Searching for doctors

Posted by cwaddell under Election 2008, Election 2008 Student articles

Kate Scroggins

When Michelle Desrosiers felt a dull ache in her neck, she cringed. It wasn’t so much the pain she experienced when she tried to move her head, as it was the thought that she would have to drive about 40 minutes to the nearest hospital to get it checked. 

But Desrosiers knew it was her only option. 

The 28-year-old single mother hasn’t been able to find a family doctor since she moved back to her hometown of Rouyn-Noranda in Western Quebec a year ago. 

Desrosiers took the day off from her job at Hydro Quebec and was standing in the waiting room by 9 a.m., hoping to see a doctor within a few hours. But she was told that her visit was a low priority and to come back later in the afternoon. Desrosiers finally saw a doctor late the next morning after a 16-hour wait. 

“My problem shouldn’t have meant a trip to the ER. I wish I could have just made an appointment with a family doctor. It’s very frustrating,” she said. 

Desrosiers has called every doctor in the area and has heard the same story each time – no one is taking new patients and most don’t even keep a waiting list.

The long trips to the hospital may be an inconvenience, but Desrosiers said she is more concerned about her long-term health.

“I’m all about prevention. But how can you stay healthy without regular checkups and routine health checks like a pap smear?” she said. “It’s scary. So many diseases could be missed this way.”

Desrosiers is not alone in her frustration. 

According to Statistics Canada, about 15 per cent or 4.1 million Canadians do not have a regular doctor. The rates are highest in Desrosiers’ home province of Quebec and in Prince Edward Island. 

And while health care is not the most talked about issue in the federal election campaign, political leaders are slowly jumping on the bandwagon pledging to fix the shortage and make sure every Canadian has a family doctor. 

The NDP and the Liberals have similar plans. Both say they’ll increase the number of training spaces in medical and nursing programs to fill the shortage. Jack Layton was the first out the gate, pledging $1 billion over five years and Stephane Dion quickly followed offering $420 million over a four-year mandate.

Both also promised some financial incentives for medical students who commit a certain number of years working a needed specialty like family medicine.

The Liberals also said they’ll forgive $10,000 of student loans for health care workers who are willing to work in rural Canada and pledged to improve the system for licensing foreign-trained medical professionals.  

The Green party is also promising to help foreign-trained doctors become accredited quicker and to forgive student loans for health care graduates who will work in rural areas and family practices. 

And yesterday, Stephen Harper released his plan which promised $10 million over four years to create new residency positions in large hospitals and $5 million per year to help Canadian trained doctors living abroad return to Canada. He also set aside another $5 million over three years to study how to recruit more nurses. 

The president of the Canadian Medical Association Robert Ouellet agreed that increasing the number of medical students is an important step in addressing the shortage. But he wants a long-term commitment from the government to fund new training centres.

“The CMA is convinced we need more doctors and that we need to be self sufficient,” he said. 

In January, the CMA launched a new campaign called “More Doctors. More Care.” The association has lobbied the government to provide $1 billion over five years to expand training for health care workers, a request similar to the NDP’s election pledge.

But not everyone agrees that expanding medical schools is the best solution.

Robert Evans, the associate director of the Centre for Health Services and Policy Research at the University of British Columbia, said the schools have increased enrolment over the past 10 years.

Because medical training can take between six and nine years depending on the specialty, Evans said Canadians are just starting to see more physicians.

“People run away saying we need to expand medical schools, the answer is yes, we already have,” he said. “If you expand now, in 10 or 20 years we could maybe have a surplus.”

Instead, Evans said the federal government could provide more funds for the provinces to increase the number of residency spots, particularly in specialties that are in need. The Conservatives made a similar promise in yesterday’s announcement. 

According to the Association of Facilities of Medicine of Canada (AFMC), medical schools have increased enrolment from about 1,500 first-year students to 2,400 positions in 2008. 

And while creating even more spots might be part of the solution, the association, which was not available for comment, has argued that there are other factors that politicians need to consider like increasing the capacity of medical schools and the number of clinical teachers “Creating more doctors is not as simple as turning up the dial on a production machine; every change in the complex process of educating medical professionals comes with consequences,” the association wrote in a press release. 

The AFMC wants the federal government to research and develop a human resource plan to make sure that Canadian medical schools are producing enough doctors to manage the shortage without creating a surplus. 

Bur Ouellet said he wasn’t concerned about having too many doctors in future and the government needs to act now to meet the health care needs of Canadians.

“Maybe there will be a surplus, but that’s 20 years from now,” he said. “In the 1990s, it was the opposite, they cut funding and spots and that was a bad move.”

Interestingly, experts say the shortage isn’t a result of Canada producing or retaining fewer doctors. In fact, the number of doctors per capita in Canada has not changed over the past 20 years. 

And according to the Canadian Institute for Health Information, in 2006 there were about 9,000 more registered physicians in Canada and about 4,000 more family doctors.  

But experts agree that the lifestyles of Canadian doctors are changing. Doctors are working fewer hours, especially the growing number of young female physicians who tend to have more family obligations. Women make up about a third of Canada’s doctors and the majority of medical students across the country are female.

 

Antonia Maioni, the director of the McGill Institute for the Study of Canada and an expert in health care policy, said there is still some debate about whether there truly is a doctor shortage in Canada. 

She said there isn’t enough data to say whether there is an absolute shortage or too few doctors for the population, or if they’re just inequitably distributed across the country so there aren’t enough physicians in communities that need them. 

And according to Maioni, it’s not just rural residents that are having trouble finding a doctor. In Quebec, it is especially difficult for Montrealers to find a family physician.

Maioni said she’s not thrilled with the “crusade of the CMA” because there are too many questions about the shortage that must be answered. But political parties have found the arguments persuasive and are grabbing hold of the issue because it’s easy to sell to Canadians, she said.

“It’s a motherhood and apple pie issue.  You can’t be against more doctors,” she said. 

Dr. Ruth Wilson, the president of the College of Family Physicians of Canada, disagreed. She said no matter how you look at it, there are millions of Canadians who want a family doctor and can’t find one – and that qualifies as a shortage.

“Some people say it’s just a perceived shortage but you go out and tell the millions of Canadians without a family doctor that it’s just a perceived shortage, and they’ll say, well that’s what I perceive for sure,” she said. 

Wilson said that doctors in Canada have always been unequally distributed across the country, and tend to concentrate more in cities.

Wilson, who practiced medicine in Northern Canada for 11 years, said the best way to get medical students to practice in rural or remote areas is to expose them to these communities in their residencies.

She said that financial incentives, like those being suggested by the Liberals and the Green party, are helpful. But about half the time, people buy their way out or find a way to move back to a city. 

Peter Coyte, a professor of health policy at the University of Toronto, said that offering doctors money to get them to under-serviced areas has been tried in Canada and around the world and it only has had a small impact.

“All of the political parties are in a stampede to attract voters and they’re using various marketing tools that at first strike a chord with what voters think are important issues,” he said. “These proposals are not cost-effective.”

There may be a lot of controversy about how the shortage is defined and the ways the parties plan to fix it, but one thing experts agree on is the dwindling number of nurses across the country.

According to the Canadian Nurses Association (CNA), Canada could experience a shortage of 113,000 nurses by 2016. The association said universities should be producing about 2,500 more nurses per year to meet the demand.

As a result of the shortage, more nurses are working more overtime. And the results could be dangerous. 

A recent report from Statistics Canada found that in 2005, nearly one-fifth of nurses admitted making mistakes with a patient’s medication and errors often occurred among nurses who worked overtime. 

Evans said the shortage is due to the cutbacks in hiring new nurses in the early 1990s, when the federal government reduced transfer payments to the provinces and there was less money flowing into hospitals. 

Also, many nurses are baby boomers who are about to retire.

“The nurses they didn’t hire in the ’90s aren’t here today. It left a hole in the nursing workforce,” he said. 

Evans said the government should give the provinces more money to expand nursing programs to try to meet the need.

As well as increasing the funding for expanding nursing programs, the CNA wanted the political parties to commit to spending more money from the employment insurance fund for skills training. No party has made that promise. 

No matter what the solution or the outcome of the federal election, Desrosiers said she wants the federal government to provide more money to the provinces. But most importantly, she wants the Quebec provincial government to act quickly, or she’s trying her luck one province over. 

“If this keeps up I’m considering moving back to Ontario,” she said. “I went to school there and I was able to find a doctor. I never waited as long as I’m waiting now.”