The pandemic has presented us with many new difficulties that we’re struggling to manage. It has also pushed to the forefront some long-standing challenges that we’ve not dealt with in the past and have become even more problematic in the time of COVID-19.
One ongoing problem that the pandemic has made much more serious and visible is the shortage of health-care workers. The focus is usually on doctors and nurses, although there are often shortages of medical technicians, technologists and other support workers.
The C.D. Howe Institute recently issued a study by Rosalie Wyonch on the acute shortages of nurses and physicians. She points out that the situation has been worsened by the pandemic.
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But most Canadians don’t need a study to know that we lack the means, especially the human resources, to deliver timely health care. The extended and growing waitlists for just about all non-emergency medical services make that clear.
That these shortages have been with us for years indicates that there’s no easy or obvious solution. Even pouring money on it would have limited results. Most doctors respond to higher rates of pay by reducing their hours. They see leisure as more valuable than extra cash.
Increasing nurses’ wages, however, would increase the number of nursing hours worked.
Instead of increasing doctors’ fees for service, Wyonch recommends reducing average costs. Not only would this save taxpayer dollars, it would induce a greater supply of services as doctors work to maintain their income level. However, fees should be increased for those medical services that are very difficult to access.
An often mentioned but rarely implemented solution to deal with doctor shortages is to allow nurses, pharmacists and others to undertake certain tasks that demand a visit to a doctor’s office. This would greatly improve the overall efficiency of the health-care system. It could be accompanied by increased income to those whose scope of practice would be widened.
The pandemic has brought those of us in British Columbia one long overdue increase in health-care efficiency. B.C. now recognizes and pays for telephone visits to doctors. Safety and social distancing were the initial reasons for making this move.
It’s now obvious that very many consultations, perhaps supplemented with images, can be satisfactorily dealt with over the phone, saving doctors and patients time for more serious issues.
The C.D. Howe report doesn’t list telephone delivery of medical services in its recommendations, but it does recommend encouraging communication and knowledge transfer among all those dealing with a patient. Implementing this recommendation is hampered because in Canada we don’t yet have complete, portable and accessible medical records. The lack of such records makes our medical histories more private but it can also be detrimental to health-care delivery.
The last three recommendations in the C.D. Howe report offer a long-run solution to our doctor shortages.
We must increase the number of places in medical schools in Canada. The fact that so many well-qualified, willing and able potential Canadian medical students are turned away underlines this need.
Many then go abroad for medical education, often without realizing that their training may not be recognized if they return to Canada, and that it will be difficult or impossible to get a needed residency once they’re home. Thus, qualified but unrecognized Canadian doctors end up practising in other countries while our medical needs go unmet.
Some recommendations in Wyonch’s report cover this issue:
- The number of residency positions must be significantly increased for locally trained Canadians, Canadians trained abroad and others trained abroad who want to come to Canada.
- We should strongly encourage the immigration of foreign trained physicians and medical students, and not only to offset those good Canadians we lose to other countries.
These recommendations have often run into opposition from the medical profession and its associations. British Columbia may soon be in a better position to counter such opposition.
A Professional Governance Act is being implemented. The recently created Office of the Superintendent of Professional Governance will have oversight over several professional associations in B.C. that were self-governing. This new structure will ensure the public and not just professional interests are well looked after.
The act doesn’t cover physicians. If it did, it could best serve the interests of the people of British Columbia by increasing the supply of medical training places, increasing medical residencies, and establishing an effective and efficient system to test, recognize and offer practice rights to medical personnel (Canadian or not) trained outside Canada.
In this way, we might at last be able to put the problem of doctor shortages to rest.
Roslyn Kunin is a consulting economist and speaker.
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