About that Health Human Resources Report…
In 2000 and 2001, I was a member of the Expert Panel on Health Professional Human Resources, appointed by the Minister of Health and Longterm Care of Ontario, Elizabeth Witmer. The final report was titled Shaping Ontario’s Physician Workforce. The link to the report is http://www.ontla.on.ca/library/repository/mon/1000/10294173.pdf, in case you want to see it.
I am going to consider some of the recommendations of that report in the context of today’s physician human resources issues.
The report had four categories of recommendations:
- Plan physician services to meet needs
A central element of the report was that Ontario should have a Health Human Resources Advisory Panel (HHRAP). This was to be a “permanent, expert advisory body responsible for continually monitoring and anticipating the health needs and making recommendations on the appropriate supply, mix and distribution of health human resources to meet health needs”. The panel wanted to remind government how important it is to keep an eye on health human resources, preferably an informed, dispassionate eye that was meant to consider trends and evaluate data and advise on such matters as numbers of medical school and residency slots. This panel was never established.
In the 12 years since the release of the report, the population of Ontario grew by about 18% from 11.4 million to 13.5 million people. This exceeds the growth predictions of the time by 7%. One of the concerns of the Panel was that the system should have enough flexibility to adjust to changing demands based on factors like population. That flexibility is not in the system.
- Provide appropriate education
This second series of recommendations had far reaching consequences in the area of medical education. The Panel recommended that medical education should be “decentralized”, that centres for medical education should be established in Northern Ontario cities and Windsor. While these recommendations led to the formation of the Northern Ontario School of Medicine (NOSM), this was not the panel’s recommendation. However, NOSM, it can be argued, follows the educational spirit of the report better that the five schools of medicine that existed at the time the report was released.
The panel also wanted medical education itself to be studied more vigourously so that medical education from the first day of medical school to the last day of a doctor’s career was appropriate to the best evidence. Not only was the education of students and residents to be carefully considered, that new concepts and skills must be learned through one’s career was acknowledged. The panel wanted Ontario physicians to have access to a suite of products tailored to treating the patients they were seeing. Had these Continuing Medical Education (CME) recommendations been followed, one could argue that some of the angst of the most recent OMA-MOHLTC Negotiation might have been avoided since savings and efficiencies could have been one of the things doctors would have learned about through this educational process.
It was in the development of these recommendations that I realized how inaccessible a medical education truly was. The average family income of a medical student’s family of origin at the time was about $100k annually. The average family income since tuitions were deregulated is $140k. As fewer young people from families of modest means enter medical school, there is a great risk that being a physician will return to being a career of the wealthy, as it was early in the 20th century and in the 19th century. We are not addressing this to any great degree but calling awareness to this fact is one of the tasks of the Ontario Medical Student Bursary fund of the OMA.
- Produce the Right Supply and Mix of Physician Services
This set of recommendations increased the number of residency spots to keep pace with the increasing numbers of medical students. It also provided for more re-entry spots for certain careers deemed to be of high need, e.g. psychiatry, as well as for opening up more spaces for International Medical Graduates to train for practice in Ontario. The panel was realistic about the costs of these recommendations but its concern for flexibility in Postgraduate Medical Education has never been fully addressed. Across Canada, there are reports of unemployed physicians with certain specialized skills such as Orthopedic Surgery and Radiation Oncology while there are still long wait lists for the services these doctors would offer. A full analysis of this situation has not been undertaken but would be helpful.
Also in this section was a recommendation to educate the public about the appropriate use of medical services. My experience with patients is that they would be grateful for valid reliable information about their health but government shies away from this, fearing that any education about appropriate use of the health care resources we have would be “rationing”. I believe that most doctors disagree with the government on this point.
- Attract and Retain Physicians Where They are Needed
The panel believed that an investment of $10million was needed immediately to fund incentives that would bring physicians to underserviced regions. They also looked for a “Rurality Index” to guide government and planning bodies as to how rural a community was. Considered by many to be an imperfect tool, the Rurality Index of Ontario nonetheless does accomplish this task and is still in use today.
An investment in a Northern Medical School was not what the Panel envisaged with $10million but one cannot deny that NOSM has brought a hub of medical education, including the health professionals needed to staff it, into the North and that is a lasting legacy of this report even though it was not recommended.
My own conclusion as I consider this report after 12 years is that we need a considered approach across Canada to Physician Human Resources, an Expert Group of all stakeholders that maintains the best knowledge on medical education and on the supply and mix of doctors needed to care for Canadians. This panel wanted such a body in Ontario. I’m sure it always seems as though each panel invents its successor to continue its work but it’s not always for nepotistic reasons and one could argue that such a group in these circumstances might have improved health care planning.