Manitobans deserve better from health-care system

Hey there, time traveller!
This article was published 29/11/2023 (713 days ago), so information in it may no longer be current.

As a family doctor here in Brandon, I have taken my turn covering walk-in shifts.

What becomes apparent very quickly is the number of patients who do not have their own family doctor.

“What am I to do?” “Can’t you help me?” “Why can’t you help me?”

As a doctor, you feel overwhelmed. I do want to help — that’s what we do — but at the end of the shift, upwards of half of the visits are by the “doctor-less.”

Keep in mind that 300,000 Manitobans are without a family doctor; that 6.5 million Canadians do not have a family doctor; that Manitoba has the lowest number of family doctors per capita in Canada; and that Canada’s physician-to-population ratio ranks 29th out of 36 high-income nations.

How can this be? How has this happened? Who is responsible? In various degrees, we all are to blame.

When I first starting working in the early 1980s, there was a freeze on handing out billing numbers, and there were parts of Canada that you need not apply to because there were “too many doctors.” As a result, restrictions were put in place — including the cutting back on medical school class size.

What is puzzling is that since then there has been very little increase in class sizes. What has allowed the system to remain stable is a series of influxes of foreign-trained doctors.

And throughout this time, there has been very little outcry, from the people working in the profession or their professional organizations, that “we need to be training more family doctors.” Concern has been expressed, but what you hear about is the need “to retain and recruit.”

Often, any meaningful recommendations or scientific evidence that illustrates the need to create more doctor training positions has fallen on deaf governmental ears. Our education system is funded by our tax base, including how vibrant our universities are, which is where the medical schools are. Simply put, we need more tax dollars spent to make needed changes to medical school class size.

A recent article by Carol Sanders that appeared in the Sun earlier this month put this into perspective: “The Manitoba government is missing out on $1.6 billion in annual revenue after seven years of cuts to income tax, sales tax, education property tax and business tax. That’s close to what Manitoba spends on a post-secondary education and training in a year.”

Essentially, governments have choked off the supply of labour.

Years ago, I heard from a friend who had moved to the Maritimes. His name was put on a waiting list to be assigned a family doctor. The wait was five years, an outrageous time frame. But why haven’t we heard from the other 6.5 million Canadians in the same predicament? Why hasn’t there been more outrage and demand for there to be change?

What about those of us who happen to have a family doctor? We hear from of the surveys that there are large numbers of family doctors who are getting burned out and fast approaching retirement age, so we all should express our concerns!

To address this, some short-term fixes need to be paired with the development of a long-term plan.

In its recent open letter to Manitoba health-care workers, our new government said “thank you for the years of dedication and care. Now it is time for us to take better care of you.”

While it does help to hear that, there are lingering questions about the NDP’s recent election platform, which stated that they will “hit Doctors Manitoba’s target of hiring 400 more physicians.”

My question: where will these new doctors come from? Shortages of family doctors seem to be a worldwide problem, including in countries such as the United States, the United Kingdom, France, South Africa and South Korea.

In the short term, we will need innovation. One suggestion is to create community or team-based clinics where doctors can work hand-in-hand with other health-care workers such as nurse practitioners, registered nurses, pharmacists, councillors and therapists. The clinic becomes your family doctor.

Can we free up time from the family doctors’ daily tasks to allow more direct contact with patients or to see more patients? Remember that this is a numbers game — the recommended number of patients a family doctor should have in practice ideally is 1,200. So even if you were to double their payment, doctors can’t be expected to see double the number of patients.

We have a number of Canadians who have received their medical training in other countries and who are still waiting to be accepted into the system. Let’s expedite this! There are a number of international medical graduates who are looking for residency positions. Can’t we make accommodations soon?

Long term, we need to sound our collective voices to let our leaders know that we need to make significant change to the number of doctors we train here in Canada, for our Canadian needs. Let’s not rely on others for a supply.

We should double the medical school class size. Let’s act soon, as it takes five to six years to train a student who is accepted into medical school and has plans to become a family doctor.

The Kinew government also needs to make good on its promise to create a medical school here in Brandon. Are there ways to make family medicine more attractive?

I’ll also suggest that when you’re approaching your elected representative that you refer to the following quote from the British Medical Journal (May 12, 2023): “Family Physicians provide high-quality, comprehensive and continuous care, often as the first point of contact for members of the community. (Family physicians) improve population mortality — you live longer — by providing crucial preventative care screening and monitoring.”

Family physicians are more cost-effective because without timely access to community care, “patients will resort to much more costly emergency departments.”

So, let’s put down our “blame fingers” and start working on this problem now, together. We all deserve better.

» Dr. Scott Blyth is a Brandon physician who has been practising medicine for more than 35 years.