Federal-provincial funding agreement needs to support doctors

“Money alone is not the answer.”— Prime Minister Justin Trudeau, Feb.7, 2023 “We’re a little disappointed.”—Manitoba Premier Heather Stefanson, Feb. 7, 2023 Prime Minister Justin Trudeau finally had a long-overdue meeting in Ottawa on Feb. 7 to discuss healthcare funding. Health Minister Jean-Yves Duclos was evasive on Jan. 29 as to the amount he was willing to give. He stated that he wanted the “right deal for patients and workers,” that he was not attempting to “micromanage” health delivery, and wanted provinces to do their utmost to recruit and retain health professionals. Trudeau eventually agreed to an additional $4.6 billion per year over 10 years in new money—roughly 16% of the amount that the 13 premiers had been demanding. Whereas they had wanted the federal contribution to healthcare to increase from 22% to 35%, it will now rise to only 24%! B.C. Premier David Eby stated that “this proposal is fiscally limited.” Ontario Premier Doug Ford indicated that he regarded it as a “starting point” and a “down payment.” A recent Leger poll found that 86% of all Canadians were worried about the state of healthcare; this was higher in rural areas and was 94% in Atlantic Canada. Read: Dr. Charles Shaver: A solution for Canada’s physician shortage The paramount issue is the severe national shortage of nurses, physicians, and other professionals. As Quebec Premier François Legault stated: “It’s not just a question of money but the big challenge now is to find workers and ensure that we can have some flexibility.” In Ontario, 1.8 million persons have no family doctor and another 1.7 million have one age 65 or greater. Over six million Canadians lack a family physician. In 2020, among 36 OECD countries, Canada ranked 29th in beds per 1,000 population and 26th in its physician/patient ratio. NDP leader Jagmeet Singh opposes any privatization, and simply states that governments should hire more doctors and nurses in the public system. Yet where will they come from? After all, only 10% of applicants or 2,800 students are accepted annually to Canada’s 17 medical schools. As noted recently in the Medical Post by health lawyer Tracey Tremayne-Lloyd, at least 3,500 Canadians go abroad to study in medical schools in the U.S., U.K., Ireland, Australia, New Zealand and Switzerland. Most would like to return to Canada, but to practice here, they must usually complete a two-year residency. Only 13% of the 3,300 admitted to residency training programs come from abroad. Currently, 13,000 foreign-trained physicians are living in Canada, but are unable to practice medicine. Admittedly, provinces are being creative. Several are fast-tracking the licensure of foreign nurses and physicians. Newfoundland and Labrador, through its Family Practice Renewal Program, is sending a team including the health minister to recruit MDs and nurses in Ireland, and possibly later to South Africa and India. Ontario is expanding the role of free-standing surgical clinics for cataract and joint replacement procedures outside of hospitals. It is also allowing health professionals to come and practice without formally registering with their licensing bodies for a year. Yet until the overall lack of sufficient numbers of nurses and MDs in Canada has been addressed, it is difficult to see how these measures will effectively help the staffing shortages in hospitals. Merely stealing skilled health workers from other parts of Canada is counter-productive. As Sylvain Brousseau, president of the Canadian Nurses Association warned, “It’s not by going to poach nurses from one province to another that you will solve the health system crisis that we are going through right now. It’s by giving them better working conditions and a better healthcare environment.” This also applies to MDs. We need to quickly reorganize care with healthcare teams, and as I stated in previous articles, we must strive to retain our older physicians. In Canada, over 15% of doctors are over age 65; in Ontario, 16% of MDs are over age 65 and 8% over age 70. The average of practicing MDs is oldest in New Brunswick, Nova Scotia, and P.E.I. A first step in at least stabilizing the current shortage of MDs would be financial support for older physicians. This includes a major reduction in annual licence fees (about $2,000 in most provinces). The Royal College of Physicians and Surgeons of Canada, College of Family Physicians of Canada, and Canadian Medical Association already give a major discount of dues to older MDs. Of note is that New Brunswick has just reduced its licence fee from $1,750 to $600 for physicians aged 70 and over; hopefully Ontario and other provinces will do the same. In addition, older MDs need government-funded short-term income stabilization. Physicians may to take time off work for a few weeks of months due to a heart attack, severe infection such as COVID-19, resection of a malignant breast or bowel tumour, prostate or cardiac surgery, a knee or hip replacement, etc. Sadly, private disability insurance is usually unavailable, and has a long waiting period to collect benefits. As a result, a prolonged illness or surgery may result in permanent retirement. As a precedent, note that all provinces offer parental leave benefits. These are paid usually for 17 weeks and vary from $1,000 per week in British Columbia and New Brunswick to $1,500 in Nova Scotia. I propose, as in previous articles, that some of the increased federal health transfer payments be earmarked to cover physicians and surgeons from age 65 to at least age 80 with no waiting period. These MDs would receive 70% to 80% of their average monthly billings for 60, or preferably 90 days. While waiting for fast-tracking of foreign graduates, increased medical school enrollment, increased residency training positions, and national portable licensure to take effect, in the short term we must do whatever it takes to encourage our older physicians to resume work after surgery or a major illness, even if only part-time. Hopefully, my reasonable proposals will be supported by the Canadian Medical Association, provincial and territorial licencing bodies, medical associations, and health ministers. During our current crisis and likely for many years to come, we will need “all hands on deck.” Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is past-chair of the Section on General Internal Medicine of the Ontario Medical Association. The views here are his own.

Federal-provincial funding agreement needs to support doctors

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