid-1870s, sir william osler changed the face of medical school instruction with the introduction of the hands-on approach. the college of physicians and surgeons of upper canada was established in 1839, and in 1869, it was permanently incorporated. in 1834, william kelly, a surgeon with the royal navy, introduced the idea of preventing the spread of disease via sanitation measures following epidemics of cholera. in 1892, dr. william osler wrote the landmark text the principles and practice of medicine, which dominated medical instruction in the west for the following half century. around this time, a movement began that called for the improved healthcare for the poor, focusing mainly on sanitation and hygiene. this period saw important advances including the provision of safe drinking water to most of the population, public baths and beaches, and municipal garbage services to remove waste from the city. during this period, medical care was severely lacking for the poor and minorities such as first nations. women in medicine in canada main article: women in medicine in the late nineteenth and early twentieth centuries, women made inroads into various professions including teaching, journalism, social work, and public health. in 1871, female physicians emily howard stowe and jennie kidd trout won the right for women to be admitted to medical schools and were granted licences from the college of physicians and surgeons of ontario. in 1883, emily stowe led the creation of the ontario medical college for women, affiliated with the university of toronto. these advances included the establishment of a women's medical college in toronto, as well as in kingston, ontario. stowe's daughter, augusta stowe-gullen, became the first woman to graduate from a canadian medical school. canadian healthcare system main article: healthcare in canada healthcare in canada is delivered through thirteen provincial and territorial systems of publicly funded health care, informally called medicare. it is guided by the provisions of the canada health act of 1984. the government ensures the quality of care through federal standards. the government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential as per the doctor-patient relationship. canada's provincially based medicare systems are cost-effective because of their administrative simplicity. in each province, each doctor handles the insurance claim against the provincial insurer. there is no need for the person who accesses healthcare to be involved in billing and reclaim. private health expenditure accounts for about 30% of health care financing. the canada health act does not cover prescription drugs, home care or long-term care, or dental care, which implies that most canadians rely on private insurance from their employers or the government to pay for the costs associated with these services. provinces provide partial coverage for children, those living in poverty, and seniors. programs vary by province. canada has a ratio of practising physicians to population that is below the oecd average. in 2006, it was reported that family physicians in canada earned an average of $202,000 a year. alberta had the highest average salary of around $230,000, while quebec had the lowest average annual salary at $165,000, arguably creating inter-provincial competition for doctors and contributing to local shortages at the time. in 2018, to draw attention to the work of nurses and the declining level of service provided to patients, more than 700 physicians, residents, and medical students in quebec signed an online petition asking for their pay raises to be canceled. in 1991, the ontario medical association agreed to become a province-wide closed shop, making the oma union a monopoly. critics argue that this measure has restricted the supply of doctors to guarantee its members' incomes. in 2008, the ontario medical association and the ontario government agreed to a four-year contract with a 12.25% doctors' pay raise, which was expected to cost ontarians an extra $1 billion. ontario's then-premier dalton mcguinty said, "one of the things that we've got to do, of course, is ensure that we're competitive ... to attract and keep doctors here in ontario...". in december 2008, the society of obstetricians and gynaecologists of canada reported a critical shortage of obstetricians and gynecologists. the report stated that 1,370 obstetricians were practising in canada and that number is expected to fall by at least one-third within five years. the society is asking the government to increase the number of residency positions obstetrics and gynecology by 30 percent a year for three years and also recommended rotating placements of doctors into smaller communities to encourage them to take up residence there. each province regulates its medical profession through a self-governing regulatory body, which is responsible for licensing physicians, setting practice standards, and investigating and disciplining its members. the national doctors association is called the canadian medical association; it describes its mission as "to serve and unite the physicians of canada and be the national advocate, in partnership with the people of canada, for the highest standards of health and health care." because healthcare is deemed to be under provincial/territorial jurisdiction, negotiations on behalf of physicians are conducted by provincial associations such as the ontario medical association. the views of canadian doctors have been mixed, particularly in their support for allowing parallel private financing. the history of canadian physicians in the development of medicare has been described by david naylor. since the passage of the 1984 canada health act, the cma itself has been a strong advocate of maintaining a strong publicly funded system, including lobbying the federal government to increase funding, and being a founding member of (and active participant in) the health action lobby (heal). however, internal disputes may occur. in particular, some provincial medical associations have argued for permitting a larger private role. to some extent, this has been a reaction to strong cost control; cihi estimates that 99% of physician expenditures in canada come from public sector sources, and physicians—particularly those providing elective procedures who have been squeezed for operating room time—have accordingly looked for alternative revenue sources. one indication came in august 2007 when the cma elected as president dr. brian day of british columbia, who owns the largest private hospital in canada and vocally supports increasing private healthcare in canada. the cma presidency rotates among the provinces, with the provincial association electing a candidate who is customarily ratified by the cma general meeting. day's selection was sufficiently controversial that he was challenged—albeit unsuccessfully—by another physician member. education and training medical students at halifax medical college in nova scotia in 1890. there are multiple components to the education of a physician or surgeon in canada, and the process varies slightly between provinces. medical school the mcintyre medical sciences building, central hub of the mcgill university faculty of medicine generally, in order to be admitted into a canadian medical school, one must have completed at least an undergraduate degree. however, not all medical schools in canada require a bachelor's degree for entry. for example, quebec's medical schools accept applicants after a two-year cegep diploma, which is the equivalent of other provinces' grade 12 plus the first year of university. most faculties of medicine in western canada require at least 2 years, and most faculties in ontario require at least 3 years of university study before application can be made to medical school. the university of manitoba requires applicants to complete a prior degree before admission. the association of faculties of medicine of canada (afmc) publishes a detailed guide to admission requirements of canadian faculties of medicine on a yearly basis. admission offers are made by individual medical schools, generally on the basis of a personal statement, autobiographical sketch, undergraduate record (gpa), scores on the medical college admission test (mcat), and interviews. medical schools in quebec (francophones and anglophone alike), the university of ottawa (a bilingual school), and the northern ontario school of medicine (a school which promotes francophone culture), do not require the mcat, as the mcat has no french equivalent. some schools, such as the university of toronto and queen's university, use the mcat score as a cut-off, where sub-standard scores compromise eligibility. other schools, such as the university of western ontario, give increasing preference to higher performance. mcmaster university strictly utilizes the critical analysis and reasoning section of the mcat to determine interview eligibility and admission rank. there are currently seventeen medical schools in canada. they offer a three- to five-year doctor of medicine (m.d.) or doctor of medicine and master of surgery (m.d., c.m.) degree. the only canadian medical school to offer the m.d., c.m. degree is mcgill university's faculty of medicine. although presently most students enter medicine having previously earned another degree, the m.d. is technically considered an undergraduate degree in canada. the annual success rate for canadian citizens applying for admission to canadian medical schools is normally below 10%. just over 2,500 positions were available in first-year classes in 2006-2007 across all seventeen canadian faculties of medicine. the average cost of tuition in 2006-2007 was $12,728 for medical schools outside of quebec; in quebec (for quebecers only), average tuition was $2,943. the level of debt among canadian medical students upon graduation has received attention in the medical media. medical school in canada is generally a four-year program at most universities. notable exceptions include mcmaster university and the university of calgary, where programs run for three years, without interruption for the summer. mcgill university and université de montréal in the province of quebec both offer a five-year program that includes a medical preparatory year to entering cegep graduates. while université laval in quebec city offers a four- to five-year program to all entering students (both cegep graduates and university-level students), université de sherbrooke offers a formal four-year m.d. program to all admitted students. the first half of the medical curriculum is dedicated mostly to teaching the fundamentals of, or basic subjects relevant to, medicine, such as anatomy, histology, physiology, pharmacology, genetics, microbiology, medical ethics, health law, and epidemiology, among many others. this instruction can be organized by discipline or by organ system. teaching methods can include traditional lectures, problem-based learning, laboratory sessions, simulated patient sessions, and limited clinical experiences. the remainder of medical school is spent in clerkship. clinical clerks participate in the day-to-day management of patients. they are supervised and taught during this clinical experience by residents and fully licensed staff physicians. typical rotations include internal medicine, family medicine, psychiatry, surgery, emergency medicine, obstetrics and gynecology, and