Ontario likely has enough doctors – if we make better use of our other health workers
Does Ontario have enough doctors? This question may have a surprising answer for some: yes, we may have enough doctors. How is this possible when many don’t have a doctor or wait days, weeks or even months for a medical appointment?
We have more doctors than ever before, but many aren’t located where we need them and many of them aren’t practicing in a way that addresses the health needs of Ontarians.
First, a look at the numbers. Ontario has 220 doctors for every 100,000 people –that’s up from 203 in 2012. But what does this number mean?
Let’s unpack the first part – the doctor side. A simple head count of doctors ignores where doctors are located. In Ontario and across the country, doctors are poorly represented in rural and remote areas and this disparity between the health services available to urban and rural patients is larger in Canada than in other countries.
In fact, only eight per cent of doctors provide health services to a 19 per cent of the population that’s located in rural Canada. Are there enough doctors in rural areas? The answer there may well be, no.
Head counts also ignore what type of doctors are included. How many are family physicians and specialists and what types of specialist? How do different type of doctors practice? In Ontario, for example, only 70 per cent of family physicians provide comprehensive primary care — that is, the front-line health care that Ontarians need most.
Now, let’s unpack the population side as there is variability there too. We have an aging population yet we have 10 times as many residency positions (training spots for new doctors) in paediatrics than geriatrics (672 vs. 63 in 2016-17). This results in what we call a “skills mismatch.”
Perhaps the question, “Are there enough doctors,” is the wrong one to be asking.
Maybe what we really need to be asking is how can all of the health workers in our system better meet the health needs of the population. There is a whole health workforce beyond doctors. This broader health workforce, which includes nurses, midwives, pharmacists and many others, undertakes a myriad of critically important tasks to meet the health needs of Ontarians.
One thing is certain: we are not utilizing their knowledge and skills to the extent that we could. Instead, we end up with what we call “skills misuse.”
Skills misuse is an endemic issue. In a recent survey that included Canadian health workers, the OECD reported that 76 per cent of doctors and 79 per cent of nurses reported they had the skills to cope with more demanding tasks in their jobs. An earlier Canadian study revealed that only half of all nurses felt they were working to full scope. Better using the unique skill sets of doctors by shifting some of their tasks to others, such as nurses, nurse practitioners and midwives, could improve access for Ontarians.
There are a number of promising practices of this kind across Canada from which to consider for expansion. Nurse practitioners can provide primary care and triage patients presenting to emergency rooms, reducing wait times and increasing patient volumes. Physiotherapists can triage patients on wait lists for hip or knee surgery, with similar outcomes to orthopaedic surgeons. Access to mental health care can be enhanced through shared care models involving psychologists and social workers.
Shifting tasks may not only be more appropriate, it could help us to achieve important wait time targets in a cost-effective manner. How could this be achieved?
We could enable the shifting of tasks among health workers better using their skills by reorganizing the way they work together and provide their services to the public. Co-locating services and using technology to support shared models of care, for example, may not only improve access, it can also improve physicians’ working conditions by making exchanges with colleagues possible and reducing on-call commitments.
If we reorganize how we provide health care, we could better support the doctors we have.
We need to move beyond a debate as to whether we have enough doctors and engage in the much more important and thoughtful discussion of how we must better use all of the health workers in our system in a way that is safe, supportive and affordable – and provides the best health to all Ontarians.
Ivy Lynn Bourgeault is CIHR Chair in Gender, Work and Health at the University of Ottawa and the lead of the Empowering Women Leaders in Health project. She is also an expert advisor with EvidenceNetwork.ca which is based at the University of Winnipeg.