THE CLASS OF 1989 AND POST-MD TRAINING

Background: ''The Class of 1989'' is a longitudinal study of 1722 peop le who were awarded an MD degree by a Canadian university in 1989. Thi s paper reports on the details of their post-MD training up to spring 1996. Methods: Several medical professional and educational associatio ns in Canada and the United States provided year-by-year information o n field and location of post-MD training, certification achieved, whet her in practice and location of practice through to spring 1996. Infor mation from all sources was linked to a list of 1989 medical school gr aduates. Results: Of the 1722 graduates 57 (3.3%) never entered post-M D training in Canada; 147 (8.5%) did 1 or more years of training in th e United States. A total of 222 graduates (12.9%) took a break of at l east 1 year from training, and 301 (17.5%) changed their choice of fie ld or specialty after starting training. Substantial numbers took 1 or more years longer to complete training than would be expected based o n the prescribed length of the training program chosen. The field or s pecialty choices of the cohort produced a generalist:specialist ratio of 58:42. The final numbers in several fields depended heavily on trai nees changing their initial career choice. Interpretation: The data po int out widely differing and often very long lead times from start to completion of training. Since 1993, changes to licensure requirements have reduced opportunities for recent graduating cohorts to delay fina l career choices, take a break in training, prolong training or change initial career choices. Rigidities in the post-1993 training environm ent point to the emergence of a number of serious problems, such as di ssatisfaction and high anxiety levels among residents, licensing autho rities being faced with people who have not completed a training progr am to certification, and insufficient provision of positions for post- MD training because of underestimates of the time needed to complete t raining programs. The insights gained from this study lead to the reco gnition that planning the specialty distribution of the physician work force is highly complex and difficult.