The coronavirus pandemic has accomplished what a multitude of government reports could not – that is, to draw Canadians’ attention to a faltering health-care system characterized by a chronic shortage of beds, overflowing emergency departments, and limited numbers of surgical personnel and operating suites. The flaws have been there for decades, but a willful blindness on the part of our politicians has successfully kept systemic change at bay and patients on wait lists for medical care.
Most recently, media stories have focussed on a scarcity of physicians.
A provincial registry in Nova Scotia lists 88,300 patients waiting for a family doctor, with 30,000 in Halifax alone. That number rises to 175,000 for all the Atlantic provinces. The situation is no better elsewhere. More than one million Ontarians, 780,000 British Columbians, and 25% of Quebeckers are without a primary care physician. Nationwide, the number is about five million, or 15% of our population.
The numbers and the consequences are even more grim when considering access to specialist care.
In Ontario, a family doctor sounded the alarm when a referral to a neurologist elicited a response stating there was a 4.5 year wait for care. In Alberta, one patient paid for his own MRI to get a prompt diagnosis only to find out that access to treatment was years away — there were 1,803 patients ahead of him on the specialist referral list. No wonder a 2016 study of health care in 11 wealthy OECD countries found that Canada had the worst access to specialist care.
The consequences of waiting cannot be underestimated. SecondStreet.org has identified 11,581 patients who died while waiting for surgeries, procedures or scans in 2020-2021. Since April 2018, that number is 26,875.
Even more frightening is that access to medical care is going to get far worse before it gets better. The numbers quoted above are pre-COVID, and the health and well-being of medical personnel have been ravaged by a two-year pandemic. The limited numbers of physicians that we do have are getting fed up and burnt out.
A November 2021 survey by the Canadian Medical Association shows that 53% of physicians and medical students have experienced high levels of burnout. It also found that 46% of physicians were considering reducing their clinical work over the next two years. Similarly, a 2018 study found that almost 40% of our doctors will be over the age of 55 and closing in on retirement within three to five years.
The evidence could not be more clear or overwhelming: Canada needs more doctors.
There are three ways to fix this problem.
The first is to increase enrollments and capacities at Canada’s medical schools. Ontario Premier Doug Ford recently announced 450 new post-secondary positions in that province’s six medical schools. Other provinces should follow suit, accordingly.
Enrollments have declined since a controversial 1992 report wrongly suggested that health-care costs were skyrocketing because of too many doctors. That reduced medical school enrollments for two decades, and Canadians have been paying for that mistake ever since as numbers of graduates declined. It’s time for enrollments to match public needs.
Secondly, doctors are like everyone else in that they need jobs when they graduate. Annual surveys by the Royal College of Physicians and Surgeons show that up to 40% of newly-certified specialists can’t find a job in a country that desperately needs specialist physicians. As a result, many are forced to leave the country.
The third way is through immigration and attracting doctors trained in other countries. It may seem like a simple solution, but the process is slow. Medical and governmental regulatory bodies do not appear to have the capability to test, monitor and give accreditation to more than a handful of the estimated 5,000 educated doctors now in Canada who wish to be licensed.
In 2020, the BC government announced that foreign-trained doctors could become “associate physicians” and carry out duties under licensed doctors to earn their full accreditation. Two years later, not one physician has been registered in the program.
Where are the health-care planners in all of this? Why is Canada heavily subsidizing the education and training of physicians only to have them leave because of a lack of job opportunities while Canadians remain underserved and are paying to recruit doctors from other countries?
It’s time to deal with Canada’s dearth of doctors and that will take coordination and effort on behalf of governments, academia and regulatory bodies. While the chances of such a collaboration are minimal, it remains our only hope to obtain/maintain even the most basic health care.
Susan Martinuk is a Senior Fellow at the Frontier Centre for Public Policy and author of the book, Patients at Risk: Exposing Canada’s Health-care Crisis.