The more things change, the more they stay the same — particularly in health care, and particularly in Red Deer.
The chronic shortage of general physicians in this community has persisted for years, and circumstances are about to get worse.
In 2000, the David Thompson Health Region launched a drive to recruit nine more doctors for the Red Deer area. With 48 doctors practising when the recruitment drive was launched, that meant there were .72 physicians for every 1,000 patients (or 1,375 potential patients for every doctor in a community of 66,000 people).
In 2004, there were about 60 family doctors in Red Deer, serving a population of 76,000 people. That meant there were .79 doctors for every 1,000 patients (or 1,246 patients per doctor).
Eight years later, we have 78 family doctors in a city of about 94,000 people, and five of those are leaving their practices from one clinic alone. That means, at 73 physicians, we have .77 for every 1,000 patients (or 1,287 patients for every doctor).
The national average for physicians (including specialists) per 1,000 people is 2.2. By comparison, the national average in Australia is 2.8, France 3.4, Germany 3.5, the United Kingdom 2.5, Sweden 3.6 and the United States 2.4.
Certainly, attempts have been made to add to the roster of family general practitioners. In the summer of 2004, a Red Deer clinic opened to exclusively serve female patients. A manager of the venture expected to have seven female doctors on staff. When the clinic closed eight months later, only two doctors were on staff. Immigration roadblocks were blamed, in part, for the failure to recruit more doctors.
More than five years ago, the Alberta Medical Association tried to make the shortage of doctors a provincial election issue. Political leaders were asked by the association for ideas on how to train, recruit and retain more doctors. The responses were less than edifying, and certainly Progressive Conservative government, in the wake the election, didn’t behave like it had heard the alarm.
The medical association projected in early 2008 that Alberta would be short up to 1,500 physicians over the next five years.
The prediction was dire, but if it was at all accurate, we are on the verge of a crisis of care.
A combination of factors — including retirement of a dominant generation of local doctors, plus the inevitable departure of younger doctors looking to live and practice in larger centres — means that Red Deer is about to lose four doctors with the closure of one clinic.
The National Physicians Survey conducted in 2010 showed that the average male doctor in Alberta was 50 years old; the average female doctor 45. A large number of Alberta’s doctors are nearing retirement.
Smaller communities in Central Alberta have enticed doctors by, among other things, taking out community mortgages on clinic buildings, providing interim housing for newcomers, and even offering them the use of cars.
But the enduring problem is far more fundamental than whether some communities are more attractive to young doctors than others.
Our medical schools are not graduating enough doctors, in great part because of constrained government funding for post-secondary education.
And, increasingly, our graduates are leaving Canada to practise. Often they are drawn away by better work conditions and pay.
Further, we have failed to establish a streamlined, yet thorough, system to license immigrant doctors.
And, finally, the new generation of doctors often prefers a different model of practice. They work fewer hours, from drop-in clinics, and often don’t have hospital privileges. They prefer that their professional lives not overwhelm their personal ones.
Who can blame them? In 2005, the Canadian Medical Association said that family doctors typically worked 70 to 80 hours a week. It’s not a model that most people would want to emulate. But to work fewer hours means seeing fewer patients.
Inevitably, patients without quick access to a family physician end up in emergency wards. And that works at cross-purposes to initiatives to speed emergency wait times for the critically ill and injured.
Ultimately, the burden falls to the province.
Alberta Liberal Leader Raj Sherman proposed, during the April provincial election, that we radically retool our medical training system. He called for incentives to relocate physicians, and a training program that takes residency to centres like Red Deer and Lethbridge. He also suggested that two-thirds of all doctors be trained as general practitioners. And he proposed that student loans be rebated for doctors who choose to practise in rural communities.
Sherman’s ideas are not the only ones, but they stood out during the provincial election because no other party seemed willing to engage thoroughly in the discussion.
And that means, likely, that the more things change, the more they stay the same.
John Stewart is the Advocate’s managing editor.