The Unhealth Department

The quack cures don't curing anything

Family Care Teams aren’t working.

We know because in July, refugee health minister John Hogan told us everything was fine. It’s the Rule of Opposites. X = Not X.

Hogan gave the local media some numbers. According to Hogan about 57,000 people self-identify as not having a family doctor. That number is way lower than numbers obtained from surveys of the whole population done by third parties. They put the number at more like 136,000 last year and upwards of 175,000 this year and this is likely the true number or close enough to it for all useful ends.

You can understand the reason for the difference if Hogan and his officials had explained that the number he gave was only the people who have signed up with the government waiting list for a family doctor. That doesn’t mean it’s all of the folks without a family doctor. It’s just the folks who need a doctor but cannot find one and the growing number on the government list reflects the urgency of their need. Calling it “different metrics”, as Hogan did in July, is dishonest. There’s no other word for it.

Even if you accept Hogan’s number as being the size of the problem - the people who need a doctor but don’t have one - there were 48,000 people on the waiting list last year and almost 10,000 *more* this year despite the government standing up six fully functional FCTs in the meantime and having another twenty-odd understaffed but with doors open. There are another bunch not even started yet.

We know the FCTs are not working because last week Hogan offered family doctors who already have full patient loads in their existing family practices $75,000 to shift from their job at a hospital to an FCT and shift their patients with them. There’s little chance Hogan’s bribe scheme will work. First, the doctors targeted by it already work for health authorities on a fixed salary. A one-time cash bonus to change work sites isn’t a big incentive. Second, anyone who bills the Medical Care Commission by the patient - that’s called fee-for-service - would make less money in the long run to join the government bureaucracy plus, if they’d be shutting a private practice, they’d be putting their staff out of work to boot. Not really attractive and for the government it shows how little real thought goes into any of these typical egg-head schemes.

As it is, there are only six FCTs that are properly staffed. That means only 36,000 patients are now part of a functional FCT somewhere in the province. We have no idea how that affects the 175,000 people across the province without a family doctor because some of the doctors in FCTs brought their existing patient loads with them. It probably doesn’t, which is why the problem grows.

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We need more doctors. We need more nurses. We needs lots of people in different health care jobs and professions. The problem is we are not getting them. People like John Hogan talk about how many people they recruit but they never tell you how many people leave either to work somewhere else or retire. Without that number, we don’t know if there more or fewer doctors or what have you.

Like doctors, for example. In July, Hogan talked about 130 new doctors in the province over the past year. The problem is that the College responsible for licensing doctors has had trouble for the past decade reporting plainly how many doctors are actually here. The College reports annually how many licences it issues but that appears to include people working temporarily for a few weeks or a few months as fill-ins called locum tenens, as well as medical students and doctors still in training. There are lots of numbers but no one at the College explains what they mean for those who - unlike your humble e-scribbler - didn’t work with and at the College for almost 20 years.

Take a number like the nearly 500 certificates of conduct the College issues annually. Those are typically issued for one reason: a doctor has applied for a medical licence somewhere else. But they don’t show up anywhere else in the numbers in the College’s annual report so that even if only a couple of hundred doctors leave each year, they’d still show up in the “licences issued” tally because they had to have a licence here *before* they moved.

The only reason to obscure that information is because you want to deceive people about what’s going on. You want to make it harder to be accountable and you want to make it look like there are more doctors working here than there actually are. That’s why you’d get these inexplicable shifts up and down in the numbers year to year and no explanation like there used to be before 2014 about the net inflow and outflow of doctors.

In the most recent annual report, the College added in 155 doctors to the total of licences issued. That’s for doctors who are licensed and who work in the Maritimes because they’ve now joined a pool of doctors who could work across the four provinces in Atlantic Canada. Only 35 doctors in the pool are from Newfoundland and Labrador by the way but that 155 has artificially increased the number of doctors who got a licence at some point in 2023. Another 180 were new licences issued and 1427 doctors renewed their licence.

But after you take out the 155 in the new pool, the ones who already have licences here but work most of the year outside the province, and the ones who left - almost 500 went looking for certificates of conduct - how many are left actually working in Newfoundland and Labrador? Likely not many more than were here a decade ago: about 1350.

That’s bad news because as doctors retire, it takes two to three new ones to cover the same patient load as the olds. Recruitment has never been heavy enough to cope with that and with all the new demand for doctors, the supply hasn’t increased. There are different reasons for this.

Memorial University is actually turning out fewer new doctors this year compared to previous years. Part of that is because New Brunswick opened its own medical school in Saint John as a branch of Dalhousie. The provincial government here bought five of the newly vacant slots and hoped to entice more out of province doctors. That didn’t work.

But more importantly, there were plenty of blank spaces in the residents program last year. That’s the training doctors receive after their four year degree. It’s crucial to becoming a practising doctor and the residency slots in Newfoundland and Labrador are open to doctors trained across Canada, in the United States, or in one of three medical schools in the Caribbean.

The Caribbean schools - like schools in Ireland and the United Kingdom - accept and graduate highly skilled Canadian students who couldn;t get into a Canadian school despite their high academic records. Canadian schools are highly competitive. But those students have a hard time finding residency slots in some provinces or avoid provinces like Newfoundland and Labrador. That turns out to be a long-term loss for this province since doctors are more likely to work where they trained.

One of the biggest obstacles to recruiting doctors is the licensing College. Over the past decade, it’s applied needlessly restrictive rules that deter doctors from coming here when others are more welcome or offer other advantages. Rather than accept doctors from other provinces who are already licensed to the same standard as here, the local College forces them to get a new licence and go through needless rechecks of background and credentials. Rather than just accept Canadian licences, the four Atlantic provinces created a new licence - that Atlantic pool - that doctors had to opt into. A doctor from Nova Scotia can rent a car here on a Nova Scotia driving licence but cannot practice medicine in Newfoundland and Labrador unless they are licenced in Nova Scotia *and* have opted into the second licence from the pool.

Compare that with Nova Scotia. In 2023, the Nova Scotia legislature passed the Patient Access to Care Act. PACA directs Nova Scotia’s regulatory Colleges to accept licences from other jurisdictions in Canada, prevents them from charging a fee to get a local licence, and requires approval of the application within five days. It takes weeks and months to get through the bureaucratic cesspool at the College of Physicians and Surgeons here.

PACA highlights include:

• “licensing or registration criteria will be waived for healthcare providers coming from other parts of Canada, as needed and in accordance with Canadian free trade obligations

• “regulators cannot charge healthcare professionals licensed in other parts of Canada an application fee

• “applications must be processed within five business days

• “supports the creation of regulations that will apply the above provisions to non-Canadian jurisdictions

• “allows all regulators to recognize the credentials and licences of healthcare professionals trained outside Canada [they weren’t prevented before. They just didn’t]

• “ensures regulated healthcare professionals can work to their full training and allows expanded scope of practice through regulations rather than legislation

• “employers will only be able to request a sick note if an employee is absent for more than five days or has already had two absences of five days or less in the previous 12-month period

• “allows the government to prescribe Workers Compensation Board forms and documents to improve the process for Nova Scotians and doctors.”

Compare that to the string of quack ideas coming from the provincial government here like opening new urgent care centres to be be staffed by existing staff at a time when the health authorities could not staff existing units including the then-new FCTs. And as expected, here we are a year or so later and the government is trying to bribe its own workers to change jobs because it is failing across the board to fix the problems that keep patients from getting new doctors and other health professionals who could care for them.

It’s crazy. But there’s one consolation. At least, when the bodies pile up there’ll be shiny new freezer units in the basement to store them in. The health bureaucracy has managed to do that.

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