Putting more doctors into practice won't necessarily improve the health care system or enhance access to services, a Toronto consultant says.
As of 2000, says Dr. Michael Rachlis, Nova Scotia had 201 doctors per 100 000 people against a national average of 187 per 100 000, and from 1997 to 2001 the number of physicians per capita grew by 6.1%. “Nova Scotia has by comparison with the rest of the country more physicians per capita, yet the headlines [about an MD shortage] don't differ,” says Rachlis. “It doesn't seem to matter.”
What does matter, he maintains, is the way physicians practise: Rachlis says that having doctors in solo practice seriously hampers access to care across the country. “While there may be more physicians than ever before, the big reason for the access problems is that doctors are not practising comprehensive care. Even if we increased the number of doctors by 50%, it wouldn't remove the access problem.”
Dr. Bob Miller, president of the Medical Society of Nova Scotia, agrees. “The number of doctors doesn't mean anything,” he says. However, a move toward comprehensive care provided by teams of doctors and nurse practitioners in smaller community clinics will require a revamping of the health care system, and Miller hopes Roy Romanow gives this serious consideration when he releases his report on medicare later this month.
The ranks of physicians working solo directly reflects the way physicians are paid, adds Miller. “Instead of fixing the fee-for-service system, we keep looking for alternatives.” He says Nova Scotia's MDs have thousands of payment codes to choose from, but there's not a single payment option for helping a patient over the phone or via email. “There are patients quite capable of communicating with their doctor by email, but doctors can't do that — they won't get paid.”
Rachlis says any discussion of physician numbers is useless without a discussion of the system as a whole. “You can't talk about the right number of doctors without talking about the right number of nurses and social workers.”
And he says any data on physician numbers must be used carefully. “Any information about how things can be more efficient can be misused. You could conclude you don't need more doctors, but that would be a mistake — you need to build a comprehensive system [before that decision can be made].” — Donalee Moulton, Halifax