Complicated knots always look difficult, if not impossible, to unsnarl.
The messy state of the health care system – with hours-long waits in emergency rooms the most obvious symptom – fits that description. New data from the Canadian Institute for Health Information show that people admitted to hospitals in 2021 spent more time waiting in the ER than ever before. There are, however, answers to ease Canada’s health care crisis, ones that won’t take years to implement.
On Wednesday, this space examined the premiers’ ask for a novelty-size blank cheque of new funding. Those demands are misleading and understate Ottawa’s health care investment. Simply spending more money isn’t the answer, and could end up propping up a failed approach.
A better diagnosis begins with fundamentals: family health and long-term care, as highlighted in the federal government’s five areas of priority.
The dearth of family physicians is forcing Canadians into emergency rooms for non-urgent care. On top of the surge in patient loads at ERs, the lack of long-term care is clogging up acute-care beds in hospitals – and denying proper care to those with acute needs. Dealing with those two gaps will do much to relieve the pressure on ERs across Canada.
As we’ve written before, hospitals should not be turned into nursing homes, with elderly patients occupying expensive and scarce acute-care beds because of planning failures in the long-term care system. In Ontario, about seven of 10 patients classified as alternative level of care, in acute-care beds, are looking for long-term or similar care. Ontario took aim at that problem last summer with Bill 7, to move people more quickly from acute-care beds into long-term care. The bill was criticized but was a sound step forward, even with its imperfections.
Problems in family medicine have also metastasized, creating more pressure on ERs. The family doctor is the true foundation of any health system: working on routine concerns; dealing with small issues before they become big ones; and connecting patients with the rest of the system.
But one out of seven Canadians aged 12 or older, almost five million people, don’t have a family doctor. Canada has among the fewest doctors per capita, 2.8 physicians per 1,000 people, of all OECD countries, far lower than Germany at 4.5 and Sweden at 4.3. About half of Canadian doctors work in family medicine. Canada is not alone in seeking more doctors; the World Health Organization has estimated a global shortage of more than six million. But there is an obvious and relatively easy place for Ottawa and the provinces to start the search: Canadians in medical schools outside the country, and physicians in Canada with credentials earned overseas but not automatically accepted in this country.
Consider Jessica Langevin. The 26-year-old, from Sarnia, Ont., is studying at the Royal College of Surgeons in Ireland. She wants to practise family medicine back in Canada, possibly in a rural area. Sounds like a perfect fit, yes?
Yet odds are stacked against Ms. Langevin. Canada has a reputation for being difficult to accredit foreign-trained doctors – even Canadians – and the number of available residency positions is low. That’s a glaring problem, since foreign-trained doctors have in the past accounted for a quarter of all doctors in Canada and almost a third in family medicine.
The situation is similar for immigrants to Canada with overseas medical degrees. There’s not enough opportunities for residencies. Between 2015 and 2020, about 5,000 foreign doctors became permanent residents, but less than 40 per cent are working as doctors. Another issue is certification exams for family doctors. Those trained in the United States, Ireland, Australia and Britain can skip them. That list is shorter than it should be.
Opening more doors for doctors trained elsewhere, Canadian or otherwise, is where Ottawa can focus any new dollars it commits, in co-operation with the provinces. That money should come with strings attached by government – to steer new doctors to family practices in underserved areas.
Specific targets require robust data. Canada, as is too common, fails on that front. We don’t know where family doctors are working, how they’re working, and where the shortages are. Collecting and collating that information, as the federal government suggests, is a necessary first step.
Health care reform is a complicated knot but it can be unravelled. Ottawa is off to a good start with its proposed focus on five key areas. The provinces should join in that effort.
Editor’s note: An earlier version of this editorial incorrectly stated that in Ontario about seven of 10 acute-care beds are occupied by a person looking for long-term or similar care. In fact, about seven of 10 patients classified as alternative level of care, in acute-care beds, are looking for long-term or similar care.