A vote for ‘train and retain’

Opinion

Hey there, time traveller!
This article was published 24/02/2024 (571 days ago), so information in it may no longer be current.

For my entire adult life, it seems that we have been lamenting physician shortages. That’s not an insignificant period of time, unfortunately.

It’s time to stop admiring the problem. It’s time for a medical campus at Brandon University.

When we need more people in occupations, we often increase the supply of training seats. This doesn’t always happen in a timely fashion, but it usually does happen, even if it is a day late and a dollar short.

In medicine, in particular, however, it seems we’ve been more reluctant in Canada to take that approach. One of the reasons is the mobility of labour. This might be one area where we complain that it’s too mobile, as opposed to having significant mobility barriers like some other occupations.

Training doctors is an expensive proposition. When I was involved in building the funding formula for Nova Scotia universities (circa 1998), it was definitely one of the most expensive degree programs (and let’s not even talk about veterinary medicine). Tuition fees cover only a small fraction of the actual costs of providing that education.

The reluctance of many jurisdictions to expand doctor training is the fear they will spend a lot of money to educate a bunch of people who will then leave for other provinces or countries (principally the United States). Nobody wants to “educate and export.”

That fear is justified. A few years ago, I heard someone bragging that almost two-thirds of University of Manitoba medical school grads were planning to stay in the province. I didn’t see it as something to brag about, but it probably tells us about how this has looked either historically within Manitoba, or compared to perhaps even worse outcomes on retention in other jurisdictions in Canada.

At the same time, simply relying on recruiting doctors from other jurisdictions (principally other countries) to fill our shortage isn’t working. It’s necessary, but not sufficient.

Training more doctors seems like the logical solution, but the question really turns to how to do it in a way that will actually contribute to reducing our doctor shortage.

The answer isn’t just scaling up the current model. We need a better retention rate. We need more family doctors. We need more doctors in rural areas. We need to “train and retain.”

Opening a medical campus at Brandon University is a good place to start. This is not a new idea. A version of it was shopped in 2010, based on the model used in Prince George, with which former Brandon University president Deborah Poff had familiarity.

It didn’t fly at that time, for a variety of reasons. Yesterday isn’t today, however. With David Docherty’s leadership at Brandon University, Michael Benarroch’s co-operative approach at University of Manitoba, and a premier and cabinet highly focused on health care, we just might have winning conditions.

Today, branch medical campuses are springing up all over the country, as jurisdictions get more serious about addressing the problem. We see developments in places like Saint John, N.B., Charlottetown, P.E.I., Sault Ste. Marie, Ont., and Sydney, N.S.

These developments are all affiliated with existing medical schools; a smart move from my perspective. Accreditation and regulatory requirements are significant issues in this sort of training, so there is no need to replicate all those functions, processes or costs using this model.

An affiliation for a Brandon University medical campus with the University of Manitoba’s Max Rady College of Medicine is what makes sense.

However, in order to get the outcomes we need, this is not a matter of just training more doctors in a different location. We need a different set of conditions. For that to be successful, Brandon University needs to be at the forefront of convening parties to shape new policy and approaches to the training.

We need a new model for admissions, financing and post-service arrangements for this project to truly be successful.

We should be admitting people based on their willingness to commit to legally binding arrangements to serve for periods of time in rural areas across Manitoba. They should, of course, be required to pay significantly less based on these arrangements but be on the hook for the full costs if they default on their commitments.

In arguing for a similar arrangement in Nova Scotia in 2017, I suggested that counties might be the logical area for commitment. In Manitoba, the rural municipality structure is likely too small and our regional health authority territories are likely too large. This would require some thought, but it should be straightforward enough.

A medical campus at Brandon University would also help the university with its longstanding desire for an upgrade to its science labs. I also suspect a local medical campus would motivate more students to take STEM-related programs at the university and elsewhere.

During the recent city budget deliberations, I saw our city council allocate money to help with physician recruitment. When I was chair of the board at Prairie Mountain Health, I saw many small communities commit resources to similar endeavours because they knew how important having doctors is to the viability of their communities. It was commendable, but I always felt some level of regret that they felt it was necessary to divert municipal tax dollars, or donated community funds, to such a key basic community health requirement.

There’s a potential structural way to address the problem: a medical campus at Brandon University with a new admission, financing and return of service model. It won’t happen overnight, but the best time to start is now.

There will be many parties reluctant to do this — not necessarily against expanding, or even expanding to Brandon, but opposed to using a new, unfamiliar model that challenges conventional patterns. If we want different outcomes, however, we must be willing to do things differently. We need to “train and retain.”

It’s time to stop admiring the problem and start doing what is necessary to solve it.