National licensure won’t fix Canada’s doctor shortage — it’ll make it worse
National physician licensure is having its moment in the sun right now, riding the wave of “removing interprovincial trade barriers.” Within the larger “trade-barriers” conversation, many in the physician community have smelled opportunity. They say Canada’s doctors should be freed from the shackles of provincial licensure requirements, once and for all.
Much ink has been spilled over this in recent weeks, with some actually arguing this will somehow “improve health-care access in underserved areas and increase flexibility for physicians.”
But here’s the rub: both statements cannot be true.
Shortages are the problem, and they won’t be solved by mobility. National certification doesn't add a single doctor to address our profound lack of them — a deficit resulting from over 20 years of provinces refusing to adequately fund medical school spots.
A single market risks deepening health inequities between provinces. Winnipeg would lose doctors to Vancouver, Fredericton to Toronto, and so on.
It’s a simple matter of supply and demand. You keep the number of doctors the same, while vastly and abruptly increasing the employers and provinces vying for their services.
The obvious result is an interprovincial bidding war over doctors.
The problem is a shortage of doctors. We need to expand the capacity of universities to train doctors and nurses. That is a solution.
In the 1980s, it was deemed there were too many doctors and nurses, so governments cut back admissions, and kept those numbers stable, despite predictions and warnings around the year 2000 that more were urgently needed. Provincial governments routinely chose spending freezes and tax cuts over investments. They throttled training capacity for decades by limiting funding for seats, residencies, and faculty salaries.
Between 2010 and 2016, Manitoba had its total federal transfers frozen. Despite a growing and aging population, the Harper Conservatives unilaterally cut health care transfer increases — in half.
After 2015, the federal government lifted the freeze and transfers for equalization and new health accords. The PC government of Brian Pallister imposed a general wage freeze and a string of damaging cuts, freezes, selloffs and overhauls, and other conservative provinces did the same, using identical talking points.
One consequence of the PCs’ cuts was that U of M’s medical school nearly lost its accreditation for family medicine. During a lengthy faculty strike, U of M Nursing and Computer Science said they couldn’t expand their programs — despite the need for graduates — because they couldn’t attract professors when Saskatchewan was paying $15,000–$20,000 more a year.
I recall meeting with a doctor at the time, who remarked that Manitoba’s health care system can’t function without the University of Manitoba. It provides people to work in the system. This is certainly true of other provinces as well.
The bottleneck to improvement is that provincial cuts and freezes are still throttling admissions. There are many more qualified Canadian applicants who could be doctors or nurses than are currently being accepted into schooling. The shortages driving our health care woes are a direct result of provincial quotas, which are set far too low.
Education is the only investment that ever had a guaranteed return.
The appeal of a “get rid of barriers” policy (and its danger) is that because it is cost-free, politicians will seize on it as an efficient and popular solution, when it is no solution at all.
Worse, while we waste time on pushing water uphill, we'll be turning away thousands of potential Canadian students. We could instead dedicate schools or admission spots for students from rural and north regions who want to return to their home communities to practise.
The massive cuts to R & D in the U.S. are a historic opportunity — almost an obligation — for Canadians. Incredible cutting-edge health research is being lost. But it doesn’t have to be forever.
Canada should aggressively commit to supporting and facilitating the northward migration of slighted research and medical talent from the U.S. But it’ll never happen, unless Canada’s provinces step up and fund it, with the federal government’s help.
The adult conversation we need to have about health care in Canada is that when policy ideas don’t reflect economic, demographic, or medical reality, people die. I’ve met many, many of their loved ones.
There are no shackles stopping any politician from doing any of these things. Just excuses.
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Dougald Lamont is a former MLA for St Boniface and former Leader of the Manitoba Liberal Party.