Government needs a serious response to doctor shortage
The NDP Opposition raised a disconcerting statistic in Monday's question period: According to the Canadian Institute for Health Information (CIHI), Saskatchewan has 215 doctors per 100,000 people — significantly fewer than the national average of 242 doctors per 100,000 people.
When Health Minister Paul Merriman was asked about this — specifically, further NDP accusations that the Saskatchewan Party government's handling of the pandemic may be making it harder to attract and keep doctors here — he responded: “That's politics. They're going to make accusations.”
To a certain extent, the health minister was right. Our vast northern area and sparse rural population made recruiting doctors here a challenge long before anyone ever heard of COVID -19. That said, our politics seems to be just one more disadvantage along with our vast sparsely populated and isolated rural and northern areas when it comes to the difficult doctor recruitment game.
In a recent excellent editorial, health policy analyst Steven Lewis noted half the 2,530 fulltime practising doctors in this province in 2020 are international medical graduates (IMGS).
Without the IMGS, “the health system would be sunk” Lewis said, highlighting the problematic ethics of recruiting from India and South Africa that have “one-third as many doctors per capita as Canada, or Nigeria, which has onesixth.”
A big part of the problem, Lewis said, is that of the 2,112 University of Saskatchewan medical graduates now practicing in Canada, only 931 or 44 per cent have remained in this province.
“Don't blame Canadian-trained doctors for not settling in rural Saskatchewan,” the health policy analyst said in the article. “No one else does, either.” Lewis noted that IMGS are restricted to where they can practise when they initially come to Canada, but eagerly depart for greener, more urban pastures with a “population density to support a school, bank, theatre, supermarket and a hospital in every town” when the opportunity presents itself.
“I grew up in Saskatchewan and the topography and emptiness are just features of home,” said Lewis, now an adjunct professor of health policy at Simon Fraser University. “But skies live elsewhere too.”
For this, Lewis was vilified “as the NDP health expert” by Sask. Party government MLAS during the regularly scheduled 75-minute debate two weeks ago in which government backbenchers preen for their constituents back home or for a future cabinet spot. They badly missed the substance of Lewis's message, which was that what the government needs to go beyond just adding the recruitment dollars we saw in the March 2022-23 budget. Instead, Lewis suggested we refocus on an “overhaul and expand primary care” model by creating clinics “where doctors, nurses, therapists, psychologists and pharmacists work in teams.”
Lewis further advocated consolidating “rural health care in well-equipped, well-staffed health centres” with at least three doctors “working in teams, supported by itinerant specialists and first class telehealth”.
But perhaps Lewis's more salient message to Premier Scott Moe's government is that rural health care problems like doctor recruitment have had little to do with the closing/conversion of arguably 52 unsustainable rural hospitals 29 years ago. If anything, Saskatchewan needs more health policies and approaches that signal a commitment to best medical practices, Lewis said.
“I suspect U of S medical students and their Canadian peers will not thrill to the prospect of working in a province where the premier — symbolically the recruiter-in-chief — waved bon voyage to the truck convoy insurrectionists and shut down daily COVID statistics reporting,” Lewis wrote.
In fairness, Merriman said Monday he has talked to the Saskatchewan Medical Association (SMA) College of Physicians and Surgeons and personal friends in medicine: “I know there's frustrations out there.”
He further emphasized the need to do “a better job of aggressively recruiting” and added that “all options are on the table.”
But shouldn't this province think outside our box shape and innovate the health system as a means of attracting doctors? Yes, we do have to overcome a lot of natural disadvantages to recruit doctors here. But the easiest disadvantage to overcome surely would be our own politics.