Canada’s sinking health care system needs more than timid changes to stay afloat

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Why, in health care, does it feel like we’re bailing out a sinking ship with an eye-dropper?

An announcement last week by B.C. Health Minister Adrian Dix is a case in point.

“New health workforce strategy improves access to health care, puts people first,” trumpeted the press release from the B.C. Ministry of Health.

The more concrete measures include expanding the ability of pharmacists to administer vaccines and prescribe some drugs, like oral contraceptives; training more doctors by adding 40 undergrad spots to the University of British Columbia Faculty of Medicine, and 88 residency spots in teaching hospitals; providing training to paramedics so they can do more airway and pain management while transporting patients to hospital; and removing the “artificial barriers” to providing credentials to international health workers.

There is nothing wrong with any of these initiatives per se, but they have all been in place in other jurisdictions for years. They feel timid and 10 years late.

In total, Mr. Dix unveiled 70 “action items” in the province’s five-year health care plan, many of which were already dribbled out in previous announcements.

The plan is vague in details and unambitious in scope. (To be fair, B.C. is no different than any other province in this regard.)

Every jurisdiction is promising to woo more international workers. We’ve been doing this for years, pilfering health workers from the Philippines, India, Syria, South Africa and other countries.

But that well is going to dry up. The World Health Organization estimates that by 2030, there will be a worldwide shortage of more than 15 million health workers.

B.C. vowed to speed up the accreditation of health workers trained in other jurisdictions: The legion of taxi drivers and care aides trained as nurses and doctors in other countries who face myriad barriers in trying to join the same professions in Canada.

Currently, it can take 18 to 24 months for them to be licensed – that is, if they are not required to restart their education from scratch. Other countries have well-established, practice-ready assessment programs that take 12 weeks. Why aren’t we implementing those here?

The same goes for initiatives that give pharmacists and paramedics more responsibilities. Every health worker should be working to their full scope of practice. That should be a given. But despite there being more than enough work to go around, our health system is rife with the tendency toward turf protection.

There is no question that health human resources – having qualified workers to deliver the care we need – is the number one challenge in health care today.

As B.C.’s “plan” states, we desperately need to recruit, retain and retrain workers, from physicians to nurses to personal support workers.

None of this is news. We see the result of labour shortages every day, from ER closures to wait times for cancer care stretching months into the future. And it promises to get worse.

But as the someday-we-may-take-action plan from B.C. also notes, in passing, the health-care workplace is broken. For the necessary recruiting and retention to happen, we need to redesign the system pretty fundamentally, both on the delivery and payment sides.

And that’s the rub. So where is the structural reform?

We need to start with rebuilding a solid foundation of primary care, ensuring every Canadian has a primary-care provider.

We can keep pumping money and people into a broken system, but the results aren’t going to get much better unless we re-engineer.

B.C. has five million citizens, and one million of them don’t have a primary-care provider. You aren’t going to fix that problem by adding 40 medical school seats and 88 residency spots.

One little glimmer of hope is a promise to hammer out a new compensation plan for family doctors, one that will, hopefully, shift away from the outmoded fee-for-service payment system. That, too, should have been done long ago.

Dithering is not exclusively a B.C. problem. Every single province and territory is taking the same tack, sporadically announcing some program or another to mollify the public. Meanwhile, they can’t seem to agree on even the simplest of co-operative measures, such as a single national license for physicians and nurses.

We don’t have a singular health system, but our 15 health systems all have common challenges that require similar solutions, and there is no lack of good ideas. There is no lack of innovation. What we have is an implementation crisis and a lack of urgency.

At some point, we have to commit to massive, bold reform instead of just fiddling around at the edges of our problems.