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Abstract. Although the last decade has been dominated by commentators lamenting the national shortage of medical practitioners, only a generation ago policy makers concluded that most Canadian provinces had too many doctors. As a consequence, provincial ministers of health placed new restrictions on the licensing of foreign-trained health professionals. Assisted by the 1976 Immigration Act, Canada suddenly witnessed a precipitous drop in the number of newly licensed, foreign-trained doctors, a dramatic reversal of the previous decade which had seen over 10,000 physicians immigrate and take up practice in this country. The 1980s was notable for a variety of health care initiatives aimed at relocating the diminishing number of foreign physicians to underserviced areas, some of which were struck down as contravening the new Charter of Rights and Freedoms. This paper will examine the period of 1976-91, when, after two decades of relatively liberal immigration and licencing policies, Canadian provinces introduced new measures to restrict the scope of practice of incoming foreign-trained doctors and to divert them to underserviced areas. The paper will explore these health policy debates in order to understand better the context of the landmark Barer-Stoddart Report (1991), which concluded that a new interprofessional mix of health care practitioners was needed to reform, and make more accessible, the Canadian health care system. Keywords. Medicare, foreign-trained doctors, Immigration Act 1976, BarerStoddart ReportRésumé. Alors qu'on ne parle plus que de pénurie en médecins à l'échelle nationale, il est bon de rappeler que les décideurs en santé canadiens faisaient

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The transition from a fee-for-service model to a prepaid health care system creates new challenges for both physicians and patients. Occasionally both can feel trapped in the new setting and must rely on new or different strategies to reach sometimes divergent objectives. This may alter the physician-patient relationship in ways that neither likes. Based on our experience in a large multispecialty academic group practice, we have developed management strategies to mitigate such stresses on both parties. These include review of marketing efforts; education of new patients to foster realistic expectations; a physician-generated, prospective internal policy for dealing with dissatisfied patients and physicians; a strong central administrative physician to serve as a "lightning rod" and counselor; and continuing physician orientation and education to improve judgment and attitudes. These strategies promote the physician's role as expert consultant-educator with the best interests of the patient as the first priority.