Recently there has been a great deal of coverage in the media regarding the surplus of doctors in Canada. An article in the November 5th Medical Post by Steven Lewis, health policy and research consultant based in Saskatoon and an adjunct professor of health policy at Simon Fraser University, highlights some of these issues. Titled, 'The dawn of the era of a superabundance of doctors', Lewis hypothesizes that provinces could have worked more collaboratively to identify root causes to access problems to care as well as health human resource numbers rather than focus on just numbers of physicians in isolation. Although I have not been a supporter of many of Lewis' views in the past, I do agree with him here. It is in many respects a perfect storm, which includes the changing population demographics and expectations, a shift from acute care to community-based services and rapid outpatient procedures, the growing impact of information technology use by both doctors and patients and the impact of multiple chronic diseases.
Many of these changes have been insidious over a number of years, however the Royal College of Physicians and Surgeons reported recently that 16% (more than 1 in 6) of the country's new specialists and subspecialists cannot find work, while another 31% are pursuing further training in an attempt to become more employable. That's a hard pill to swallow after 12-15 years or more of graduate and post-graduate study. Gone are the days that specializing would guarantee a busy career with guaranteed healthy income from day 1 of clinical practice.
The shift towards collaborative and team-based care has also had a significant impact on the demand for clinical services and the need for specific types of physician and supportive care resources. This has further changed the pattern of practice of many clinicians and the way that communities have planned their physician resource needs. Economists Barer and Stoddard (authors of the infamous 1991 BS report - Toward Integrated Medical Resource Policies for Canada) have also weighed in to the debate.
There is no doubt that we are experiencing a sea change in terms of the way that care is delivered and the resultant mix of medical services needed to meet the needs of the population. Facilitated now by technology in almost every setting, EMRs, EHRs, telehealth, mobile tools, portals (and more), the one missing ingredient that still has to be addressed is patient (or consumer) accountability. The system is changing and the tools and processes are being put into place to facilitate this change, however the weak link is that patients can still utilize an unlimited number of medical services without any need to be accountable for their demands on the system. For Joe Public, the healthcare system is still 'free'. After more than 30 years in clinical practice, I strongly believe that convenience still trumps quality 9 times out of 10. Simply changing the supply side of the equation is not enough. We need a healthcare system in which patients take increasingly greater responsiblity for their health and do so in a way that treats the healthcare system as a precious resource. Is this the impossible dream?