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Dr. Charles Shaver
Two patients recently died after waiting several hours to see a doctor in emergency departments in Nova Scotia. Others have died unexpectedly in ERs in New Brunswick and in Ajax, Ontario.
In 2020, among 36 OECD countries, Canada ranked 29th in beds-per-1,000 population and 26th in its physician/patient ratio. More than 5 million Canadians lack a family physician. They are forced to line up at walk-in clinics or go to understaffed, crowded emergency departments.
These have closed periodically especially in rural areas across Canada due to a shortage of nurses and other staff. No wonder the premiers and pollsters rank health care access as the main issue of concern for Canadians.
Premier Doug Ford recently announced that new outpatient facilities would soon perform diagnostic tests, cataract extractions, and eventually hip and knee replacements. This will especially benefit now-underemployed orthopedic surgeons. Prime Minister Justin Trudeau found this proposal “innovative” and indicated that it would not violate the Canada Health Act. Problematic, however, is whether this would further exacerbate the already severe shortage of nurses and MDs in hospitals.
Apparently, a federal-provincial health transfer funding agreement is imminent. However, the main problem is still a severe shortage of nurses and MDs across Canada. This will not be improved if Ontario and other provinces allow them to practice without first registering with their licensing body. Such poaching of out-of-province health staff will be like “shifting the deck chairs on the Titanic.”
Note that Federal Health Minister Jean-Yves Duclos has urged the premiers to focus on recruiting and retaining health professionals. Thus, a step in reducing further shortages of MDs might be financial support to existing older physicians. This includes a major reduction in annual licence renewal fees (about $2,000 in most provinces), and government-funded short-term disability benefits.
A decade ago, 10% of physicians were age 65 and over; now it is more than 15%. Like their patients, these physicians may need to be off for a few weeks or months due to a severe infection such as COVID-19, prostate or cardiac surgery, resection of a malignant bowel or breast tumor, depression, a heart attack, a knee or hip replacement, etc. Private disability insurance usually has at least a 2-4 week waiting period, and is difficult or impossible to obtain after age 65. Sadly, such an illness or surgery could easily result in permanent retirement.
In previous articles, I cited as a precedent the parental leave programs for doctors across Canada. Benefits are generally paid for 17 weeks, and vary from $1,000 in New Brunswick and British Columbia, to $1,300 in Ontario to $1,500 in Nova Scotia.
I therefore propose, as in my earlier article, that Ontario and all provinces and territories provide coverage to practising MDs from age 65 to at least 80 with no waiting period at a rate of 70-80% of their previous average billings for 60 or preferably 90 days.
If Ottawa were to subsidize this targeted program, it should be agreeable to Duclos and welcomed most premiers. Only 10% of applicants are accepted to our 17 medical schools. An increase in enrollment, as well as more residency training positions for the 13,000 foreign-trained physicians already in Canada, will take many years to have an impact.
In the meantime, we should encourage our older physicians to resume work, if even part-time, after surgery or a major illness. Hopefully provincial medical associations and health ministries will agree. During our current crisis and likely for many years, we will need “all hands on deck.”
— Ottawa physician Dr. Charles Shaver is past-chair of the Section on General Internal Medicine of the Ontario Medical Association. The views here are his own.