LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors ofaccepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publication les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite (ocorrespondance> sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession des droits d'auteur. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou dejia paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Tobacco control boards? I could not agree more with the contention of Dr. John C. Acres in his letter "A licence to smoke?" (Can Med Assoc J 1992; 147: 847) that the medical model has failed and will never succeed in preventing smokingrelated diseases. The extreme example of this is the fact that families of patients dying of smoking-related tumours virtually never show any willingness to give up smoking themselves. I think that the principle of a nonmedical solution is a sound one, but the idea of a licence for current smokers is both impractical and naive. It would be extremely difficult to prove who is and who isn't a current smoker, and, as long as tobacco is readily -
For prescribing information see page 1877
accessible, licensed smokers could purchase cigarettes for the nonlicensed. Furthermore, the licensing procedure would create an unwieldy bureaucracy. I think a much simpler solution would be to severely restrict the accessibility of tobacco. Cigarettes should be sold by government-run tobacco control boards, which would carry generic packages and operate from 0900 to 1530. Purchasers would have to provide proof of legal age. Selling tobacco by any commercial outlet would be completely illegal and strict penalties enforced. All profit generated by the boards could be used to fund antismoking advertising targeted at the preadolescent and adolescent. A most effective campaign would feature high-profile athletes and entertainers showing that smoking is neither glamorous nor "cool." Ellen Warner, MD, FRCPC Director of medical oncology St. Michael's Hospital Toronto, Ont.
Pushing tobacco T he Oct. 15, 1992, issue of CMAJ contains in the Letters section a healthy discussion about tobacco, arising from an article by Charlotte Gray (Can Med Assoc J 1992; 146: 2230-2232), which I didn't read. One day in the late 1920s, when I was a medical student, a man appeared on the campus and gave medical students three boxes, labelled A, B and C, each containing 100 cigarettes. He said that after we had smoked them all he would return to find out which brand we liked best. He never did return. It is significant that he didn't make the engineering students this offer. Obviously the tobacco industry was intent on making smokers out of medical students, then lay people would not hesitate to follow the doctors' example. How's that for pushing? Hyman J. Skully, MD Vancouver, BC
[Dr. Acres responds:] Dr. Warner's proposed solution is certainly one that I could support
were it to be adopted by any government in this country. The purpose of my letter was to provoke this kind of response and not necessarily to promote my solution as the only possible one.
Why another examination? he Editor's Page in the May 1, 1992, edition of CMAJ (146: 1515), by Dr.
I hope that others will write Bruce P. Squires, on the topic of a to CMAJ with their proposals and second part to the Medical Counthat eventually the CMA will cil of Canada (MCC) examination adopt what seems to be the best of mainly questions the need for the lot and recommend it strongly such an examination. However, to all governments in this country. there are other reasons to be seriously concerned about this new hurdle. John C. Acres, MD, FRCPC Moncton, NB As the longest serving resiCAN MED ASSOC J 1992; 147 (12)
1743
dency director at Dalhousie University and the longest serving psychiatry residency director in Canada I have had ample experience of the disruption to proper study when postgraduates face the annual May examination to become a licentiate of the MCC (LMCC). Since virtually all Canadian graduates succeed in this examination either in the final year of undergraduate study or during the first postgraduate year this problem has, up to now, been one entirely affecting the progress of foreign medical graduates. Last year and this year in my small psychiatry program I saw residents distracted from their proper fields of study because of the LMCC examination. With the introduction of the new, part II examination all postgraduates will be distracted well into the second postgraduate year. One might assume that planners in both the family practice and the specialty streams would have ensured a fairly broad range of experience for residents in the first postgraduate year. However, for reasons of convenience and logistics the MCC is planning to hold its second LMCC examination in November of the second postgraduate year. Thus, specialty training program directors can expect their trainees to be distracted from their chosen field of study from some time in the middle of the first postgraduate year until almost halfway through the second. Whenever I review the new licensing requirements and the changes overall in postgraduate education I echo Maurice Chevalier, who used to sing "I'm glad I'm not young any more."
in prelicensure training rules leaving sour taste in medical students' mouths," by Simon Kirby (ibid: 1617-1619), then president of the Canadian Federation of Medical Students (CFMS). Kirby's main points are as follows: first, although a portable licence was a major goal of the new system, it may not be achieved; second, the new, part II qualifying examination is costly to students and entirely unnecessary if they are also to be evaluated by a college; and, third, the new system provides considerably less flexibility in career choice and route to licensure and may coerce students into choosing a specialty too early. As a final-year medical student I wish to comment on the lack of communication by the licensing bodies and on the significant decrease in flexibility in routes to licensure. After I had completed my first year of medical school I was appalled to discover that my class would be the first to be required to complete the 2-year internship. I think that the licensing bodies have a lot of gall to make decisions about our futures without telling us before we enter our career program. It is one thing to start a course of training knowing what is in store so that it can be planned for and quite another to have the requirements changed in midflight. Why was this not in my application package? Worse, 2 years later none of us is completely sure what those final requirement possibilities are, only months before our applications to the Canadian Intern and Resident Matching Service are due. Who's running the show here? It certainly appears as if this whole process has been extremely poorly orgaWilliam 0. McCormick, MB, FRCP nized. Medical/clinical director In the next few months we and director of postgraduate must come to grips with a choice psychiatric education of training propostgraduate Dalhousie University Halifax, NS grams. Many of us can choose between family medicine and speI was interested to read "Changes cialty training. However, it is not
1744
CAN MED ASSOC J 1992; 147 (12)
true that most graduating students know which specialty they will choose. In the past many general licensees have spent time practising before deciding on a specialty. Can we go to Africa and work for a year or two? Can we work in northern Ontario for a year or two? Can we join Medecins sans frontieres and work where there is a need? The answer is Not immediately, despite the fact that now (when most of us do not have family commitments) is the best
time. To get a licence we must now also be certified by a college. The shortest route is through 2 years of family medicine training. We know that the Ontario government may restrict billing numbers in the near future. It is not surprising that the Professional Association of Internes and Residents of Ontario in its May 1992 open letter to third-year and fourthyear medical students advised us to get our licences in the shortest time possible, obtain a billing number and start working. Undoubtedly family medicine is unprepared and in the long run will be unwilling to take in all those graduates who do not wish to do specialty training immediately. Although, in general, medical students are flexible and could enjoy practising in various types of medicine, many will be forced into something they do not want to do. This is reduced flexibility. It will not be surprising if students choose family medicine to obtain their licence quickly, work for a couple of years (perhaps in underserviced areas in the North or in underprivileged areas of the world) to pay off debts and gain clinical experience and then return for more training. Michael D. Hill Class of 1993 University of Ottawa Ottawa, Ont.
Three cheers for Mr. Kirby's valiant attempt to describe the plight LE 15 DECEMBRE 1992
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors ofaccepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publication les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite (ocorrespondance> sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession des droits d'auteur. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou dejia paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Tobacco control boards? I could not agree more with the contention of Dr. John C. Acres in his letter "A licence to smoke?" (Can Med Assoc J 1992; 147: 847) that the medical model has failed and will never succeed in preventing smokingrelated diseases. The extreme example of this is the fact that families of patients dying of smoking-related tumours virtually never show any willingness to give up smoking themselves. I think that the principle of a nonmedical solution is a sound one, but the idea of a licence for current smokers is both impractical and naive. It would be extremely difficult to prove who is and who isn't a current smoker, and, as long as tobacco is readily -
For prescribing information see page 1877
accessible, licensed smokers could purchase cigarettes for the nonlicensed. Furthermore, the licensing procedure would create an unwieldy bureaucracy. I think a much simpler solution would be to severely restrict the accessibility of tobacco. Cigarettes should be sold by government-run tobacco control boards, which would carry generic packages and operate from 0900 to 1530. Purchasers would have to provide proof of legal age. Selling tobacco by any commercial outlet would be completely illegal and strict penalties enforced. All profit generated by the boards could be used to fund antismoking advertising targeted at the preadolescent and adolescent. A most effective campaign would feature high-profile athletes and entertainers showing that smoking is neither glamorous nor "cool." Ellen Warner, MD, FRCPC Director of medical oncology St. Michael's Hospital Toronto, Ont.
Pushing tobacco T he Oct. 15, 1992, issue of CMAJ contains in the Letters section a healthy discussion about tobacco, arising from an article by Charlotte Gray (Can Med Assoc J 1992; 146: 2230-2232), which I didn't read. One day in the late 1920s, when I was a medical student, a man appeared on the campus and gave medical students three boxes, labelled A, B and C, each containing 100 cigarettes. He said that after we had smoked them all he would return to find out which brand we liked best. He never did return. It is significant that he didn't make the engineering students this offer. Obviously the tobacco industry was intent on making smokers out of medical students, then lay people would not hesitate to follow the doctors' example. How's that for pushing? Hyman J. Skully, MD Vancouver, BC
[Dr. Acres responds:] Dr. Warner's proposed solution is certainly one that I could support
were it to be adopted by any government in this country. The purpose of my letter was to provoke this kind of response and not necessarily to promote my solution as the only possible one.
Why another examination? he Editor's Page in the May 1, 1992, edition of CMAJ (146: 1515), by Dr.
I hope that others will write Bruce P. Squires, on the topic of a to CMAJ with their proposals and second part to the Medical Counthat eventually the CMA will cil of Canada (MCC) examination adopt what seems to be the best of mainly questions the need for the lot and recommend it strongly such an examination. However, to all governments in this country. there are other reasons to be seriously concerned about this new hurdle. John C. Acres, MD, FRCPC Moncton, NB As the longest serving resiCAN MED ASSOC J 1992; 147 (12)
1743
dency director at Dalhousie University and the longest serving psychiatry residency director in Canada I have had ample experience of the disruption to proper study when postgraduates face the annual May examination to become a licentiate of the MCC (LMCC). Since virtually all Canadian graduates succeed in this examination either in the final year of undergraduate study or during the first postgraduate year this problem has, up to now, been one entirely affecting the progress of foreign medical graduates. Last year and this year in my small psychiatry program I saw residents distracted from their proper fields of study because of the LMCC examination. With the introduction of the new, part II examination all postgraduates will be distracted well into the second postgraduate year. One might assume that planners in both the family practice and the specialty streams would have ensured a fairly broad range of experience for residents in the first postgraduate year. However, for reasons of convenience and logistics the MCC is planning to hold its second LMCC examination in November of the second postgraduate year. Thus, specialty training program directors can expect their trainees to be distracted from their chosen field of study from some time in the middle of the first postgraduate year until almost halfway through the second. Whenever I review the new licensing requirements and the changes overall in postgraduate education I echo Maurice Chevalier, who used to sing "I'm glad I'm not young any more."
in prelicensure training rules leaving sour taste in medical students' mouths," by Simon Kirby (ibid: 1617-1619), then president of the Canadian Federation of Medical Students (CFMS). Kirby's main points are as follows: first, although a portable licence was a major goal of the new system, it may not be achieved; second, the new, part II qualifying examination is costly to students and entirely unnecessary if they are also to be evaluated by a college; and, third, the new system provides considerably less flexibility in career choice and route to licensure and may coerce students into choosing a specialty too early. As a final-year medical student I wish to comment on the lack of communication by the licensing bodies and on the significant decrease in flexibility in routes to licensure. After I had completed my first year of medical school I was appalled to discover that my class would be the first to be required to complete the 2-year internship. I think that the licensing bodies have a lot of gall to make decisions about our futures without telling us before we enter our career program. It is one thing to start a course of training knowing what is in store so that it can be planned for and quite another to have the requirements changed in midflight. Why was this not in my application package? Worse, 2 years later none of us is completely sure what those final requirement possibilities are, only months before our applications to the Canadian Intern and Resident Matching Service are due. Who's running the show here? It certainly appears as if this whole process has been extremely poorly orgaWilliam 0. McCormick, MB, FRCP nized. Medical/clinical director In the next few months we and director of postgraduate must come to grips with a choice psychiatric education of training propostgraduate Dalhousie University Halifax, NS grams. Many of us can choose between family medicine and speI was interested to read "Changes cialty training. However, it is not
1744
CAN MED ASSOC J 1992; 147 (12)
true that most graduating students know which specialty they will choose. In the past many general licensees have spent time practising before deciding on a specialty. Can we go to Africa and work for a year or two? Can we work in northern Ontario for a year or two? Can we join Medecins sans frontieres and work where there is a need? The answer is Not immediately, despite the fact that now (when most of us do not have family commitments) is the best
time. To get a licence we must now also be certified by a college. The shortest route is through 2 years of family medicine training. We know that the Ontario government may restrict billing numbers in the near future. It is not surprising that the Professional Association of Internes and Residents of Ontario in its May 1992 open letter to third-year and fourthyear medical students advised us to get our licences in the shortest time possible, obtain a billing number and start working. Undoubtedly family medicine is unprepared and in the long run will be unwilling to take in all those graduates who do not wish to do specialty training immediately. Although, in general, medical students are flexible and could enjoy practising in various types of medicine, many will be forced into something they do not want to do. This is reduced flexibility. It will not be surprising if students choose family medicine to obtain their licence quickly, work for a couple of years (perhaps in underserviced areas in the North or in underprivileged areas of the world) to pay off debts and gain clinical experience and then return for more training. Michael D. Hill Class of 1993 University of Ottawa Ottawa, Ont.
Three cheers for Mr. Kirby's valiant attempt to describe the plight LE 15 DECEMBRE 1992
