Putting our health-care workers to better use

It’s not just about having more doctors. It’s time we used all the skills that the wide variety of health workers have to offer

Does Ontario have enough doctors?

Surprisingly, the answer is: Yes, we may have enough doctors.

How is this possible when many people 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 aren’t practising in a way that addresses people’s health needs.

Ontario has 220 doctors for every 100,000 people – that’s up from 203 in 2012. But what does this number mean?

A simple head count of doctors ignores where they’re located. 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 19 per cent of the population located in rural Canada.

Are there enough doctors in rural areas? The answer may well be: No.

Head counts also ignore what type of doctors are included. How many are family physicians, and how many are specialists and what types of specialist? How do different types of doctors practise?

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, since there’s variability there, too. We have an aging population yet we have 10 times as many residency positions (training spots for new doctors) in pediatrics as in geriatrics (672 versus 63 in 2016-17). This results in a skills mismatch.

So perhaps we shouldn’t be asking if there are enough doctors.

Maybe what we really need to be asking is how can all of the health workers in our system better meet the needs of the population. There’s a whole health workforce beyond doctors. This broader workforce, which includes nurses, midwives, pharmacists and many others, undertakes a myriad of critically important tasks to meet the public’s health needs.

We’re not utilizing their knowledge and skills to the extent that we could. Instead, we end up with skills misuse.

Skills misuse is an endemic issue. In a recent survey that included Canadian health workers, the Organization for Economic Co-operation and Development (OECD) said 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.

There are a number of promising practices of this kind across Canada to emulate. 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 orthopedic 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 achieve important wait time targets in a cost-effective manner.

We could reorganize the way health workers 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 about 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.

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 adviser with EvidenceNetwork.ca, which is based at the University of Winnipeg.


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