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Ivy Lynn Bourgeault Headshot

How Many Doctors Does Canada Really Need?

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There is growing talk of a new Health Accord between the federal government and the provinces and territories. This is such good news -- great news, in fact. If I were asked to have one thing on the agenda, it would be for an explicit conversation about the merits of having a dedicated health workforce agency in Canada -- like pretty much every country has already, except Canada.

Why a health workforce agency? First, let's establish that the way we all experience our health system is through its people, our health workers.

When we are waiting for care, that care is delivered by someone, a health worker, or more often, a group of health workers, each offering their skills and expertise. The health care "system" is largely its people. In simple economic terms, the health workforce makes up the bulk of the costs of our system - from doctors' fees to nurses' salaries, from personal support workers in long-term care centres to dieticians in the community.

Which is why it is surprising that we put so few resources into the planning of how the people that make up our health system can best work, and best work together, to better meet the needs of patients and the population more broadly.

Why do we not dedicate even a fraction of what we put into actually paying our health workers for their services into coordinated planning for those services? Let's not forget that for many of our health workers in Canada, the tax payer also provides public funding for their education. But then, too often when the newly minted health professionals are ready to work, only those who have private health insurance have access to their services.

It may be surprising to the public, as it was to me, to find out how little Canadian governments plan for the number and type of health worker we need now and in the future -- from the medical specialists for an aging population with multiple chronic conditions, to the number of physiotherapists, occupational therapists, and personal support workers to enable older adults to remain independent in their own homes.

You might also be dismayed, as I am, at the tiny fraction of the one billion dollars a year in health research that goes toward better understanding our most valuable resource -- its people, or what we call health human resources.

But here's the kicker: pretty much every country in the world has an agency or organization dedicated to knowing as much as it can about their health workforce so they are best able to meet the needs of patients and the broader population. Rich countries and poor countries alike have these organizations. Such agencies are especially critical for poor countries because they have to make the most out of the few health workers they have.

Canada, it seems, can afford to get it wrong, over and over again.

It must be acknowledged that Canada does have a number of organizations that undertake a small part of the job of a health human resources agency, but it is far from a coordinated and sustained effort. For example, we have had three Task Forces in the past 20 years dedicated to the physician workforce, yet we are still plagued with problems of some highly trained surgical specialists finding it difficult to find operating room time; we have many Canadians going abroad for medical training; and we still have many communities going without family physicians.

We don't just need another short term task force to manage health worker supply. We need effective management of our entire health workforce on an ongoing basis.

The issue with health human resources is not a problem of not enough -- it's not simply a supply problem, in other words. There are issues with how our existing health workforce is best utilized. Some of that is a distribution problem -- getting the right kind of health workers to the right places to treat the people who can most benefit from their skills. There are also issues with how we can better enable health workers to work with each other and better address the increasingly complex health issues our population faces. Finding the best evidence to support the best approaches to more equitable and efficient utilizing of our whole health workforce is what a Canadian health workforce agency could examine.

So, when the various stakeholders gather together to discuss what should go into a new Health Accord, I hope this time that the health workforce is front and center.