Pain management training for doctors faces funding issues

It took more than seven years of lobbying, but the first two residents in Canada's first accredited pain medicine program will begin their training this July at Western University's Schulich School of Medicine & Dentistry.

Dr. Pat Morley-Forster is the medical director of the Pain Management Program of St. Joseph's Health Care London and a professor at Western, where shehas led the charge for the program to be approved by the Royal College of Physicians and Surgeons as an accredited sub-specialty program.

She says, until now, there have been no standards in the country for doctors who manage chronic pain.

"When a patient went to a pain clinic, they could have somebody who was a family doctor, who perhaps attended a few weekend courses or a month course, or they could have had somebody who is a long-term specialist," Morley-Forster said.

"Now we are not only going to provide the public with certified and recognized pain specialists, but they will have had two years of training that encompasses psychiatry and rehabilitation and palliative care and pediatric pain," she says.

"This one doctor will have at least been exposed to, and probably be experienced in many, many more varieties of treatment, because we know that rarely does one thing work for one person, even if they have the same problem as somebody else."

Morley-Forster says she underestimated how long it would take to set up the new program, initially thinking it might take "maybe three years or so."

After the college approved pain medicine as a sub-specialty in 2010, it took several years for the course curriculum and testing standards to be developed.

Funding remains a concern

But while Morley-Forster says launching the program this July this is a big step, there is still more work to do. The school has found funding for these first two residents, but there is no guarantee for next year.

"Provincial governments, and Ontario included, have put a cap on the funding for new residency programs and this is a new residency program, so we do not have any designated funding for this and are having to borrow funding for the two-year residency positions from other programs, so this has been a struggle for us. It involves a lot of negotiation"

CBC contacted the Ontario Ministry of Health to ask if the province was considering new funding for the new program, but the initial response from a spokesperson in an e-mail appeared to indicate they were unaware of the program's existence.

"Ontario does not fund pain management as a discrete medical sub-specialty, as there are currently no Royal College accredited pain medicine programs in the province (or the rest of Canada). However, residency training in anesthesia which can have a pain management focus is funded by Ontario."

Morley-Forster says the response is frustrating and shows the challenge of a lack of awareness of the problem of pain.

UBC also faces funding issues

In fact, the Royal College of Physicians and Surgeons says several other medical schools across the country are now setting up for pain management programs.

One of those is the University of British Columbia, which has run into similar issues after it applied for accreditation for its program with the college in January.

Dr. Brenda Lau, who headed up the committee that put together the application, says if they receive approval, it will be up to the university's residency allocation committee, which includes members of the university, Ministry of Health and regional health authorities, to decide how money from the province is divided up.

Lau says if there is no new funding, it comes down to redistributing the funds already in place, and she has already been asked to look at asking other specialties to contribute towards the new program.

"It is a massive challenge, it is hard. This is hard work. Every specialty is already in shortages they are having to face," she says.

"Let's take anesthesia: when you have fewer anesthesiologists for example, it has a downstream effect on surgeries, on wait lists. So one can understand why an individual specialty would not want to give up even a single position."

B.C.'s Minister of Health sent a short response to the CBC's questions about funding.

"Currently postgraduate training in B.C. is focused primarily on family medicine in order to meet the needs of the province. Specialty training similarly targets the needs of the population with a focus on capacity building in the generalist specialties," said the statement.

"Any decision on whether to provide new programs must be considered in alignment with the current needs of the province and the most responsible use of tax payer dollars."

• Read more about a new chronic pain medicineprogram developed by the Doctors of B.C.