A physician shortage is affecting Canadians, especially in the fields of family and rural medicine, and the effects of this shortage are exemplified in rural regions such as Saskatchewan. Further impacting residents of Saskatchewan is the seeming difficulty in attracting and retaining specialists on our provincial roster of health professionals. According to the saskdocs.ca webpage under the tab Work Opportunity, on November 9, there were 297 positions waiting to be filled by physicians in Saskatchewan. Over 120 of those positions were for family physicians, but in the advertised positions is also found supporting evidence for a comment made by Dr. Tamara Hinz and quoted in an August 1, 2023, article in the Prince Albert Herald. She stated, “What we’ve seen with the children’s hospital in Saskatoon is that it’s not necessarily a ‘Build it and they will come’ type of situation.” Amongst those 297 advertisements, 13 pediatric specialist positions needed to be filled, representing almost every area of specialization including neonatology, neurology, nephrology, urology, rheumatology, gastroenterology, nephrology, psychiatry, infectious disease, and developmental pediatrics. It is ironic that the people of Saskatchewan can raise millions of dollars to support kids in the province, nearly $1.16 million over the course of two days just last week for the Jim Pattison Children’s Hospital Foundation, but our government can not hire and retain an adequate supply of pediatric specialists to help treat them.
Dr. Hinz went on to say “I don’t think that, historically, our health authority or government have really recognized that – that they kind of put one person in a position and feel like it’s sort of mission accomplished.” (paherald.sk.ca; August 1, 2023, We need to do more…) After reading an article regarding the shortage of liver specialists in the province, this reporter reached out to the Saskatchewan Health Authority and the Saskatchewan Medical Association asking what they see as the main issue that attracts specialists to other provinces over Saskatchewan. It cannot all be tied to the rural and remote nature of the province, as Manitoba, which is equally rural, has three times as many hepatologists, according to the article, as Saskatchewan. Many people ask the question why? Why is Saskatchewan unable to retain and attract specialists and family physicians? The public is tired of hearing that healthcare across Canada is struggling to fill positions, they already know that what they do not know is what has made Saskatchewan a place that specialists do NOT want to practice.
Not surprisingly, the Media Relations department within the Saskatchewan Health Authority issued a statement that did not shed any light on the situation. Their response, in part, reads:
“The Saskatchewan Health Authority (SHA) is committed to ensuring Saskatchewan has the health professionals needed to provide the necessary health services for residents across the province.
It is currently a highly competitive market nationally and internationally when it comes to physician recruitment, even more so when it comes to recruiting specialists or sub-specialists.
The SHA is prioritizing recruitment and retention of physicians to the province. The SHA and Ministry of Health are diligently working with stakeholders, including physician partners, SHA staff and senior leadership, the Saskatchewan Medical Association (SMA), individual communities, the University of Saskatchewan’s (U of S) College of Medicine, and the Saskatchewan Healthcare Recruitment Agency (SHRA). The SHA is actively recruiting and advertising across Canada, in the United States, and overseas.
Ministry of Health data shows the number of licensed physicians in Saskatchewan increased 62% between 2007 and 2023, or more than 1,000 doctors. The number of physician specialists increased [by] 79%. That said, we know [that] there’s more specialists needed and as noted above, the SHA continues to recruit these much-needed physicians.”
The statement, “the number of licensed physicians in Saskatchewan increased 62% between 2007 and 2023, or more than 1,000 doctors” raises the question, how does that relate to the number of practicing physicians? A physician who is retired or who has gone into research is still a licensed physician. A physician who has left practicing medicine to take on an administrative role is still a licensed physician. Using a number or percentage without a point of reference is just a number that ‘muddies the water’ and does nothing to clarify or enlighten. Likewise, the statement, “The number of physician specialists increased 79%”, could represent a still very small number, or it could be significant. For example, an increase of 79 percent from a starting point of 10 only means a total of close to 18 full-time equivalents, whereas from a starting point of 200 the result would be a final total of 358. Again, clarity is gravely lacking, and the figures could be considered deceptive and at the very least misleading.
The Saskatchewan Medical Association replied, in part, with the following:
“Support for rural medicine and the recruitment and retention of physicians in rural and regional areas are high priorities for the Saskatchewan Medical Association (SMA). We need to understand the reasons why physicians leave certain positions and address these concerns. There is no single solution that can be applied to each physician’s situation. …
New funding is welcome in this year’s provincial budget to recruit specialist physicians, bolster the Saskatchewan International Physician Practice Assessment (SIPPA) program, and develop a dedicated agency to deal with [the] recruitment and retention of health care workers.
The SMA recognizes the need to address issues around [the] recruitment and retention of physicians and health care workers. SMA members are calling for a level of investment in health care that will improve care for patients and create more sustainable working environments for physicians.”
Judging from what the public has heard from physicians themselves, perhaps the most indicative part of both responses is found in the last seven words, “create more sustainable working environments for physicians”. Incentives offered by the SHA in conjunction with the SMA include financial incentives for specialists to come to Saskatchewan and stay for thirty-six months, for eligible graduates who stay in the province, and for physicians who maintain a practice for extended periods, a parental leave program for physicians working in a self-employed practice, and a continuing education fund to assist with the costs of continuing their medical education, as well as programs specific to rural practice. However, money cannot solve everything.
The question remains, how did we get to this point? Researchers have been delving into that very issue for nearly twenty years already, with many articles published within the last ten. In the 1970’s Canada enjoyed one of the highest physician-to-population ratios among developed countries and the number of physicians per population was growing steadily until 1993. The 1992 Barer & Stoddart report on physician numbers in Canada stated there was an overabundance of physicians which resulted in governments implementing policies to control that growth. In the period from 1990 – 1993, 1040 physicians began practicing medicine every year, but in the period from 1994 – 2000, that number dropped to 313 per year. (Chan, B.T.B, 2002, From perceived surplus to perceived shortage: what happened to Canada’s physician workforce in the 1990’s. Canadian Institute for Health Information, https://secure.cihi.ca/free_products/chanjun02.pdf) What policymakers failed to give attention to was the predicted shortfall of more than 90,000 physicians in the United States by the year 2020. (Association of American Medical Colleges [AAMC], 2010; Council on Graduate Medical Education [COGME], 2005). A greater earning potential, generous incentives, and opportunities to work and advance their education led many Canadian physicians to cross the border.
In a 2017 article in the Global Journal of Health Science, titled Physician Shortage in Canada: A Review of Contributing Factors, the authors cite the elimination of the one-year rotating internship and making a two-year family medicine residency a minimum requirement to practice, along with increasing the number of residency positions for specialists while decreasing those for family medicine residency as resulting in nearly halving the number of new family physician starting practice by the year 2000. As well, policies that capped remuneration and expenditures, limited interprovincial physician movement, and imposed financial penalties for practicing in “over-serviced” areas, further succeeded in driving Canadian physicians to the United States, thereby reducing the overall supply of not only family physicians but all physicians. (Global Journal of Health Science, 2017, Physician Shortage in Canada: A Review of Contributing Factors, Andrei V. Malko & Vaughn Huckfeldt, Saba University School of Medicine, The Bottom, Saba, Dutch Caribbean (https://www.ccsenet.org>journal>gjhs>article [Canadian Centre of Science and Education])
The SHA said in their statement, “The province also continues to train more doctors at home through a number of initiatives that include the expansion of medical student seats and residency seats at the University of Saskatchewan’s College of Medicine”, but that expansion of seats was a paltry four new spots in the program. It takes seven or more years after being accepted into the medical program before a physician is eligible to practice, so those four extra doctors will be a while. Saskatchewan, and Canada for that matter, should have started addressing the issue about ten years ago when the situation was still just a problem, not a crisis.
Malko and Huckfeldt identified another problem that keeps many from entering the field of family medicine and that is a lack of popularity and appeal in the field. In Canada, medical students reported that family medicine lacked prestige and that faculty often encouraged the brightest students to pursue a specialty career as opposed to the low-paying field of family medicine. In the United Kingdom, family medicine is reportedly considered a prestigious specialty. Students at the time the research was conducted, were broadly exposed to various aspects of family medicine, had positive role models throughout their training, and faculty praised the knowledge and skills of family physicians which led more students to consider pursuing a career in the field.
Any advertising agency can explain how crucial a positive association is in drawing people to a product. A positive association between rural origins, rural exposure, and eventual rural practice is necessary to encourage medical students to follow a path into rural and family medicine. Medical school’s educational and training curriculum with a strong rural commitment plays an important role in changing rural practice perception among students so they can come to appreciate rural healthcare, rural lifestyle, and people in the community. However, unless provinces and health authorities address some of the dissatisfactions related to rural practice in Canada, rural medicine will continue to take a backseat to urban.
By Carol Baldwin, Local Journalism Initiative Reporter
Original Published on Nov 17, 2023 at 12:47