It is difficult to imagine how things could get any worse—but they likely will. In Canada today, nurses are struggling under the burden of staff cuts and hospital policies that demand they work longer hours while caring for more and sicker patients. It is taking its toll: a recent survey showed that about 40 per cent of Quebec nurses suffer from severe stress and are ready to quit. Doctors, too, are frustrated by exhausting workloads, and other problems such as poor access to diagnostic equipment.
They also see their colleagues reaping much greater financial rewards in the United States. As a result, some are fleeing the country—a net loss of 513 active physicians in 1996. Although that is less than one per cent of the total physician base, it is up fully 130 per cent from 1991. Add to that mix the increasing medical needs of an aging baby boomer population and what emerges is a formula to totally overwhelm the system. “I hope I don’t get sick in 20 years,” says Danielle Fréchette, 40, a researcher for the Ottawa-based Royal College of Physicians and Surgeons of Canada, “because I don’t know who’s going to be around then to treat me.”
There are no simple solutions. What is clear is that the system’s human resources—principally the general practitioners, family practitioners, specialists and registered nurses—are demanding to be heard in the midst of wholesale health-care re-
structuring by the provinces. A case in point is Ontario. Over the past 10 years, it has slipped from
fourth to last place among provinces and territories in terms of per capita numbers of working RNs. Doris Grinspun, executive director
of the Registered Nurses Association of Ontario, says many RNs have been replaced by lower-paid registered practical nurses and personal-care support workers with less training. But what Ontario
Levels of service
The numbers of general and family physicians, specialists and registered nurses per 1,000 population have shifted over a decade (ranking in red)
failed to realize, says Grinspun, is that downgrading creates hidden costs. “The lower the education and skill level of the health-care provider,” she says, “the higher the level of supervision required— more charge nurses, more nurse managers. And that’s big money.” The provinces, meanwhile, have concerns of their own. Financially
sound Alberta ranks only ninth in the number of GPs and FPs, sixth in specialists and ninth in RNs. But Garth Norris, director of communications for Alberta Health, cautions against drawing conclusions based solely on those numbers. ‘We’re not particularly interested in per capita comparisons with other provinces,” Norris says. “Our concern is whether we have the right amount of physicians and the right number of nurses in the right places.”
That said, Canada overall ranks a poor 20th among 28 members of the Organization for Economic Co-operation and Development in terms of per capita doctors. Furthermore, Dr. Victor Dirnfeld, president of the Canadian Medical Association, worries that a decision to reduce medical school enrolment in 1994, and less willingness among new doctors to sacrifice family time to work long hours also conspire to undermine the system’s ability to meet patients’ needs. “The impact on health care hasn’t been too bad so far,” says Dirnfeld, “because those who remain to deliver the service work longer and harder.” But even the most dedicated healthcare workers eventually reach their limit.
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