By Dr. Katharine Smart
As we collectively start to plan for a post-pandemic future, the Canadian Medical Association (CMA) and other health care partners continue to sound the alarm about Canada’s health workforce crisis. Health workers are dealing with long work hours, increased workload, harassment and intimidation, and ongoing distress caused by the pandemic, among many other challenges.
These are not new problems. Before the pandemic, 30 per cent of physicians reported high levels of burnout. But COVID-19 has exacerbated the cycle of health worker burnout and staff shortages, pushing hospitals to the brink. The lack of primary care capacity means that emergency rooms are perpetually congested and surgery backlogs continue to increase.
In October, during the fourth wave of the pandemic, the CMA and the Canadian Nurses Association (CNA) hosted an emergency summit, bringing together nearly 40 national and provincial health organizations. Health care workers and advocates made it clear that creating a comprehensive health human resources plan should be a top priority. Since then, I have continued to hear from health workers across Canada that this issue can’t wait.
But during these conversations, we are also continuously confronted by obstacles when we try to move the dial on health workforce planning. One key barrier we face is that we can’t manage what we can’t measure. In short, we don’t have the data we need: Where is the biggest need for physicians and primary care providers? How many physicians are needed in each area? How does technology including virtual care affect these numbers? And how do we incentivize physicians to stay in primary care?
The data we do have is discouraging. For example, Canada is lagging behind other member countries of the Organisation for Economic Co-operation and Development (OECD), with 2.7 physicians per 1,000 population compared to average of 3.5. And along with a shortage of physicians, the way we distribute our health workforce is problematic. About eight per cent of physicians practise in rural areas, caring for the 19 per cent of Canadians living there. The lack of pan-Canadian licensure limits mobility of the workforce.
We also work in provincial siloes, hindering a coordinated national response in areas where health staff shortages are the most severe. Recently in Newfoundland and Labrador, where nearly one in five people do not have a family physician, the provincial government proposed new measures including a team-based care approach.
And in a recent study from B.C., where one in six people do not have a family physician — a statistic matching the national average — researchers pointed out that workforce planning in the context of primary care needs to account for shifting models of practice. The study found most physicians are finding alternative ways to model their practice by blending community-based practice with work in other locations.
While trying different approaches to improve primary care access is commendable, the compartmentalization of health care — both within provinces and across Canada — means the full scope of Canada’s health workforce crisis is unknown.
While there are no quick fixes for this decades-long struggle, our actions now will determine how we recover from this pandemic. We have an opportunity to create tangible solutions for a robust and sustainable health care system. We are all accountable, and together, we can pave the way for a better health care future.
Dr. Katharine Smart is President of the Canadian Medical Association.