Curing Canada’s doctor shortage
We do not presume to know whether medical degrees should take four years to earn; or only three, as an editorial in the latest edition of the Canadian Medical Association Journal (CMAJ) suggests might be the case. But we know this: The length of time must be determined by medical necessity not fiscal expediency. Shortening the length of doctors’ professional education just so our socialized health care system can graduate more physicians is a non-starter.
It’s clear we have a problem. The country has approximately 15,000 too few doctors, a figure roughly double the total number of students in all years of study at our 17 medical schools combined. At a doctor-patient ratio of just 2.3 per 1,000 population, we are 24th on the list of 28 industrialized countries. Approximately 1.5 million Canadians cannot find a family physician as a result.
If this scarcity can be alleviated, even in part, by shortening the duration of doctor training, it might be worth a look, provided Canadians can also be reassured the change will not dull the skill of the country’s new doctors. However, it doesn’t go to the twin hearts of the problem: socialized medicine and centralized planning of health care. Graduating more doctors sooner won’t cure the underlying condition. Rather, it is more like treating a wound on the left hand by suturing the right one.
The doctor shortage began in the mid-1980s — not coincidentally, at the same time the last Trudeau government passed the Canada Health Act, which forbade user fees, balanced billing by doctors and private clinics and hospitals. Immediately, doctors began moving to the United States by the hundreds every year. The effects of this exodus were compounded in the early 1990s when provincial health ministers consciously decided to limit enrollments in their medical schools. Doctors, they reasoned, were the enemies of health budgets; limit the number of doctors and there would be fewer tests ordered, fewer hospital beds filled, fewer surgeries performed and lower costs to their department’s budget. (By this thinking, eliminating doctors altogether would really bring provincial cost into line.)
Over the quarter century since the Canada Health Act became law, approximately 12,000 Canadian doctors have moved south. According to another article in the CMAJ last winter, “this is the equivalent of having two average-sized Canadian medical schools dedicated to producing physicians for the United States” every year for 25 years. Add to this the way politicians and bureaucrats deliberately reduced the number of medical school graduates — the number fell 14% between 1991 and 2000 — and it is easy to see why there are too few doctors in this country. It’s not because our medical degrees are four-years long rather than three.
The governing bodies for doctors in each province — the colleges of physicians and surgeons — also deserve some of the blame. In most cases, they have willingly gone along with government caps on the number of doctors because it means less competition for existing doctors. The burden of this closed-shop attitude has been borne primarily by foreign-trained doctors who have more trouble being certified to practise in Canada than in most other industrialized jurisdictions. Many of the very best international doctors end up in the United States — even though some initially want to come here — simply because they are more welcome south of the border.
The Association of Faculties of Medicine of Canada is already studying what, medically, is the right length of time to school doctors. When it reports in 2009, it may well suggest shortening medical school to three years. But if it does, that will be tangential to solving our doctor shortage. Med schools didn’t create the shortage and they won’t be able to solve it. That will take courageous politicians willing to open up our health system to private innovation and physician competition.
Editor’s Note: This article originally appeared at nationalpost.com. It has been moved or deleted, we were unable to locate its new home. We will keep this archived on CG’s website.