Adding fuel to the doctor crisis
Five million Canadians are currently without a family doctor-and things are only getting worse
CATHY GULLI AND KATE LUNAU | Jan 2, 2008 | 17:23:34
Provincial governments are also slowly recognizing the need for change, with some proposing benefit plans for doctors. This would be a major boost since physicians are ostensibly self-employed, and so most have no such plans. Still, packages for limited parental leave and other programs are in their infancy. Many doctors are hopeful. “As a young female physician who wants to have children one day, it is something I think about,” says Dr. Danielle Martin, 32, a family doctor based in Toronto.
Meanwhile, in Alberta, the province’s medical association recently announced a $56-million program to help family doctors cope with rising costs—which Slocombe once grappled with. And in 2005, Ontario announced it would put up $33 million over three years to boost the training of family physicians by 141 annually.
Alongside these fledgling efforts, the same central complaint remains—Canada needs to increase its doctor supply. Enrolment at Canadian medical schools has steadily increased since 2000 (2,460 new students enrolled in 2006), but Dr. Nick Busing, president of the Association of Faculties of Medicine of Canada, says that’s not enough. “We need to be talking about a target minimum of 3,000 entry-level positions for Canadians, and get there as quickly as possible.”
Day also takes issue with losing those 1,500 Canadian students who study abroad because they couldn’t get into medical schools here. “These are people who had 90 per cent averages,” he says. “They speak one of the official languages, they’re highly educated, they’re Canadian, they know the culture.” If universities across the country are maxed out, Day suggests Canada accredit foreign schools, which would make it easier for graduates to return and practise here. “That’s one solution,” he says. “It’s just a matter of doing it.”
What’s more, those students who do receive a coveted spot at a Canadian medical school eventually graduate with an average debt load of $158,728, according to the Canadian Federation of Medical Students. That debt—which Martin calls “mortgage-size”—can deter people from lower-income or rural backgrounds from pursuing a medical career. Foreign doctors who move to Canada also face roadblocks as they attempt to become licensed physicians, sometimes including up to six years of additional training at a Canadian university and the successful completion of certification exams.
But observers see some improvements in the system. In 2005, the Canadian government allotted $75 million to a program aimed at integrating internationally trained Canadians and immigrants—including doctors—into the workforce. In 2006, 360 international medical graduates began postgraduate training (on top of the 2,460 who entered med school). What’s more, “a good number of Canadians who trained abroad are coming back into the system,” the CFPC’s Wilson notes. In 2006, for the third year running, the number of Canadian physicians returning home was greater than the number who left (238 compared to 207).
Despite such small victories, Canada’s health planners can’t ignore the fact that the doctor shortage is about to get worse. The country will soon have an older population than ever before—and a female-dominated medical workforce unwilling to work the hours its predecessors did. Day also warns that more Canadian physicians may be drawn to the U.S. if the presidential candidates keep their promise of delivering doctors to the 47 million Americans who are uninsured today. Between 1993 and 2004, roughly 4,000 Canadian physicians went south.
The Lancet article explains plainly just what a plentiful and sustainable doctor population could mean for Canada—improved patient satisfaction and a healthier population, all at a lower financial cost. But such a rosy picture is still a long way off. As of right now, the Canadian health care system “is broken,” Bob Boudreau says. “It needs to be fixed.” If not for the sake of doctors, then for the patients who depend on them.
“Make sure you absolutely need help before you go to a physician,” Boudreau says. “Odds are, your doctor is more sick than you.”