David Bond

David Bond is pictured in a 2018 file photo in downtown Kelowna.

Well you have to hand it to the prime minister and the provincial premiers. Faced with a collapsing health care system whose reform would require difficult decisions and generate strong resistance from some major stakeholders, the political leaders once again chickened out and agreed to continue massive spending increases that for several decades have only made things worse.

Health care is a provincial responsibility. The provinces are strident in the opposition to any interference by the federal government attempting to impact structure or incentives for change or data relating to the quality of care across the nation.

The provinces just want the feds to send money, lots of money, without any strings attached. So, rather than raise all the funds required, the provinces want the federal government to share a good portion of that burden and to complain when they (the provinces) believe they need greater funding but not wanting to raise provincial taxes.

Contrary to what the provinces claim, additional funding will not deal effectively with the crisis in health care. What is needed is a fundamental reform of health care administration.

First, there needs to be an end to the artificial barriers to entry of physicians that have been trained outside of Canada. Those barriers are discriminatory and really are designed to protect graduates from Canadian medical schools being forced to practice in smaller rural locations.

Moreover, each province licenses doctors and moving from one province to another is not easy. (Though just a week ago the four Maritime provinces agreed to allow Doctors licensed in one province to work in the other three.) Indeed the head of the College of Physicians and Surgeons in Nova Scotia said there should be one national licensing body thereby allowing doctors to work anywhere in Canada.

Such a rational approach may cause him to be subject to reprisals by those determined to maintain the current inefficient system.

All doctors, whether educated in Canada or abroad, should be treated the same. That is not currently the case. Obtaining residency positions in Canadian hospitals for foreign-trained doctors is exceedingly difficult. And if these doctors do a residency outside Canada it frequently is not recognized by the provincial Colleges of Physicians and Surgeons.

While they may be Canadian citizens they are treated in a discriminatory fashion and forced to go to rural postings and pay exorbitant fines if they leave such postings before their initial contract is up (usually five years.)

As a result more than 1,600 foreign- trained Canadian doctors work outside of Canada. That is a unique form of Canadian-forced brain drain and should be stopped immediately. Indeed bringing about the national licensing organization without the ability to discriminate again foreign trained and residency acquired experience should also be stopped.

All physicians obtaining licenses in Canada should be subject to being required to locate where provincial authorities believe the need is greatest.

There is also one additional major change that needs to be made. Nurse practitioners are graduates of post education after receipt of their RN classification. They are skilled in administering health care under the supervision of a physician.

However, in most cases across Canada they are frequently subject to discrimination by licensed doctors. Provinces need to make it more attractive for such nurses to be hired. For example, in rural small communities without resident doctors nurse practitioners could administer health care subject to oversight by a doctor who could visit such communities on a regular weekly or bi-weekly fashion.

While not a perfect solution to the doctor shortage in rural Canada it would be a stop gap measure until the supply of trained doctors was significantly increased.

None of these changes will occur unless provincial governments act now to fundamentally change the powers and of their individual Colleges of Physicians and Surgeons and making them subject to independent accountability oversight.

David Bond, a PhD in economics from Yale is a retired bank economist and instructor at UBC, the University of Western Ontario and the University of Quebec.

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