The Future of Healthcare is Mobile

A strong economy depends on an efficient and effective health system. Right now, we don’t have one. 

It’s estimated that more than six million people in Canada do not have a family doctor. Emergency departments are overwhelmed. And patients are waiting months, sometimes years, for life-altering surgical procedures. Access to care is even more challenging in rural and remote communities, which account for 18% of Canada’s population but are served by only 8% of the country’s physicians.

Relief is not likely anytime soon. Some doctors are already reducing hours or shifting specialties due to exhaustion, burnout and job dissatisfaction. Over the next decade, retirements in the profession, as well as global competition for health human resources, will further exacerbate shortages.

As Canada works to recruit, train and retain physicians, we will also need to figure out how we expand access for patients and offer better support to healthcare providers. 

The Opportunity of Mobile Healthcare

One solution gaining momentum is removing barriers to medical practice between provinces and territories. A more mobile profession could help narrow the gap between rural and urban care, improve physicians’ work-life balance and allow for faster responses to crises across the country.

Right now, most physicians are licensed to practise only in one province or territory. A family doctor in British Columbia, for example, can’t automatically or easily relieve a colleague in Manitoba or provide care to a patient in Quebec. There are some exceptions, but that would require someone to have licenses in all three provinces. This involves a lengthy application process, sometimes months long, and thousands of dollars in fees. 

A 2023 member poll conducted by the Canadian Medical Association (CMA) showed that 95% of physicians and medical learners support national licensure. More than seven in 10 indicated it would improve access to health care in rural, remote and northern communities (75%), access to family physicians (71%) and access to specialist care (70%). 

One Medical License, Many Benefits

The COVID-19 pandemic had a huge impact on physicians’ health and wellness, with many already stretched from supporting an ailing health system. The CMA’s 2021 National Physician Health Survey found that 53% of physicians and medical students had experienced high levels of burnout nearly double the number reported in 2017. Close to half of respondents were considering reducing their clinical hours.

A short-term replacement called a locum is one release valve for doctors. However, many provinces and territories have difficulty securing them. In July 2023, there were 1,087 open locum positions listed on government recruiting websites across Canada. This means that taking sick days, a vacation, parental leave, or a learning opportunity involves either burdening a colleague or sacrificing patient care. 

A national pool of locums would improve access and continuity of care for patients, reduce workplace stress and improve the sustainability of our health workforce. Almost half (45%) of physicians from the CMA’s member poll said they would be more likely to work as locums in other jurisdictions if a national licensure system were in place. This support is especially important for female doctors seeking parental leaves, primary care practitioners working in small teams and rural and remote physicians with few or no peers to cover for them.  

Pan-Canadian licensure could also help with physician recruitment. One in four physicians in Canada is an international medical graduate (IMG). More than 70% of respondents to the CMA’s member survey believe the opportunity to work in different parts of the country provided by national licensure would make Canada more attractive to IMGs. 

Pan-Canadian licensure could improve equity in rural and remote health care as well. Expanded virtual care could reduce the frequency and duration of fly-in medical visits to remote areas and allow for consultations when patients’ conditions don’t accommodate travel. It could also increase access to specialist medical services in rural communities, where patients are often forced to take time off and pay for transportation to larger centres.

In addition, more flexible virtual care would allow patients to stay with a family doctor even when they move to another part of Canada, bridging gaps until they find a local provider, which can sometimes involve years on a waitlist.

The Path to Physician Mobility

Recently, there has been significant progress toward broader medical licensure in Canada. 

Even groups outside of healthcare, such as the Federation of Canadian Municipalities, are acknowledging the need to better enable physicians and nurses to work anywhere in Canada. 

Changes have already been made through a new Atlantic Physician Registry, allowing doctors to practice across Nova Scotia, New Brunswick, PEI and Newfoundland and Labrador. Ontario announced plans to recognize the credentials of health professionals licensed elsewhere in Canada.

In October 2023, all of Canada’s health ministers gave the green light to implement a process allowing health professionals to practise in any other Canadian jurisdiction without significant delay or the need to meet additional regulatory requirements. 

The National Registry of Physicians (NRP), a database of all licensed physicians in Canada, was launched this spring by the Medical Council of Canada, a key step toward the portability of physician credentials. 

The CMA welcomes these efforts. Now, they need to be accelerated. A truly pan-Canadian approach to physician mobility can make a big difference today and in the future. 

Let’s make sure it’s easier for doctors to go where patients need them most.