Changes in Newfoundland medicine: A 50 year perspective
by Dr. Ian Rusted
In the last two issues of MUNMED, Dean Emeritus Dr. Ian Rusted has looked at the development of health care in the provinces. In this concluding article, he looks at the development of the medical school and its impact on Newfoundland's health care system.
To pave the way to a medical school, I recommended a meeting between the minister and deputy minister of health with University President Raymond Gushue and Dean M.O. Morgan, along with two representatives from the Newfoundland Medical Association -- myself and Dr. A.M. House. That meeting book place in mid-September of 1966? leading quickly to the McLeod-Stewart preliminary report and subsequent MacFarlane and brain Commissions. The course was rapid but not always smooth! My first formal meeting with Premier Smallwood was necessary to overcome initial resistance to any special commission.
Meanwhile, there were major changes happening to the province's health care system. The U.S. Armed Forces Hospital at Fort Pepperell was converted to a Children's Hospital, accommodating all children from Victoria and Alexander wards of the General hospital, and the Salvation Army Grace Hospital was reconstructed. These changes coincided with the Hall Royal Commission on Health Services, followed by the MacFarlane and Brain Commissions. Their recommendations and the creation of the $500 million Health Resources Fund (most of it to be matched by the provinces) led to a revolution in Canadian health care, especially in Newfoundland.
In addition to these developments, it is important to remember that Memorial University moved to its new campus in 1961-62 and immediately began to expand rapidly, including plans (in 1966) for a degree program in nursing. Also, the College of Trades and Technology was development and new hospitals began to be built. Some of the new hospitals included St. Clare's in St. John's, in Carbonear, Gander, Grand Falls, Corner Brook, St. Anthony, and at three locations in Labrador. This was followed a few years later by other new regional or community hospitals -- creating new demands, needs and opportunities for health care professionals.
With our all too common negativity, many opinions were expressed that a Newfoundland medical school would never get 25 or 30 applicants per year. In fact, the average numbers were 150 to 200 from Newfoundland and 700 in total each year. Since the advent of the medical school, students have been admitted from every region of the province -- from Capstan Island in the Straits of Belle Isle (and several other Labrador communities) to Fox Harbour, Placentia Bay and from Lumsden to Rose Blanche. This was one of the major mandates of the medical school -- to make it possible for more Newfoundlanders to choose a career in medicine -- and it has been fulfilled.
The second major objective, from the beginning, was to improve the standards of health care in the province. This too has been achieved, bringing with it increased expectations.
However, within two years of the first graduating classes, there were cries that Newfoundland would have too many doctors! By 1977 this had reached such a peak that I felt compelled to write one of only two letters that I have ever directed to a premier of our province, pointing out that:
"No anglophone medical school in Canada has all its graduates remaining in their own province. The average is closer to 60 per cent or less, ranging from 30 per cent in Saskatchewan to a high of 75 per cent of the Newfoundlander who have so far graduated from our own medical school... Most MUN graduates are in smaller Newfoundland communities, contrary to the impression created by recent press reports. From the 116 graduates in the three classes between 1973-75, 80 were Newfoundlanders and 61 of these are still in the province as of Jan. 1, 1977. Of the 46 in general practice, 36 were outside St. John's, Corner Brook or Grand Falls. They are located at Burgeo, Hermitage, Jeffreys in the Codroy Valley, Lourdes (Port au Port), Cow Head, Hampden, Springdale, Labrador City, Botwood, Bonavista, Catalina, Grand Bank, Placentia, Come by Chance and several other places."
A year later, Dean A.R. Cox and I still felt compelled to write a
letter to the editor of the Evening Telegram with similar, updated information. By this time, some of our graduates were beginning to feel that the message was clear -- most of them were not wanted in their own province.
More recently, during a severe recession with radical changes in the health care system, it is not surprising that there has been considerable concern and public criticism -- partly because of cutbacks in hospital care before many aspects of ambulatory and home care have been refined. This has been further aggravated by the out-migration of many younger people, the age group least likely to need medical care. They are also potential caregivers of older family members.
In 1965 there were only 330 MDs in the province, 178 rural and 152 urban. MUN graduates in Newfoundland have more than doubled that number of physicians. If they were to follow the usual Canadian pattern, 50 per cent would be specialists -- and most of the specialists in the province are graduates of Memorial, from both the MD and postgraduate programs. In fact, there are 100 more generalists than specialists in Newfoundland.
This province has survived worse episodes than our recent serious difficulties, many of them during these past 50 years -- a period that, I hope, I have been able to place in clearer perspective.
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