My local newspaper had this heading recently: “The Doctor Shortage in Canada.”
We’ve had a doctor shortage for 40 years.
When I was finishing university in 1982, the Alberta government cut back on medical placements at the University of Alberta and University of Calgary. My recollection is that both schools went from 120 to 90 annual placements. In other words, Alberta would be graduating 25% fewer doctors. Other medical schools across Canada did the same.
The reason given for this move was that the government(s) believed that we were living healthier, so we would not need as many doctors. This did not make sense to me. I was on the back end of the Boomer generation. The front end was moving into the age where health problems become more frequent. Even if we were living healthier, the bigger numbers of the Boomer generation would ensure a continuing demand for health services for a long time.
I thought this feeble reason a mere façade for the medical profession to ensure that doctors would remain in short supply. Create a shortage; their paycheck goes up; Economics 101.
Most of my graduating class of engineers found engineering employment. The next year, the Alberta economy went into recession. Only a few engineering graduates were lucky enough to find engineering work.
As time has marched on, various cohorts of university graduates have been unable to find jobs in their field. Teachers, nurses, accountants, and lawyers entered their first year of university with great prospects of great employment upon graduation — with that “promise” disappearing by graduation. Colleges and trade schools have had their own cycles of not graduating enough graduates in one year and graduating too many a few years later. Many young Canadians have had their great investment in education fall way below their expectations.
The medical profession has been exempted from this boom/bust cycle. For the past 40 years, Canadian doctors have always been in demand. When the shortage was a little too acute, we preferred to recruit from other countries rather than open up new university placements.
We could argue that educating a medical doctor costs society twice as much as an engineer, so that M.D. education deserves to be better managed in terms of number of graduates. But to have one faculty managed this way — and all other faculties left to the whims of “free enterprise” — is unfair to new students entering those faculties with realistic expectations.
The doctor shortage has become more acute in Canada. Immigrant doctors are not picking up enough of the demand. That has forced the medical profession to relax some of its control of medical procedures under its mandate.
With a trend starting 20 years ago, nurse practitioners are assuming tasks we used to allow only doctors to do. For example, my mother’s Type 2 diabetes is managed by a nurse. If this disease gets a little out of control, the family doctor will be called in.
Another example started this year: pharmacists are becoming the front lines for minor cases of cold/flu/COVID/RSV. They dispense the first round of medicine; if that does not work, then call in the doctor.
Last spring, I had an eye infection. My doctor sent me to my optometrist, who figured out the right kind of eye drops. Slowly and reluctantly, doctors are letting go of their domain. Lower-level health practitioners are handling more of the doctor workload.
If these changes are good now, why not 20 or 30 years ago? Why wait until we are in a crisis to force these changes?
Let’s face it! Our democracies have proven unable to predict the needs of the economy or social structure five years in advance, let alone a generation from now. And our democracies have also proven unable to challenge entrenched power structures.
It really is time to consider a new democracy. A kinder, wiser democracy.
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