Lois Ann Dort

Chronicle Herald April 28, 2018

This week the government of Nova Scotia issued a press release stating that a team would be travelling to Dublin and London to promote the province and attract doctors. After the backlash they faced for failing to attend a recent recruitment expo in Newfoundland and Labrador, the government must have thought it necessary to toot their horn on this expedition. But is this best or most ethical way forward when tackling our doctor crisis?

For any one of the now over 40,000 people in the province who are on the wait list for a family physician, recruiting doctors by any means necessary may seem the correct prescription for their ills. However, Nova Scotia’s doctor shortage is part of a global problem that requires more consideration than this band-aid solution.

First, we should consider our problem in the Canadian context. As of 2015, Nova Scotia had the highest physicians-per-population ratio in the country; 261 physicians-per-100,000 population. Data from 2016 show this proportion has dropped slightly but this is mainly attributed to retirement. So even with one of the worst rates of pay in the country; docs still want to call Nova Scotia home.

A survey on physicians in Canada conducted by the Canadian Institute for Health Information published last year stated that, “Migration patterns suggest that Canada continues to gain more physicians from other countries than it is losing.”

It appears we aren’t that bad off when it comes to doctors but somehow, we still have a wait list. We do need more doctors. So now we are involved in courting rituals with docs from overseas; this week we’re looking for dancing partners in Dublin and London. But here’s the rub, Ireland and England have their own doctor shortages that they are trying to alleviate.

Last year newspapers in Ireland reported that one third of the doctors working in the country were trained overseas; the greatest per cent of which came from Africa with Pakistan taking a close second. And why can’t Ireland hold onto doctors, because folks like us lure them away with incentive packages; the grass is always greener — even when you’re looking at it from the Emerald Isle.

The health care system in England is no better off in terms of the doctor deficit. The Guardian and The Telegraph carry articles on the health care crisis almost as often as this paper reports on the issue facing Nova Scotia. They too are looking at overseas recruitment as an answer and are asking government to adopt measures that will make it easier for foreign docs to work in the National Health Service.

A pipeline for doctors is pushing the supply from Africa, through to Europe and on to us in Canada. Is this supply chain sustainable? Is it at cross-purposes with our national foreign aid policy? And most importantly, is it ethical?

Doctors are bleeding from the African continent like an arterial hemorrhage. If the practice of overseas doctor recruitment isn’t stopped, there will be no health care personnel left on the ground in countries where people are most in need. The numbers are drastically low as it is. The World Health Organization states that over 45 per cent of its member states have less than 100 doctors per 100,000 people. The Canadian average is 230 doctors per 100,000 people and we don’t face the ravages of war, malaria and disease outbreaks like the Ebola crisis of 2014, that many African nations confront.

It is worth mentioning that Canada spends billions on overseas aid for health initiatives. In the early 2000s the Government of Canada implemented the Muskoka Initiative on Maternal, Newborn and Child Health which focused funding overseas on health education and treatment and prevention of disease. In the span of 10 years, from 2010 to 2020, over $6 billion dollars have been directed towards this initiative.

Canadians feel good about helping others in this way but is it not a bit of bait and switch if we give them money for health care and then lure their doctors and other health professionals away. Developing countries need the money, there is no doubt about that, but they also need their doctors to put that money to good use. It’s another iteration of the classic foreign aid debacle of building schools for students who have no pencils, no paper and no teachers. Only this time, it is our own demand for a scarce resource, doctors, that is creating the fly in the ointment of aid.

There is a global doctor shortage. It’s our responsibility as global citizens not to exacerbate that shortage in developing countries. The solution to Nova Scotia’s doctor shortage should not be poaching healing hands from overseas, but investment in physician training on our own turf.