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World J Surg (2007) 31:15361544 DOI 10.1007/s00268-007-9072-9
Surgical Education in the Canadian Socialized Health Care System
Gilles Beauchamp
Published online: 30 May 2007 Socit Internationale de Chirurgie 2007
The International Surgical Week (ISW) met in Toronto more than 15 years ago, and since then the practice of surgery in Canada has changed signicantly. During that interval the Canadian Health Care System (CHCS) has entered into a crisis followed by a reform that is still ongoing. The crisis has touched all aspects of the surgical practice as well as medical education.
What has happened in the CHCS during the last 15 years? Has the training of the residents in surgery been altered by the evolution and changes in the CHCS? What are the events that have modied the training of our surgical residents? What have been the reactions and responses of university departments of surgery to deal with the heath care crisis and its impact on the surgical training? These are some of the questions that visitors, especially our neighbors from the United States may ask Canadian surgeons at the ISW meeting this year in Montreal.
American surgeons are practicing in a very different health care system. Some think that the Canadian surgeons are working in a socialized health care system that is not very efcient. This article should shed some light on the recent evolution of the CHCS. Although there are great similarities between the Canadian provinces, the province of Quebec is renowned for having the most socialized health care system in Canada. My comments are based on my experience as a chairman of a university department of surgery in that province.
Canadian health care system
In Canada, all health care institutions are under the Canada Health Act. The Canada Health Act, which is part of the Canadian federal legislation adopted by the Parliament of Canada in 1984, lists the conditions and criteria to which the provinces must conform in order to receive funding from the federal government for health care delivery [1, 2].
The purpose of this law was to maintain national standards for public health care delivery. It established the principles for the entire country. The Act lists a set of criteria such as public administration, comprehensiveness, universality, portability, and accessibility that each...