Ca­na­da’s scar­city of doc­tors

Grea­te­ru­se­co­uld­be­ma­deof­nur­se­prac­ti­tio­ner­sandphy­si­cian as­sis­tants,in­clu­ding­fo­rre­la­ti­vel­yun­com­pli­ca­ted­me­di­cal­pro­ce­du­res

La Jornada (Canada) - - PORTADA - Jo­seph Ques­nel is a re­search fe­llow with Fron­tier Cen­tre for Pu­blic Po­licy (

Whi­le health ca­re is a dy­na­mic ser­vi­ce cha­rac­te­ri­zed by the con­ti­nual in­tro­duc­tion of new drugs and me­di­cal de­vi­ces, phy­si­cians re­main at the cen­tre of health-ca­re de­li­very. So it’s worth no­ting that Ca­na­da lags well behind al­most all de­ve­lo­ped coun­tries in the avail-

abi­lity of phy­si­cian ser­vi­ces.

Ca­na­da ranks 29th out of 33 high-in­co­me coun­tries for the num­ber of prac­ti­sing phy­si­cians re­la­ti­ve to the po­pu­la­tion. Un­less phy­si­cians in Ca­na­da are much mo­re pro­duc­ti­ve than phy­si­cians in ot­her high-in­co­me coun­tries, the da­ta sug­gest that Ca­na­da suf­fers from a re­la­ti­ve scar­city of phy­si­cian ser­vi­ces.

Me­dia re­ports of Ca­na­dians who ac­ti­vely (yet un­suc­cess­fully) look for re­gu­lar fa­mily doc­tors, as well as his­to­ri­cally long wait ti­mes for con­sul­ta­tions with spe­cia­lists and treat­ment by spe­cia­lists, al­so sug­gest Ca­na­dians would be bet­ter off if the re­la­ti­ve supply of phy­si­cians in­crea­sed.

Ho­we­ver, des­pi­te re­cent growth in do­mes­tic- and fo­reign-trai­ned phy­si­cians prac­ti­sing in Ca­na­da, a new Fra­ser Ins­ti­tu­te study pro­jects only a small in­crea­se in the phy­si­cian-to-po­pu­la­tion ra­tio from now un­til 2030, gi­ven ex­pec­ted po­pu­la­tion growth over that pe­riod.

As­su­ming that the supply of fo­reign-trai­ned phy­si­cians fo­llows its re­cent trend, the ra­tio is pro­jec­ted to in­crea­se from 2.74 phy­si­cians per 1,000 Ca­na­dians in 2015 to 2.97 per 1,000 in 2030. If this pro­jec­tion is reaso­nably ac­cu­ra­te, the re­la­ti­ve supply of phy­si­cians in Ca­na­da in 2030 will be al­most 13 per cent be­low the cu­rrent ave­ra­ge phy­si­cian-to-po­pu­la­tion ra­tio in ot­her wealthy coun­tries. Cru­cially, the scar­city of phy­si­cians in Ca­na­da will be exa­cer­ba­ted by an aging Ca­na­dian po­pu­la­tion that will li­kely in­crea­se the per-ca­pi­ta de­mand for health-ca­re ser­vi­ces.

And fi­nally, a de­crea­se in the ave­ra­ge num­ber of hours that Ca­na­dian doc­tors work (as an­ti­ci­pa­ted by the Ca­na­dian Me­di­cal As­so­cia­tion) will ma­ke mat­ters wor­se.

So what can be do­ne to ad­dress this gro­wing pro­blem?

Trai­ning mo­re phy­si­cians in me­di­cal schools and fun­ding mo­re re­si­dency ope­nings are ob­vious go­vern­ment initia­ti­ves to help in­crea­se the supply of doc­tors in Ca­na­da. Ho­we­ver, they’re al­so re­la­ti­vely ex­pen­si­ve initia­ti­ves.

Ot­her po­li­cies might mo­re ef­fi­ciently ad­dress the re­la­ti­ve scar­city of phy­si­cian ser­vi­ces.

For exam­ple, grea­ter use could be ma­de of nur­se prac­ti­tio­ners and phy­si­cian as­sis­tants, in­clu­ding for re­la­ti­vely un­com­pli­ca­ted me­di­cal pro­ce­du­res.

Anot­her, per­haps mo­re con­ten­tious, ini­tia­ti­ve would be to im­ple­ment so­me de­gree of pa­tient cost-sha­ring for basic me­di­cal ser­vi­ces in pla­ce of ‘first-do­llar co­ve­ra­ge,’ whe­re go­vern­ment in­su­ran­ce co­vers all costs of basic me­di­cal ser­vi­ces. Ot­her coun­tries with uni­ver­sal health-ca­re co­ve­ra­ge, in­clu­ding Fran­ce, Ja­pan, the Net­her­lands, New Zea­land and Swe­den, prac­ti­se cost-sha­ring. And in the­se coun­tries, ap­pro­pria­te pro­tec­tions are usually es­ta­blis­hed for low-in­co­me pa­tients and tho­se with chro­nic health con­di­tions. Cost-sha­ring should dis­cou­ra­ge re­la­ti­vely unim­por­tant uses of va­lua­ble me­di­cal re­sour­ces, in­clu­ding phy­si­cian ti­me via doc­tor’s ap­point­ments and ot­her ser­vi­ces.

Clearly, any set of po­licy initia­ti­ves meant to mi­ti­ga­te Ca­na­da’s phy­si­cian scar­city pro­blem will ta­ke ti­me to de­sign and im­ple­ment.

But con­ti­nuing an un­pro­duc­ti­ve de­ba­te about whet­her Ca­na­da has too many or too few doc­tors will simply de­lay nee­ded chan­ge and con­tri­bu­te to even grea­ter in­con­ve­nien­ces and ot­her eco­no­mic costs, as Ca­na­dians wait lon­ger and search har­der for phy­si­cian ser­vi­ces. -TROYMEDIA

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