On July 1, 1962, Saskatchewan’s doctors went on strike. They feared they’d be facing lower pay under the province’s new medicare law – Canada’s first – which came into effect that day. A socialist government, which knew a thing or two about labour economics, responded by bringing in replacement workers.
The result was the most consequential act of strike-breaking in Canadian history. Before the month was out, the doctors had caved, and within a few years, every province adopted medicare. Had the party of Tommy Douglas not found temporary doctors in Britain and the United States, and had it not brought them in quickly, medicare might have died then and there.
History is filled with ironies. And lessons.
Six decades later, Canada has a shortage of doctors, and it’s not temporary. Several million people do not have a family doctor or regular health clinic – surveys say between one in eight and one in five Canadians are in that position. In some provinces, it’s as high as one in three. Just 40 per cent of Canadians say they can easily access primary care after hours.
A recent RBC study estimated that Canada could be short 30,000 family doctors by the end of the decade.
What does Canada need? To replace this shortage with a surplus.
The goal should be to have 100 per cent of Canadians registered with a family health clinic. Not in a decade. Now.
Can it be done? Yes. But only if we are seized by the same urgency that gripped Saskatchewan’s government in 1962. For medicare, it’s do or die.
I believe in universal health insurance, and I’m opposed to extra payments for insured services. But as I wrote earlier this week, I understand why some doctors have sought loopholes in the system, whether above board or under the table, to demand things like “membership” payments from patients. It all comes down to supply and demand.
For decades, provincial governments have tried to lower health care costs by limiting the supply of doctors. That involves limiting the number of medical school students and capping the number of postgraduate medical apprenticeships, known as residencies.
In 1962, Saskatchewan had a temporary doctor shortage because doctors withdrew their labour. In 2023, Canada has a continuing doctor shortage because governments have choked off the supply of labour.
Don’t blame doctors who try to take advantage of this situation. Blame the game, not the player.
It’s up to governments to change the game. That means expanding the physician supply, massively and quickly. Let’s go from shortage, with all the problems that brings, to surplus – with all the benefits that would bring.
Why not aim to bring in and license, say, 10,000 additional primary-care professionals by the end of 2024? And then another 10,000 the following year?
As a first step, provincial governments need to radically increase the number of residency positions. Last year, Canada had barely more than 1,600 residency spots in family medicine. Why not double that? Why not triple it?
We’d then have more residency positions each year than there are graduates from Canadian medical schools. Problem? No. Solution.
There’s a whole planet of qualified physicians who want to practise in Canada. And thousands of those foreign-trained doctors are ... Canadians. They went abroad to places like Ireland or Australia because there are so few seats at medical schools in Canada. Many want to come home.
What’s Canada doing in response? Almost everything possible to block their return.
A 2010 study estimated that 3,500 Canadians were going abroad for medical school every year, and 90 per cent wanted to come back to Canada. There may be more Canadians at medical schools overseas than in Canada.
Yet the number of foreign-trained medical school graduates applying for a Canadian residency is low and has been dropping for a decade. Why? Because Canada makes it so difficult for them to get one of the few residency spots.
So, Step 2: make it easy for foreign graduates to practise in Canada. Consider graduates of a long list of approved medical schools in places such as Britain, Australia, the United States and the European Union as equivalent to graduates of Canadian medical schools. Make them eligible for all of the thousands of new residencies I’m proposing – which in any case could not be filled without them.
And in the case of fully trained physicians from the list of approved countries and schools, treat them as eligible to work here – with no more multiyear rounds of applications and retraining and recertification, which appears to be mostly designed to reduce Canada’s supply of physician labour.
If they’re Canadian citizens – and thousands of applicants will be – there isn’t even an immigration issue. They can start work tomorrow. They just have to choose window or aisle on the flight home.
Governments have to stop aiming to create a physician shortage.
Two other big reforms are needed. One involves sharply increasing the number of nurse practitioners – the one group of professionals who can compete with, and replace, family physicians. The second involves rethinking how our public insurance system manages primary care physicians, how it pays them and how it connects pay to performance. More on that, next week.
