Doctors,nurses, perfusionists, and other personnel in short supply

By Randall F. White, MD, FRCPC
29 June 2008

At St. Paul’s Hospital in Vancouver, where I practice, 50 heart surgery cases have been cancelled since April 2008. The spokesperson quoted in The Province on June 26 said that the hospital sometimes lacks enough perfusionists to keep the cardiac operating rooms open. The opposition health critic in the legislature blames the government for its 2006 decision not to fund a perfusionist training program at Thompson Rivers University in Kamloops.

A few days before, The Province newspaper reported that BC Children’s Hospital in Vancouver has cancelled 50 surgeries since April because of a shortfall of at least 10 intensive-care nurses. The same week, The Globe and Mail reported that a small town in BC is so desperate for doctors that it is raising money to build a new health clinic for physicians who have yet to be hired. The public is painfully aware of the physician shortage. The 2008 Health Care in Canada survey found that 19% of people named it second only to wait times as the leading problem in our system.

In January 2008, the Canadian Medical Association launched a campaign to raise political capital for increased domestic training of physicians, an appropriate advocacy issue for Canadian physicians. But at the same time, the CMA leadership, including president Dr. Brian Day, advocates for a second tier of health care. They haven’t explained how this second tier would be staffed given the immediate need for 26,000 physicians to bring Canada up from a ratio of 2.1 doctors per 1000 population to 3 per 1000, the mean among OECD nations.

Doctors aside, private hospitals and clinics require nurses, perfusionists, and other personnel who are in short supply and who require expensive, lengthy training. These facilities would take such personnel from existing institutions, including St. Paul’s Hospital, BC Children’s, and the others that serve most Canadians. Wealthy people who can afford to pay a premium could avoid wait lists and cancellations while the rest of Canada would endure even more such failures of the public system.

This pattern occurred in Australia after the introduction of a privately funded, privately owned tier of hospitals. According to the Australian Medical Association, wait times and crowding in the public hospitals have reached a crisis. The same would happen in Canada; in fact, we have a crisis despite having no official second tier. So let’s forget tier two, train more health professionals, and make our existing system work better.