Through the twentieth century, the nature of medical practice has changed more quickly, more dramatically, and far more publicly than that of any other profession in Canada. In this study Bernard Blishen identifies the social and political pressures on the medical profession and assesses how it has responded to them. Among the changes doctors have confronted are third-party pressures from government and hospital bureaucracies, greater public knowledge, improved technology, recognition of patients’ rights, and legal challenges. Blishen discusses how the doctors achieved dominance in the health field, reviews demographic changes within the profession and the larger population, examines data on the changing health status of Canadians, and charts physician supply against patient demand. He finds that the chief source of his profession’s collegial strength has been the homogeneity of its membership. This homogeneity is declining with increasing numbers of women and ethnic groups in the profession and increasing specialization. Blishen offers a comprehensive, quantified overview of a profession in transition, and suggests the implications of its changes for all Canadians.

This report explores various ways to increase the relevance of education for health care professionals as a strategy for improving the quality of health care and increasing access to services. Noting that the health work force can account for up to 70 percent of the health budget, the report concentrates on innovations in education that can make learning easier and more efficient while also producing graduates equipped with the knowledge and skills most relevant to high priority health problems. Particular attention is given to factors that are known to influence the success of two kinds of innovations: those dealing with the learning process and those dealing with the relevance of education to community needs and practices. The report also challenges educational institutions to expand their sphere of influence to include advice and guidance on the development of health policy and services and provides examples of innovative approaches. The report is organized in five main sections that cover the following topics: (1) the need for a fresh look at the education of health professionals, (2) learning from innovations in the education of health professionals; (3) creating links with new partners in the community; (4) strategies for change applied to health systems and to educational institutions; and (5) organizational and practical issues. Recommendations are made to educational institutions, member nations of the World Health Organization (WHO), and to WHO as an organization. Contains 24 references and 10 suggestions for further reading. (KC)

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