Health sciences > medecine

UQAM recently elected a new rector: Stéphane Pallage. During the rector's race, when I heard that he had been instrumental in the creation of a faculty of medicine at the Université du Luxembourg, where he had also served as rector, I wrote to the candidate to ask him whether he envisaged a faculty of medicine for UQAM. (I also preached for my educational parish, saying that I thought it would be optimal for such a faculty to collaborate with the faculty of education.) His response? "A Faculty of Health Sciences is conceivable in the foreseeable future." Since then, in the media, rather than "faculty of medicine", he's also used the term "faculty of health sciences".

Different universities, different names

At Université de Montréal, Université Laval and McGill University – the three oldest in Quebec – most healthcare training programs are housed in faculties of medicine. At the Université de Sherbrooke, the Faculty of Medicine and Health Sciences and health-oriented programs even have their own campus near the Centre hospitalier de l'Université de Sherbrooke (CHUS). In Montreal, the Centre hospitalier de l'Université de Montréal (CHUM) is rather far from the Université de Montréal campus. That said, it's right next to UQAM, which wouldn't hurt the proposed Faculty of Health Sciences (as Pallage pointed out in his reply to me: "The immediate vicinity of the CHUM also opens up a lot of opportunities for clinical research").

If this faculty was to be created, I hope it would offer what would be Quebec's fifth medical training program – perhaps focusing on family medicine, public health and social and community medicine, to stay close to UQAM's specialties... (Plus, it would be a nice foil to what we used to sing during my initiations at the Université de Montréal: "Les med fam devraient aller à l'UQAM, aller à l'UQAM, aller à l'UQAM" [are they still singing that nowadays?]).

More importantly, if this faculty were to be created under the name "Faculty of Health Sciences", it would be following – and accentuating – the general trend towards diversifying healthcare practice and moving away from the “hero image” of medicine. It would go even further than the Université de Sherbrooke's Faculty of Medicine and Health Sciences, by dropping "medicine" from its name altogether.

Why go beyond medicine?

Make no mistake: I have nothing against medicine or doctors. Even though I've never been the most corporatist of people, I remain attached to the profession, and above all have immense respect for the abilities of those who practice it. But I tell myself that excellent candidates are attracted by the challenges of practicing a rigorous profession, and that if medicine occupied less space in the healthcare field, the same candidates would spread out to practice other professions.

I've mentored candidates in several professions and talked to students in quite a bunch of healthcare programs – not least as part of the activities of the Forum de la relève étudiante pour la santé au Québec (FRESQue), of which I was president. There are several reasons for wanting to be admitted to limited enrolment programs such as medicine, pharmacy, physiotherapy, occupational therapy, optometry, nutrition, speech therapy and so on. First, a taste for demanding training. Secondly, the desire to help others with what often concerns them most. Finally, social recognition and a high income undoubtedly contribute for some – although I think this motivation becomes more important later, in practice.

What I think is a pity, when medicine is over-valued – leaving more or less formally the management of healthcare in the hands of doctors and giving them almost all diagnostic and therapeutic powers – is that inevitably, those who want their work to have the greatest possible impact on the lives of their clientele are strongly attracted to this profession... to the detriment of others. Pharmacy, physiotherapy, occupational therapy, etc. often become plans B, C, D, etc. even when what most interests candidates is the management of medication, physical activity and general customer occupancy.

Because doctors prescribe drugs and their dosage. Because doctors diagnose musculoskeletal disorders and prescribe physiotherapy treatments. Because doctors make occupational therapy referrals. In short, because doctors remain the control center of healthcare in Quebec. How can we be surprised, then, that this is so often the program of first choice? And that the Ferdinand-Vandry pavilion, occupied by Université Laval's Faculty of Medicine, is said to be a place where all aimed for medicine – those in the medicine program as well as those in others? (The joke doesn’t apply to the Université de Montréal, given that healthcare programs are spread across several pavilions other than Roger-Gaudry.)

Medicine, from brain to pivot

In my view, medicine should become a hub rather than a control center for healthcare. The specificity of doctors, due to the history of the profession and their current training, is to give them a global understanding of the human body – just deep enough to be able to sketch out diagnoses and treatments, which different specialists will take up and refine. After all, doesn't a physiotherapist become such a specialist in musculoskeletal disorders that he or she can be compared to a cardiologist for the heart, a gastroenterologist for the digestive system, and a pneumologist for the lungs? This role of front-line consultation and dispatch, which the current organization increasingly tends to assign to ever-better-trained nurses – nurse clinicians, specialized nurse practitioners – could remain the preserve of those doctors currently known as "family doctors", who could once again become "general practitioners" (their federation has kept this name, by the way). After all, the subjects of healthcare are always just people, not families...

Back to university programs

But I'm falling into organizational considerations, bordering on the political, which take me away from my thoughts on training. The two remain linked, because initial training not only teaches the profession, but also shapes professional identity – and creates amongst students what will later be seen in the field. Nevertheless, the specific contribution made by universities can be distinguished.

What they must hope for is that as few students as possible in non-medical health programs see them as a way to get their grades back up to apply to medicine again. In the current state of healthcare organization, this makes sense, and I'm not telling those who are in other programs for this reason to stop doing it, or to feel bad about it. If their goal is to have the greatest impact on Quebec's health, I can understand them for trying to do that. What we need is to organize care so that a greater diversity of means – and professions – can achieve this same objective.

Universities would do well to rename all their faculties of medicine "faculties of health sciences". UQAM, for example, would do no small feat by giving this name to its future faculty of healthcare training programs – especially if it includes a medical program.

It may only be symbolic, but symbols are not unimportant. The next step would be for training programs to help develop a culture of interprofessional collaboration that goes further than the few collaborative care/health sciences (CSS) courses that various universities have implemented, and which all too often remain disconnected from practice... But that's for another blog post. I hope this one has given some food for thought to those in the process of applying to university!