Healthcare still ranks high as a priority area of concern for most Canadians. An estimated 5 million Canadians are without a family doctor and virtually every Canadian has experienced, either directly or directly, what they would assess to be a delay in receiving needed care. Two weeks into the federal election campaign, health finally emerged as an issue. In a 48-hour period, the Liberals and the NDP made announcements targeting the needs of our healthcare workforce. The particulars of each party's health platform vary; the NDP is proposing a $1 billion allocation over 10 years to increase first-year medical and nursing school admissions by 50% (1200 new spots for faculties of medicine and 6000 for nursing), while the Liberals are proposing to invest $420 million over a 4-year mandate to create a Doctors and Nurses Fund to increase the number of medical professionals in Canada. Undoubtedly, the Conservatives will enter into the fray before the end of the campaign.
These announcements come at a time when our faculties of medicine are already responding aggressively to calls for expansion. There has recently been a rapid increase of medical school enrolment in Canada; we have moved from a recent low of roughly 1500 entry-level medical school positions to just over 2400 positions in 2008. We have also begun to take in more international medical graduates; more than 350 first-year postgraduate training spots were allocated to them in July 2008.
These increases, and calls for future increases, have come on the heels of mounting public pressure for governments to address the "doctor crisis" and have not been the result of a systematic, evidence-based analysis of how many physicians and other health professionals we actually need in this country. If there is a single lesson to be drawn from Canada's cherry-picking from the recommendations contained in the 1991 Barer-Stoddart report, and the resulting doctor shortage we are currently experiencing, it is that health human resource decisions need to be informed by evidence and consider our future predicted need. There is no question that in the end, decisions regarding the size of our medical workforce will be shaped in part by the will of the people. This is entirely legitimate and appropriate. Canadian values and demands may well trump the evidence; but due diligence requires us to at least assemble and consider the best available evidence about what the actual needs of Canadians are likely to be in the future. Without this critical step we run the very real risk of perpetuating the boom and bust cycle we have experienced in the last few decades.
The Association of Faculties of Medicine of Canada (AFMC), and others in the health sector have been calling for Federal leadership in developing a planning mechanism to better determine the numbers of physicians and other healthcare workers required in this country. To date, Federal governments have not acted on this recommendation. Based on current or proposed trajectories, will we have too few doctors or will we have too many doctors? How ought we to integrate physicians with team-based models of care? How do we determine the appropriate scope of practise for physicians and other healthcare workers so that they are complimentary and not overlapping? These elementary and elemental questions need answers.
Canada needs Federal leadership in the development of a human resource observatory that will monitor the number of trainees we have, conduct research, and provide careful recommendations to help us plan our health human resources into the future. This important initiative could be accomplished with a modest investment; what is missing is not the money - it is the political will.
Association of Faculties of Medicine of Canada
afmc