Patchwork Solutions won’t Fix Fraying Health System 

The severe pressures on our health-care system have renewed interest in revitalizing it. 

While bold thinking is needed, we must guard against unintended consequences. 

Among the proposed solutions is something called “pan-Canadian licensure,” which would allow a licensed physician to work in every province and territory in the country. 

Currently, physicians are regulated and overseen by provincial and territorial bodies. As an Ontario pediatrician, I am a member of the College of Physicians and Surgeons of Ontario; with few exceptions, to practise elsewhere in Canada, I must be a member of that province or territory’s college. 

The concept of allowing physicians to work anywhere in Canada has the endorsement of the Canadian Medical Association and other prominent medical groups. The association argues patients as well as physicians would be better served by pan-Canadian licensure, particularly in rural and remote areas of the country where virtual care could increase the availability of health services. 

Data from the Organisation for Economic Cooperation and Development (OECD) certainly shows there is a need for better rural and remote service — Canada has the lowest rural physician density among comparable OECD countries. 

But is pan-Canadian licensure a panacea or a Pandora’s box? 

Comprehensive research on the consequences of virtual care is lacking. Research on the promise and pitfalls of virtual care is mixed. Episodic and fragmented care, where there is no continuity of care, may lead to worse outcomes and more costly care. 

In some cases, it can be extremely convenient and productive to go to a doctor’s appointment from the comfort of home. But medicine is an art as well as a science, and subtle clues that may be evident to a physician at an in-person appointment may not come through on a computer screen. 

Moreover, the lack of adequate high-speed internet in rural and remote areas is a serious problem — a glitchy, low-quality connection is an obstacle to patient-doctor communication and diagnosis, and people without the means to buy a machine with a good webcam will again be disadvantaged. 

Indeed, some health-care advocates suggest that virtual care platforms could exploit a pan-Canadian licensure system to reap considerable financial rewards while providing little in the way of actual care. And greater mobility could see medical professionals gravitate towards more lucrative work in urban centres, leaving underserved areas even more bereft. 

As a pediatrician for over 30 years before my appointment to the Senate, I have dedicated my career to improving the health and well-being of children across Ontario. Over these years, I have seen the health system excel — and I have seen it falter. I know that there is no magic solution to our health-care woes. 

I believe that pan-Canadian licensure can help to resolve some problems in the health-care system, but it will take more than that to fulfill the main objective of the Canada Health Act: “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial and other barriers.” 

There is a risk that politicians and health leaders seeking to appear decisive and active on the health file will enact this one change and pat themselves on the back for their leadership — while ignoring other systemic problems. 

In fact, the Ontario government recently held a press conference trumpeting an “as of right” rule to allow Canadian health-care workers to work in Ontario immediately, wherever they are registered. 

The fabric of Canada’s health-care system is old and fraying fast. Patches are no longer enough. We must weave a new system — pan-Canadian licensure is but a single thread. 

 By Senator Sharon Burey 

The Honourable Sharon Burey was appointed to the Senate in November after a distinguished career as a behavioural pediatrician. She represents Ontario in the Senate. 

TAN