Yes, if we make better use of other workers

Does Ontario have enough doctors? This question may have a surprising answer for some: yes, we do. How can this be possible when many people don’t have a family doctor, or wait days, weeks or even months for a medical appointment?

We have more doctors than ever before, but many aren’t located where we need them and many of them aren’t practising in a way that addresses the health needs of Ontarians.

First, a look at the numbers. Ontario has 220 doctors for every 100,000 people — that’s up from 203 in 2012. But what does this number mean?

Let’s unpack the first part — the doctor side. A simple head count of doctors ignores where doctors are located. In Ontario and across the country, doctors are poorly represented in rural and remote areas, and this disparity between the health services available to urban and rural patients is larger in Canada than in other countries.

In fact, only 8 per cent of doctors provide health services to the 19 per cent of the population that’s located in rural areas. Are there enough doctors in rural areas? The answer there may well be no. Head counts also ignore what type of doctors are included. How many are family physicians and specialists and what types of specialist? How do different type of doctors practise? In Ontario, for example, only 70 per cent of family physicians provide comprehensive primary care — that is, the front-line health care that Ontarians need most.

Now let’s unpack the population side, where there is variability as well. We have an aging population yet we have 10 times as many residency positions — training spots for new doctors — in pediatrics as we do in geriatrics. This results in what we call a “skills mismatch.”

Perhaps “are there enough doctors?” is the wrong question to be asking.

Maybe what we really need to be asking is how all the health workers in our system can better meet the needs of the population.

There is a whole health workforce beyond doctors. This broader workforce — nurses, midwives, pharmacists and many others — undertakes many critically important tasks to meet the health needs of Ontarians.

One thing is certain: we aren’t using their knowledge and skills to the extent we could.

Instead, we end up with what we call “skills misuse.”

Skills misuse is an endemic issue. In a recent survey that included Canadian health workers, the OECD reported that 76 per cent of doctors and 79 per cent of nurses reported they had the skills to cope with more demanding tasks. Better using the unique skill sets of doctors by shifting some of their tasks to others, such as nurses, nurse practitioners and midwives, could improve access for Ontarians.

There are a number of promising practices of this kind across Canada, which could be considered for expansion. Nurse practitioners can provide primary care and triage patients presenting to emergency rooms, reducing wait times and increasing patient volumes. Physiotherapists can triage patients on wait lists for hip or knee surgery, with similar outcomes to orthopedic surgeons. Access to mental health care can be enhanced through shared-care models involving psychologists and social workers.

Shifting tasks may not only be more appropriate, it could help us to achieve important wait time targets in a costeffective manner. How could this be achieved?

We could enable the shifting of tasks among health workers by reorganizing the way they work together and provide their services to the public. Co-locating services and using technology to support shared models of care, for example, may not only improve access, it can also improve physicians’ working conditions by making exchanges with colleagues possible and reducing on-call commitments.

If we reorganize how we provide health care, we could better support the doctors we have.

We need to move beyond a debate as to whether we have enough doctors and engage in the much more important and thoughtful discussion of how we must better use all our health workers in a way that is safe, supportive and affordable — and provides the best health to all Ontarians.