A shortage of medical professionals, chronically long waiting lists and a landmark court decision have combined to create the perfect storm in Canada's health-care system, say top officials of the Canadian Medical Association.

"Right now, things in medicine in Canada are not particularly rosy,'' said Dr. Albert Schumacher, the association's out-going president.

"We're confronted with very significant wait times which, in some instances, are unfortunately increasing every day . . . for core procedures -- hips, knees, hearts, cataracts.''

An even bigger issue from the profession's standpoint, for both the short and long term, is the shortage of health-care professionals -- the main reason behind the long wait lists, Schumacher said.

"We need to move our country to a goal of self-sufficiency in the supply of doctors, nurses and other health-care professionals. We've been too long plundering from other countries that can ill-afford to lose people.''

The system is struggling to recover from deficit cuts by governments in the 1990s.

Nurses were laid off. And funding cuts filtered down to universities, which in turn cut medical enrolments, said Schumacher.

Canada now ranks lowest among industrialized nations in the world in terms of its self-sufficiency in supplying health professionals, said the general practitioner from Windsor, Ont.

Even though medical schools are scrambling to increase enrolments again, it will only take the country to 80 per cent self-sufficiency, he added.

These are among the hot topics that will preoccupy doctors at the national association's annual gathering in Edmonton this week.

The other is a recent landmark decision by the Supreme Court of Canada that has brought new urgency to the issue of waiting times and public-versus-private health care.

The court overturned Quebec's ban on the use of private insurance to pay for medical procedures available in the public system. In a split decision, it ruled that Quebec was violating the right of patients to seek private care when faced with long waiting times in the public system.

The ruling has widely been seen as paving the way for more private-sector involvement in Canada's health system.

The Canadian Medical Association and other defenders of Canadian-style public health care -- which is founded on the principle of equal access to medical care based on need, not income -- say the ruling should be a kick in the pants to governments.

Politicians need to start doing something concrete to reduce chronically long waiting times for patients who need to see specialists or undergo certain medical procedures, says the CMA and others.

But they say governments aren't moving fast enough.

Incoming president Ruth Collins-Nakai, an Edmonton pediatric cardiologist, fears the groundbreaking court decision, coupled with physicians' frustration, may lead to professional divisions over the role of the private sector.

It is expected the 270 elected delegates will vote on potentially contentious resolutions dealing with the public-private issue.

The gathering comes soon after a major report by a coalition of doctor groups outlining benchmarks for reasonable waiting times in five priority areas: diagnostic imaging; cancer care; cardiac care; joint replacement and cataract surgery.