#Healthcare4All – By the Numbers: Why 2 Tiers Divide Without Conquering

Post by #Healthcare4All team member, Megan


What if we cut our number of doctors and surgeons in half? When people propose a dual private-public healthcare system, they’re proposing that we divide up our healthcare professionals – doctors, nurses, specialists – between two systems.

One of the concerns around creating 2 tiers in healthcare, one public and one private, is that doctors and surgeons then have to choose how to spend their time. If you were a doctor, which would you choose? The public system where the wages are set based on government guidelines or accessible pricing, or the private system where you can charge anything you’d like – maybe twice, three or four times what a public provider charges. It’s healthcare, so people will pay a lot to be healthy–if they can afford it, of course. So, it’s appealing to be a private, for-profit health care provider (just ask Brian Day). What’s not so appealing? Being in the public healthcare system and watching doctors jump ship. What would dividing up our doctors look like? Let’s do the math.

According to the College of Physicians and Surgeons of BC (the organization that issues medical licenses to – you guessed it – the physicians and surgeons in BC), there were 11,361 active, licensed physicians and surgeons in the province in 2013. BC Stats tells us that there are 4,624,000 people in British Columbia in 2014.

4,624,000 people divided up by 11,361 doctors and surgeons equals… about 407 people per doctor right now. What if 25% of those people are part of the private system only? What about 50%? Cut out even 25% and you have 8,521 doctors and surgeons for 4,624,000 people–that’s 542 people for every doctor or surgeon. Imagine treating 542 people a year!

Except, hold up. Some of those 11,361 are specialists, who don’t deal with most people on a regular basis (although I have on good authority that they are busy people!). Almost everyone will have to see a general practitioner once a year though. The College of Physicians and Surgeons reports 5,875 general practitioners working in BC in 2013.

4,624,000 people divided up by 5,875 general practitioners is… about 787 people per doctor right now.

No wonder it isn’t very easy to find a family doctor these days.* In May 2012, the Canadian Foundation for Healthcare Improvement provided these sad facts:

“There are 120 family medicine physicians for every 100,000 people in Montreal; 169 in Vancouver; 160 in Toronto; 118 in the Champlain region (which includes Ottawa). The Outaouais region of Quebec (just across the river from Ottawa), makes do with 97. In Erie St. Clair, in Southern Ontario, the number is 69.”

If you’re not in a big city center, the picture does not improve. Nationally, 2005 statistics place 9% of doctors in rural Canada, serving about 21% of Canadians. Imagine losing 10, 20, 30% of those health professionals to private-only practice. You think waits are long now? Oh boy. The exact stats may have shifted since 2012, but there’s no way that dividing up those numbers between two systems would be an improvement, anyway you slice it.

However, it might not even be about the number of doctors. Canada has been doing much better about increasing the number of doctors in the last few years. Since 2008, the ratio of  doctors to patients has generally been going up and up, and there are certainly more doctors entering the country than leaving it. Good news! But distribution of the doctors that we do have may be the real problem, and dividing that number up isn’t likely the solution we’re looking for.

According to the Canadian Foundation for Healthcare Improvement, “Determining the “right” number of doctors is tricky. It depends on many factors, such as: the size and health needs of the local population; the hours that doctors work; the supply of other health practitioners; how the roles of the health workforce are defined; and how much money there is to go around.” Most of these factors are influenced by the widespread introduction of a private service, because we’re asking to split up the current health resources into 2 tiers–it’s not just doctors but clinic space, nurses, specialists, support staff… all going to be divided up between two systems, and one of them will be offering a pay raise and special funding. If we want the most people to access the best care possible, private care isn’t going to solve problems for most people. In fact, it may make distribution an even more difficult problem to navigate.

We have to continue to demand Tier-Free Healthcare, push for solutions that actually solve problems, and make sure that we show our support as the province faces a legal battle for universal, public healthcare this fall. To learn more about the issue, click here.

*Are you among the many people (youth or otherwise) who are looking for a family doctor? Check out the College of Physicians and Surgeons “Find a Physician” page to try to find one by searching in your area. You’re not the only one missing a family doctor (like me!).