Doctor shortages, the Premier and the medical establishment’s gatekeepers

Who can forget last summer’s musical chairs, complete with schoolyard finger-pointing, Cabinet post switches, firings of old and hirings of new high-priced Horizon and Vitalité Health Network CEOs, and dismissals of board members of the two health authorities?

A cynical interpretation — but one difficult to avoid — is that these changes were attention diversion stunts and callous ones at that, given their occurrence during some of the worst days of New Brunswick’s ongoing health care crisis.

Premier Blaine Higgs is loath to admit to “failures” in New Brunswick’s health care system under his watch. Instead, he speaks of “challenges” and this euphemism frequently turns up when spinning his administration’s “innovative” approaches to dealing with what is dysfunctional, close to the breaking point, or broken.

And how have these innovative practices been going? For the most part, the Premier has played Scrooge with the purse strings to the province’s budget, repeating ad nauseum the conservative mantra that throwing public money at such problems cannot fix them. His aversion to spending public monies for the common good, coupled with an embrace of business management models, created a frightening specter of impending collapse of our health care system last summer.

But, following a series of heart-breaking health system failures in our hospital Emergency Rooms (ERs), the Premier’s tune seemed to change. The public was appalled to learn about would-be patients, in overcrowded, understaffed ERs, dying before they could be attended to.

In response to these tragedies — or so it seemed — Higgs began admitting a self-evident truth: the shortage of health care workers is the essential problem underlying our ailing, sometimes broken, health care system.

In another seeming eureka moment, the Premier finally conceded that fixing the system will require “ramped up” public spending, albeit with his usual austerity-speak qualifications! Maybe someone advised him that Tories in poor provinces, with a fed up populace, need to lean “Red” if they are to stay in power?

In a televised CPAC interview with Michael Serapio in early February, Higgs identified fixing labour shortages, quickening the ability to bring in more foreign medical professionals, and speeding up medical certification processes as key issues in need of urgent addressing. Indeed.

However, some of the above needed transformative change is outside of the Higgs’ government’s jurisdiction. Quickened physician recruitment, for one, first requires structural and policy changes within the province’s non-governmental medical establishment.

The sad reality at present is that rapid recruitment of physicians from outside of Canada and the U.S. is shackled by policies restricting the number of international medical graduates (IMGs) eligible to enter pathways to medical licensure here. The source of these barriers is our province’s “gatekeeper” to physician licensing: the College of Physicians and Surgeons of New Brunswick (CPSNB).

My own awareness of CPSNB’s oddly restrictive physician recruitment policies began in 2014–15, when a Mexican-trained and a Cuban-trained doctor, both working in Venezuela, requested that a friend assist them in offering their services to New Brunswick.

Both knew about Canada’s shortages of doctors in underserved areas and emphasized their willingness to work anywhere in the province or elsewhere in the country. These two experienced and English-proficient physicians — one a paediatrician, the other a family doctor — were demonstrably excellent, compassionate, and dedicated to serving patients’ needs, based on years of my friend’s family receiving their medical services in Venezuela.

In response to their requests, my friend traveled to the CPSNB office in Rothesay, with personal testimonials and the doctors’ résumés in hand. During that visit, the Registrar at the CPSNB, a most courteous and pleasant man, kindly reviewed the two cases. But then, the atmosphere in the room changed. He explained that he had received hundreds of such requests from IMGs to practice in the province and scrolled through a vast email folder as proof. To my friend’s dismay, the Registrar then pronounced there was “no hope” that those doctors could practice medicine in New Brunswick. He was asked why and gave no answer.

No wonder. For reasons uncomfortable to ponder and not made transparent to the public, the CPSNB has erected walls that prohibit many IMGs from practicing here. With three exceptions, unless an IMG was educated and trained in a medical school located in certain former British Empire countries (outside of Canada and the U.S.), they cannot become licensed to practice medicine in New Brunswick. This policy excludes thousands of graduates from highly respected internationally-acclaimed medical schools located in the Global South and elsewhere.

Across Canada, physician licensing is under the jurisdiction of medical regulatory authorities in each province or territory. But the CPSNB has elected to follow physician recruitment guidelines formulated by national colleges.

Its Ottawa-based parent, the Royal College of Physicians and Surgeons (RCPS), recommends that credentials of Medical Specialist IMGs be deemed acceptable only if they were trained in the following jurisdictions: the United Kingdom, Ireland, Australia, New Zealand, Hong Kong, Singapore, South Africa, Switzerland, and France. The number of “approved” medical schools in those few jurisdictions is slightly over 60.

For Family Physicians, an even smaller list applies, one that adheres to guidelines of another higher-order gatekeeper, the College of Family Physicians of Canada (CFPC). The CFPC recognizes Family Medicine degrees only if obtained from medical schools situated in Australia, Ireland, the United Kingdom, and the U.S.

Why has the CPSNB elected to follow such highly discriminatory barriers to IMG recruitment, given that it doesn’t have to, and given the crying need for more doctors in the province? Other provinces and territories have rejected such restrictions on physician recruitment and their regulatory bodies have drafted their own recruitment guidelines, which include drawing IMGs from a much larger pool.

For example, Nova Scotia’s College of Physicians and Surgeons (CPSNS) recently formulated a streamlined pathway for licensure of IMGs with emphasis placed on demonstrated competency, as determined by concentrated supervision and assessment. In response to overcoming doctor shortfalls in NS, the CPSNS recognizes degrees from schools listed in the World Directory of Medical Schools: over 3,600 accredited medical schools.

In the short-term, New Brunswick must license more IMGs, and create expedited pathways for more experienced international doctors to practice here. This need is currently beyond urgent. As of June 2022, the most recent figures I was able to gather, there were 181 vacancies for doctors in New Brunswick as well as 783 vacancies for Registered Nurses.

Both the Premier and the CPSNB have the power to act in ways that address this urgency. Physician recruitment obstacles that make no sense need to be dismantled by the CPSNB and new guidelines created that address our province’s physician needs.

But does the Premier have the will to do his part? Serious funding support from the province’s bountiful, federal transfer funds-bolstered budget is needed to hire more health care professionals to prevent future crises that continue to cost lives today. But that hasn’t happened to the degree needed.

In recent State of the Province speeches, the Premier and Finance Minister boasted about their 10.6 per cent increased health care spending for 2023–24. Community activists and opposition party critics immediately deemed the increases to be inadequate, at best.

While opposition parties can be expected to level such objections, their criticisms transcend partisanship. Given the dire straits of our health care system currently, it is inconceivable to me that a 10.6 per cent funding increase can even come close to approaching what is truly needed.

NB Green Party leader David Coon outlined some of these needs, including human resources (recruitment and retention of medical professionals) and infrastructure (building and equipping urgent care units within hospitals and community health centres), as well as alternative funding models (to attract more Nurse Practitioners).

We must always predicate our attempts to understand fiscal decisions and public policies of conservative governments by reminding ourselves of the decades-long right-wing agenda and propaganda campaign aimed at eroding universal health care and other public services.

Inevitably, this leads to wondering if the Higgs’ government’s maintaining of health care inadequacies through chronic underfunding is by design. This suspicion is hard to avoid, given his long-standing attraction to and advocacy of increased private sector involvement in health care delivery. Follow the money, always. Noam Chomsky famously stated: “That’s the standard technique of privatization: Defund, make sure things don’t work, people get angry, you hand it over to private capital.”

Creeping privatization of health care has been well underway here for some time and is gathering steam. Recent commentaries by Susie Proulx-Daigle and Bernadette Landry review this trend.

Still, this is New Brunswick, and we’d like to think better of our Premier and his government. It is such an awful thought, given the human costs involved, that conservative austerity budgets have been intentionally designed to ensure inadequate health care and other public services. In Canada, and especially here in the so-called “friendly” Maritimes, some of us would like to think that “our” Tories — in contrast with more extreme and unbending U.S. conservative politicians — are better than that.

The ball is now in Premier Higgs’ court. He could still do the right thing and transfer additional funding support for health care, ideally under advice from community groups and representatives of all health care worker sectors. Even if for the wrong reason. Even if because he fears voter discontent in the next election, the “surplus Premier” should make health care in New Brunswick better.

Gary Heathcote is a writer and retired anthropologist living in Cambridge-Narrows, NB.