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Medicare Meltdown: Canada used to have one of the best doctor ratios in the world. What happened?

News

Canada’s health-care system is under siege. The country is still grappling with an acute crisis in our hospitals stemming from the COVID-19 pandemic while the slow-moving quagmire caused by the country’s aging population threatens to become a larger disaster. Can our system handle it? This five-part Hub series produced in association with the National Post looks deep into the world of Canadian health care, not just to identify problems, but to offer solutions for the future.

Efe Türker received his third dose of the COVID vaccine in February and quickly realized he was in for a rougher bout of side effects than he endured from his first two shots.

Türker developed a fever in the evening that got progressively more severe until he fell into a fitful sleep. At 5 a.m., he woke up, shivering in a pool of his own sweat. When he went to wash his face, Türker lost consciousness and collapsed in his apartment, banging his head on the floor as he went down. His dog found him lying there a few minutes later, and was able to wake him up.

Head trauma can result in anything from an uncomfortable bruise, an excruciating concussion, or a deadly brain hemorrhage. But Türker did not seek serious medical attention, or even a checkup. Not worth the trouble, from his perspective.

“There’s absolutely no way you see a doctor at any logical time in Victoria, be it a general practitioner, or anything,” says Türker. “I have never seen a doctor since I arrived in Victoria.”

Medical Meltdown

A shortage of practitioners, and laborious wait times, are not new problems in Canada, but they are especially acute in Greater Victoria, where news reports of walk-in clinics closing down have become a frequent occurrence. Walk-in clinics in the Victoria-proper neighbourhoods of James BayCook Street, as well as the nearby municipalities of Colwood and View Royal, have closed, leaving as many as 3,000 more people per closure without a go-to medical facility.

An estimated quarter of Greater Victoria’s nearly 400,000 residents did not have a family doctor in February. In April, the wait times to see a doctor at a walk-in were the highest in Canada, at 161 minutes.

The story is beginning to look the same across the country. In Hamilton, the city’s hospitals are short 675 workers, in Toronto, paramedics are practicing “hallway medicine” in the ERs, and in Airdrie, just outside Calgary, staffing shortages are keeping the urgent care centre closed overnight for at least the next eight weekends. Local news broadcasts across the country are packed with stories about wait times, staffing shortages and the frustration these problems are causing Canadians.

Victoria is no longer a cautionary tale, but a microcosm of the rest of the country. Especially frustrating is that Canada once had one of the highest ratios of physicians to population in the developed world.

Canada’s universal, taxpayer-funded, health-care system remains a pillar of national pride, but when compared to the country’s peers in Western Europe, it now ranks near the bottom of the pack. The favourite solution of the federal government and provincial premiers has been to boost funding, but it has created an expensive system that consistently underperforms in delivering quality health care when compared to similar countries.

The Commonwealth Fund’s 2021 report comparing the health-care systems of 11 developed countries, put Canada in 10th place, just ahead of the United States. Canada placed 10th in equity and health-care outcomes, 9th in access to care, 7th in administrative efficiency, and 4th in care processes.

According to the World Health Organization’s pre-pandemic rankings of global health systems in 2015, Canada ranked 30th out of 190 countries. France is ranked number one, while the United States comes in at 37, making Canada out as a lubber, rather than a leader, in providing health care for its citizens among its peers.

According to a 2015 Commonwealth Fund Report, 38 percent of Canadians felt the system worked well, 51 percent wanted fundamental change, and 10 percent believed it needed to be totally rebuilt. It would be quaint to still believe nearly 40 percent of Canadians feel the system worked well in 2022.

As waiting times continue to lengthen, and the number of doctors plummets in many of the country’s leading cities, both the health-care system and its cherished status among Canadians are waning.

Shortages

Camille Currie is the organizer and founder of BC Healthcare Matters, a grassroots advocacy group that emerged as a result of the province’s medical shortages. Currie says doctors in B.C. face several unique challenges when compared to the rest of the country.

“We have the highest cost of living in Canada,” said Currie in an email. “Our family doctors can’t afford to stay in business here while making the lowest median salary in the country, while 30-50 percent of their pay goes to overhead costs, which are higher here than anywhere else due to our cost of living.”

In 2019, B.C. doctors were described by the CBC as being paid the third least after their counterparts in Nova Scotia and Newfoundland. Victoria is annually ranked as one of Canada’s most expensive cities in the country, with higher costs for everyday needs like groceries and energyHigh commercial rents are driving long-standing businesses out of the city’s downtown.

Currie says the province continues to fund urgent primary care centres, but they are being used as walk-in clinics due to the shortages.

“The people using these facilities are citizens without family doctors and without access to walk-in clinics,” says Currie. “The B.C. government has wasted millions of dollars on these facilities, and still claims they are also the answer to our family doctor crisis.”

In February, the provincial government committed $57 million for 10 more urgent and primary care centres in the province by 2025, increasing the total number in the province to 50. Just six will be on Vancouver Island.

“Overhead is higher than anywhere else, doctors can only bill the government for $31 per patient, the lowest in the country,” says Currie. “Doctors can only see a maximum of 50 patients a day and can’t bill for countless tasks that use up their time, like checking labs, writing referrals, doing full physical exams.”

Currie also says that while there is demand, the supply of doctors is insufficient to meet it, and B.C. cannot attract more physicians without change. In October, the B.C. government announced a plan to raise the salaries of doctors in the province by over $100,000 per year, which some doctors labelled a “seismic shift.”

Federal and provincial politicians in Canada often respond to surges of complaints regarding health care by promising to funnel millions or billions of dollars to the provinces to help alleviate the shortages. Currie says this does not solve the issue.

“Our problem isn’t a federal funding issue, our problem is an effective use of health care funds,” says Currie. “Alberta has a similar health ministry budget as B.C., so how are they able to provide for all their citizens and we aren’t?”

For many Albertans, however, the situation is not optimal either. Alberta’s residents have complained about their own long wait times, and many have opted for out-of-province treatment.

B.C. continues to place highly in provincial health care rankings, largely due to the overall health of the population. However, that could change, especially as the population of Canada continues to age, and current trends continue.

Shirley Bond is the B.C. Liberal MLA for Prince-George Valemount, and once served as the minister of health during her party’s 16 years in government from 2001 to 2017. With the B.C. NDP now governing the province, Bond is the health care critic and is aware of the pressures facing walk-in clinics, such as the costs of overhead.

Regarding federal funding, she says it continues to play an important role in improving B.C. health care, especially in the province’s more rural regions. Her riding of Prince George-Valemount, located almost 800 kilometres away from Vancouver, is serviced by the University Hospital of Northern British Columbia and lacks many vital facilities.

“It is a regional centre, and we have no cardiac care,” says Bond. “We need enhanced surgery, surgical capacity, we need significant investment in my community.”

Nonetheless, Bond acknowledges the need to re-examine the health-care system in B.C.

“We do need additional resources, and we also need to look at how we utilize those resources and are there ways that we need to consider a more innovative approach,” says Bond. “We certainly need to have more dialogue with the people who actually can operate the system, they’re the experts.”

Credentialing

Bond says she is looking at the Ontario government’s recently announced plans to revamp the province’s health-care system, which includes additional training spots for nurses and removing barriers for foreign-trained medical professionals to begin practicing.

Ontario’s plan for credentialing foreign doctors has been slow and controversial, but Bill Tholl says the provinces can provide templates for each other when formulating policy, due to Canada’s decentralized health-care system.

“Historically, one of the big upsides of having a decentralized system is we learned from one province to another,” says Tholl. “It’s kind of a natural experiment, in fact, our national Medicare program might be referred to as kind of a provincial experiment in my home province of Saskatchewan.”

Tholl is one of Canada’s leading health-care policy analysts, is an author, and has served on numerous health care-related committees and organizations.

“I’d say the fundamentals are still pretty darn good, but the rest of the world is changing and we’re not keeping up,” says Tholl, regarding Canada’s medical delivery. “We really haven’t taken up the challenges of change very well in the Canadian health-care system.”

Tholl says many of the problems with Canadian health care can be traced back to the 1990s. Following the 1980s, Canada was racked with fiscal chaos, chronic budget deficits, and inflation. It prompted a major policy shift towards balanced budgets and getting government spending under control.

Tholl says the federal government prioritized costs over care as part of its program of austerity and fiscal rebalancing, resulting in a reduction of enrolments in medical and nursing schools, by respective rates of 15 percent and 50 percent.

“I know it sounds odd to say, but we’re still recovering from that shock to the system,” says Tholl.

Tholl says that while the federal government subsidizes both undergraduate and residency training programs, they remain below their pre-1990s ratios, keeping not only the number of homegrown surgeons and family doctors capped but also residency training spots.

When asked why the federal government would not simply increase the number of spots to generate more medical professionals, Tholl says the pandemic may spur those changes.

“I think they’re realizing just how much the pendulum swung too far in terms of constraining physician supply and nursing supply,” says Tholl. “God only knows the pandemic has shown just how fragile….how we were operating beyond the capacity limits of the currently available doctors and nurses.”

Even if changes were to be made, Tholl says it could take anywhere from six to 12 years for new professionals, such as cardiac surgeons, to enter the system.

Tholl cites the “South African Solution” as a way to help alleviate health care shortages in the short term. It’s a policy developed by Saskatchewan’s government to enable the province to effectively lure South African doctors, who undergo similar training to their Canadian counterparts, and push them into the province’s medical workforce. In 2016, more than half of Saskatchewan’s doctors had been trained outside Canada, with most coming from South Africa, Nigeria, and India.

Immigrant doctors would be a welcome addition to Canada’s medical workforce in 2022, as many medical professionals across Canada are retiring due to burnout from the pandemic, lessening the already short supply.

“You’re seeing a lot of concern in the health-care sector about the ‘Great Resignation,’ that those that can’t afford it, those that have had enough,” says Tholl.

Tholl mentions the Ontario government is resorting to awarding thousands of dollars in individual bonuses to nurses to remain on the job. The purpose is to stave off resignations and retirements as a short-term fix until nursing schools can begin producing more graduates to replace the retiring ones.

However, Tholl points out that medical school is still an expensive and highly competitive process.

“It’s always been competitive, but I suspect it’s more competitive now than it’s ever been,” says Tholl.

Tholl explains that the competition continues past medical school and affects how graduates can obtain residency training spots. The already-subsidized cost of medical school cost $17,000 CAD per year on average in 2021, and nearly $30,000 per year in Ontario.

Tholl says that once students graduate, often with significant debt, they go into specializations that pay more than a general practitioner, such as becoming a dermatologist. While dermatology may be a huge help for acne-ridden teenagers, they do not surgically repair injured knees or perform heart transplants.

Federal funding

“If you got in a car and drove yourself from St. John’s, Newfoundland, all the way to Victoria, British Columbia, you would find yourself in 10 very different provinces with 10 different realities,” says Nadeem Esmail, a senior fellow at the Fraser Institute. “The decentralization of health care and giving the provinces the ability to determine health-care policy allows them to tailor their system to their provincial realities.”

Like Tholl, Esmail says the decentralized approach could allow the provinces to individually experiment with different health-care policies being undertaken around the world, if only the federal government would give more autonomy to the provinces.

“The involvement of the federal government is in fact, holding the provinces back from setting optimal health-care policy or ideal health-care policy for the population,” says Esmail.

Esmail says the Canada Health Act is limiting policy innovation because it governs what provinces can and cannot do in terms of health-care policy in return for federal health transfer payments. He says that the provinces are dominated by government-run monopolistic hospitals and a health-care system that precludes any cost-sharing of user fees.

“We’re not able to encourage more informed decision-making among those who can afford it,” says Esmail. “We’ve trapped ourselves in this very ineffective set of health-care policies as a result of federal interference and provincial policy making.”

One common practice of federal and provincial governments when addressing health care is to pledge further funding, especially during election seasons. Like Camille Currie, Esmail does not consider federal funding to be the problem or the solution.

In March, Ottawa announced an additional $2 billion would be delivered to the provinces to help alleviate pandemic-related medical backlogs. This is on top of the $4.5 billion that was already given to the provinces during the pandemic to assist in handling the crisis.

Bill Tholl says it can’t always be known if the provinces are actually spending the transfers on health care as intended. The federal government and the premiers are currently locked in a dispute over future transfers, with Ottawa demanding guarantees it is spent on health care.

“It’s literally a transfer from a federal banking account that goes across the street to a series of provincial accounts,” says Tholl. “With no accountability attached to those funds, they become general revenue for the provinces, indistinguishable from all the taxes that the provinces raised.”

Tholl says the transfer payments not only perpetuate problems in the health-care system, but also widened interprovincial disparities in aspects like waiting times and the ability to attract doctors.

“I think we have to focus on what is important here, and that is delivering the best possible universal access health-care system to the population,” says Esmail. “In that regard, allowing the provinces to experiment, allowing the provinces to learn from one another, to try policies that have been successful elsewhere, has incredible power.”

Esmail says that Canadians want a comprehensive, affordable, and universal health-care system, but the way it has been structured ties the provinces to a system that monopolizes the delivery of both medical treatment and health-care insurance.

“This disallows cost-sharing for universally accessible services, which is unfortunate because those are the very policies employed by 100 percent of the developed world’s most effective, highest-performing universal access health-care systems,” says Esmail.

Esmail advises understanding what countries like AustraliaFranceGermany, or Japan have done, all of whom deliver high quality but faster health care at lower costs than in Canada while allowing for cost-sharing between public and out-of-pocket spending.

In France, for example, state-run health care remains the backbone of medical delivery, while the smaller private options help to alleviate the pressure of costs and backlogs.

“It’s private alternatives to the publicly funded health-care system, or to the government-run health-care system,” says Esmail. “Allowing that project competition in encouraging more informed decision making through cost-sharing creates a better universal access health-care system for everyone.”

Private alternatives

Efe Türker says going back to Turkey would be a preferable option if he needs medical attention, rather than stewing on waiting lists in Victoria, or seeking private treatment elsewhere.

“It is easier, simpler, and in most cases cheaper, for me to literally buy a ticket, fly across the world to my home country, to see a doctor and get free treatment and fly back,” says Türker.

One of Türker’s friends has made the trip back to Turkey after being injured and received both treatment and physiotherapy before his scheduled appointment in Canada. When Türker is sick and needs medical advice, he calls his uncle, who is a practicing physician in Turkey.

“It would get diagnosed from an 11-hour time zone away,” says Türker. “This shouldn’t be the case for anyone.”

The solution may be found by a nationwide imitation of successful provincial health-care policy innovations, which was the genesis of Canada’s universal system in the first place. Whether the new solution is re-funding medical and nursing schools, nationalizing the South African Solution, or expanding access to private alternatives, boosting provincial autonomy on health-care policy, or all of those combined, the headlines across the country show that Canadians need solutions fast.

“At the end of the day, provinces are too busy shuffling deck chairs on the Titanic, implementing small adjustments here and there without recognizing, or at least while deliberately avoiding, the larger picture for political reasons,” says Esmail.

Medicare Meltdown: Is ‘liberalized’ care the answer to Canada’s health-care crisis?

News

Canada’s health-care system is under siege. The country is still grappling with an acute crisis in our hospitals stemming from the COVID-19 pandemic while the slow-moving quagmire caused by the country’s aging population threatens to become a larger disaster. Can our system handle it? This five-part Hub series produced in association with the National Post looks deep into the world of Canadian health care, not just to identify problems, but to offer solutions for the future.

Talk to provincial premiers and they’ll likely tell you that fixing Canada’s health-care system is easy: It just takes cash, about $28 billion, more or less. That initial lump sum would bring the federal government’s contribution up to a level that the provinces have agreed will get things to where they need to be. Then, more increases after that.

The federal government says it can’t afford it. After bursting its budget during the pandemic, including billions flowing to the provinces, federal Health Minister Jean-Yves Duclos has implied that the premiers want blood from a stone.

It’s the usual federal-provincial donnybrook over money, but with an urgent new backdrop: a health-care system that appears to be in meltdown. Badly understaffed emergency rooms are shuttering across the country, wait times are spinning out of control and the president of the Canadian Medical Association is warning of system “collapse.”

How the provinces solve this problem, if they solve it, could set the course for Canadian health care for decades to come.

One problem is that Canada already spends a lot on health care relative to similar countries, even if the federal government’s sudden claims of fiscal restraint seem hard to believe. And increased health-care spending would have to be funded by more taxes. But the existing Canadian tax burden also ranks high, relative to its peers.

Canada hovers around 11th in the world in health-care expenditure per capita, with provincial per capita spending in 2019 ranging from about $4,600 to $6,400 (the territories, which face unique geographic and demographic challenges, are outliers). Around 70 percent of this is public spending, which is low compared to OECD peers like Sweden, France, and Germany, with the remainder coming from employer-based insurance programs, out-of-pocket spending, and other private sources. Yet, in 2021, the Commonwealth Fund ranked Canada 10th out of 11 Western countries in quality of care, behind only the U.S.

Registered nurse Dana Pagazzi disinfects herself at Surrey Memorial Hospital in Surrey, B.C. on June 4, 2021. Jonathan Hayward/The Canadian Press.

The most commonly proposed alternative to more spending is allowing the provinces to increase private delivery of health care—often seen as politically radioactive as tax hikes. In the 2021 election, then-Conservative leader Erin O’Toole was forced to defend himself against Liberal accusations that he was in favour of “two tier health care” after he said he might be inclined to let the provinces experiment more with private delivery.

It is a perpetual argument over two unpopular ideas, but the pandemic has pushed Canada’s health-care system to the brink, and usually risk-averse politicians may be open to ideas that, in normal times, get laughed out of focus groups.

A Shrinking Pie

While Canada’s health expenditure has creeped upwards, its average annual growth rate— 1.4 percent per capita between 2014 and 2019—has been slow. Yet, health spending as a proportion of provincial budgets keeps growing, approaching 40 percent, as tax revenue at all levels of government has fallen from 34.7 percent of the GDP in 2000 (above the OECD average of 34.3 percent) to 33 percent in 2019, a reduction of almost $50 billion in revenue.

“Health-care spending isn’t suddenly ballooning, but government budgets are getting relatively smaller,” said Danyaal Raza, a family physician and University of Toronto professor who is an outspoken advocate for medicare. “Health care has been relatively insulated from public spending reduction,” he said.

While health-care spending enjoys untouchable status, provinces continue to rack up massive debt, and provincial budgets are feeling the squeeze. Alberta has cut post-secondary education. Ontario has cut educationfirefighting, and transit. Manitoba has also cut education. But even the most cash-strapped provinces have been loath to cut health care, and nearly as loath to increase sales or other taxes to raise revenues.

Registered nurse Dana Pagazzi at Surrey Memorial Hospital in Surrey, B.C. on June 4, 2021. Jonathan Hayward/The Canadian Press.

“Ottawa normally has the ability to take in more money than it needs, but provinces have a much harder time of it,” said Katherine Fierlbeck, a Dalhousie University political scientist who specializes in the politics of health care. The Trudeau government has promised to pony up $45.2 billion in Canada Health Transfers to the provinces this year, which is an increase of nearly five percent over last year. And Canadians become used to a certain level of services. “So if Ottawa decides to turn the taps off the provinces are left holding the bag, and their choices are pretty darn tough,” Fierlbeck said.

Canadians’ view of what constitutes “health care” has also expanded beyond the domain of doctors’ offices and hospitals contemplated by the Canada Health Act when it was adopted in 1984. Looking after the elderly, for example, was seen in earlier generations as the responsibility of their children but has become a form of state-provided health care, evolved over the years into an awkward mishmash of programs and funding sources.

“When you’re talking about budgets there are numerators and denominators, and what places like Ontario do is dump a lot of costs on local governments,” said Raisa Deber, a professor at the University of Toronto who focuses on health policy. “The easiest way to save costs is to shift them to someone else….And one of the problems that we run into is that the minute I send care outside of a hospital or a doctor it doesn’t have to be covered under the Canada Health Act. So what you call ‘health care’ is a bit of a moving target.”

Liberalization versus privatization

As O’Toole discovered in the 2021 election, Canada’s political climate is a hostile environment for any discussion of greater privatization, no matter how sensible. A more palatable term might be what Montreal Economic Institute economist Maria Lily Shaw calls the “liberalization” of health care. Pointing to the mixed systems of Sweden and Britain, Shaw argues for a larger role for private clinics while still maintaining government-funded universality.

There are a few private clinics in Canada already, staffed by doctors who have opted out of government funding and who can only perform procedures that, for various obscure reasons, aren’t covered by the provinces. Although they only contribute to about one percent of the health-care economy, governments in B.C. and Quebec recently turned to paying private clinics to help them clear the surgical backlog created by COVID.

In other OECD countries it’s fairly standard for people to be covered by universal state care but still be allowed to also hold private insurance. In Quebec, where there are fewer limitations on what opted-out doctors can do than in other provinces, private care is becoming more “trendy,” according to a recent CTV report. Shaw points out that Quebec’s is, essentially, a nascent two-tier system, where those who can afford to pay cash can skip the line.

Shaw argues that a codified duplicate insurance program—that is, allowing people to buy private health plans for medical procedures—would ease access while negating that blatant wealth advantage. “It’s an insurance policy that a person can purchase that will cover the cost of services that are already covered under the public insurance scheme. Say: the installation of a pacemaker. So it’s another method of payment.” Duplicate insurance exists in almost every single OECD country, Shaw said. “The proportion of the population that has a duplicate policy will vary depending on the waitlists in the public system,” she added. “In Sweden, they made it legal in 2010. In the U.K., they’ve always had a market for it.”

About one in 10 Swedes have private health insurance, mostly provided by employers looking to keep their workforce healthy. Additionally, about 24 percent of Swedish health care is provided by privately run, but publicly funded health centres. The evidence shows that private clinics competing for public funds with state hospitals can lead both to finding more efficiencies.

“Doctors and nurses still have a code to respect,” Shaw said, “they can’t treat a patient faster or with less attention just because the hospital is run by entrepreneurs. There’s competition between the institutions, the patient has a choice to go where they want to be treated.”

Sweden’s experience shows that liberalization is neither a quick fix nor a savings windfall, but it does get better results. There, a growing number of private insurance holders are shopping for medical care in the parallel private system, while the public side of the system has struggled with recent cuts and growing wait times. Still, the Commonwealth Fund still overall ranks Sweden (seventh out of 11 countries measured) ahead of Canada (10th out of 11), and significantly higher on access to care (Sweden is sixth, Canada ninth) and equity (Sweden is sixth, Canada tenth), with both countries spending about the same as a percentage of GDP.

Liberalization would have to be done carefully, but it is a potential way out of the increasingly dead-end options of spending more public money or privatization. And the provinces already seem to be drifting in that direction. The B.C. NDP and Premier Francois Legault’s Coalition Avenir Quebec are paying private clinics to help with backlogs. Saskatchewan has been successful in reducing wait times for MRIs and CT scans by outsourcing them to private diagnostic clinics (the example O’Toole was praising when he got in trouble). Alberta has previously done the same.

In Ontario, Health Minister Sylvia Jones announced a plan in mid-August to increase surgeries in existing private clinics as part of a broader rethink of a provincial system that has stretched well past its limits. As in other provinces experimenting with private delivery, the plan is for the services to be publicly covered, but take place at private clinics.

With the soaring cost of living, the thought of any meaningful tax hike right now, even if it were done in the name of funding health care, can only seem terrifying to provincial politicians, be they NDP or Conservative. As Ottawa continues to hem and haw, provincial governments of all stripes seem more open than ever to experimenting with liberalization as a way to break through the confines of the Canadian health-care system.


Four non-toxic solutions

Health-care reforms can quickly turn into political footballs if a particular party sees the opportunity to scare voters, or if the federal government is in a mood to pick a fight with one of the provinces.

But there are plenty of smaller ideas that can help with efficiencies, if politicians simply have the will to push them.

“Governments have been very hesitant to invest more in health care reform in new ways,” said physician and professor Danyaal Raza, an outspoken advocate for medicare. “The pandemic revealed all the gaps. I’m hoping this is an opportunity for us to actually make those investments and get over those hurdles, in both funding and will.”

Here are four politically non-toxic ideas that provinces could get behind:

  • Centralized referral systems

Your family doctor decides to refer you to an orthopaedic surgeon. She happens to know a good one, and so that’s the referral you get.

But pulling from a mental list fails to account for current wait times, newly established surgeons and other factors that lead to a “big mess” of crossed wires, said Dr. Raza. The specialist you were referred to may be backlogged by months, while someone else in the same field might have open appointments next week.

By using regional referral centres, family doctors instead consult a central database that reveals nearby surgeons with the shortest wait times. Patients who insist on a particular specialist can be free to wait as long as it takes, but less picky patients can be referred to surgeons who are available, rather than just the ones their doctor happens to know.

It’s a straightforward and non-controversial improvement that would require provinces to pony up some initial funding to get going.

  • Better record-keeping

With the exception of Alberta, whose electronic health-care system is world-renowned, the provinces are more often a mess when it comes to record-keeping, said Maria Lily Shaw, an economist at the Montreal Economic Institute. “A lot of provinces are very much behind in records, both in collection—we have a lot of handwritten records that aren’t systematically entered into a computer—and in sharing, even between institutions and health-care professionals.”

This creates mundane annoyances that snowball into inefficiencies that slow everything down for everyone. Doctors are forced to play paperwork detective. Patients have to track down and provide copies of their own scans. Vaccinations, allergies, and prescriptions need to be updated every time you interact with a new part of the system.

The U.K., Shaw noted, has had electronic records since 1996. “We’re so behind…It’s unfathomable.”

  • Virtual consultations

The joy of being able to finally get your doctor to call you on your cell phone is one of the few good things to come out of the pandemic. Before, even small concerns required driving to his or her office, only to have to sit in a waiting room for up to an hour, or more. And more virtual care, where it can be used, should be used, said Dr. Raza.

“In the first month of the pandemic, we had more progress on virtual care than we had in years prior,” he said. “I’m hoping it’s here to stay. It’s been good for patients, it’s been great for me.”

Virtual consultations could even be done across provincial borders, if the medical licensing system were reformed, said Raisa Deber, a professor at the University of Toronto who focuses on health policy. Right now, every province issues its own medical licence, meaning that a specialist in Edmonton can’t treat someone from Yellowknife unless the patient flies down to see them.

“In many cases you could treat people remotely,” Deber says. “So is there scope for coming up with a national approach to licensing so that specialty services could be available throughout the country without having to start replicating everything? Because it’s very hard for people in small communities to get the specialized care they need.”

  • Easier foreign credentialling

Canada has 2.8 doctors per 1,000 residents, while most of our European peers range from 3.0 to 5.5. One way to address that, said Shaw, is to make it more feasible for properly trained foreign doctors to practice in Canada.

The impact of these shortages is felt when Canadians are referred to a specialist physician by a general practitioner. These wait times have been increasing throughout the pandemic, with the average wait of 22.6 weeks in 2020 growing to 25.6 weeks in 2021, according to the Fraser Institute. Although there is a lot of variation between the provinces, the shortest average wait time, in Ontario, is still 18.5 weeks.

“Any other country that has doctors or nurses that want to come practice, it shouldn’t be that complicated to come to Canada, especially (from) developed countries where we know their medical faculties are just as good as ours,” said Shaw.