Kirsten Johnson is past-president of the Canadian Association of Emergency Physicians. James Maskalyk is an emergency room physician and an associate professor at the University of Toronto.
With the announcement of billions of dollars in new funding for the provinces, the federal government hopes to resuscitate health care for Canadians. A significant proportion of the new funding is devoted to improving access to care, but interestingly, a solution has been at hand for decades that could be delivered tomorrow. It would improve access to care and provider well-being, and cost Canadians nothing: national licensure for health care workers.
We both have devoted our lives to medicine, and have practised it throughout the world with the World Health Organization, the Red Cross and Médecins Sans Frontières. During the COVID-19 pandemic, like the SARS crisis before it, we volunteered our time and expertise to ensure the safety of Canadians, but even during this remarkable time, with one of us licensed in Ontario and the other in Quebec, we couldn’t cross the Ottawa River and work in a hospital on the other side if they needed a doctor.
The human body is the same no matter where you find it, and in a country like Canada, national educational bodies ensure training prepares graduates to work in any part of our country. Upon graduation, however, health care workers are forced to obtain provincial licenses at significant cost and extensive administrative time. Not only does this system curtail their mobility – it defies the ethics of medicine by denying care to all people, no matter who or where they are.
The health care crisis is far from over, and there are signs it will get worse before it gets better. Statistics from the Newfoundland and Labrador Medical Association suggest 26 per cent of residents don’t have a family physician. Based on the dire need for doctors in Newfoundland and Labrador, one of us decided to obtain a license and help a few weeks a year.
The process and the application took months, 40 hours of administrative time and cost $6,060. In addition to completing more than 40 documents, it was necessary to submit notarized copies of a Canadian medical degree, obtain reference letters from busy colleagues twice – once for the regulatory body and another time for the health authority (both separate forms), spend eight hours doing online courses, add another province to malpractice insurance (and incur the added cost) and join another provincial medical association ($1,875 per year). The Northwest Territories is sending regular e-mails asking for doctors, but it is difficult to afford the time or money to get a license to practise there, despite their great need.
There is some movement. Premiers of Atlantic provinces have announced that as of May 1, a doctor licensed in one province can work in all four. Ontario is making similar promises for health care workers registered in other provinces. These ad hoc solutions are not what Canadians nor health care workers need. We need a national license. This will eliminate the time, cost and administrative burden put on doctors and other health care workers who simply want to help deliver much-needed care anywhere in their own country.
This is not only about patients, but physicians too. We need help. There has never been a larger number of us considering leaving the profession. If provincial and federal governments want to know what to do about that, they can adopt the strategy we use with our patients: listening. In the latest survey by the Canadian Medical Association, 95 per cent of doctors support national licensure, the closest thing to a consensus either of us has seen in our profession.
There are many reasons for the enthusiasm: added flexibility, a more interesting practice, a chance to travel and work in our own beautiful country. And just as important, medical professionals share a true interest in helping people who need it most, no matter who or where they are. For many of us, it is why we went into medicine.
Concerns that this will exacerbate existing disparities are unfounded and defy evidence. Already, more than 90 per cent of physicians are located in urban areas, and the proportion is growing. It has been shown, in many different contexts, that exposure to a rural practice environment can improve the likelihood of a person working in one. Further, fears from provincial colleges about losing income or authority could be offset by efficiency found in harmonization and data-sharing, paving the way for other innovations, like a health record that could follow every Canadian.
This is the time for our federal government to announce a strategy for a national license and a time frame and to appoint an oversight committee to oversee implementation. Along with better access, it will boost the collective mood for patients and health care workers alike, an improvement that cannot come soon enough.