REGINA LEADER-POST COLUMN – Convince Saskatchewan Health Care Workers to Stay at Home

What happens if you need a doctor or nurse and they’re not there? It could be a life-threatening delay. Or perhaps you have to wait an extra month or two with chronic pain while you wait for surgery.

Sadly, governments across Canada are reporting a shortage of doctors and nurses, including in Saskatchewan.

While the Moe government has started on a plan to attract more health-care workers to this province, and train more staff in the first place, another option deserves attention: convince more Saskatchewan nurses and doctors to stay here instead of leaving. 

Most people in Saskatchewan probably know someone who has moved away to cities like Calgary and Edmonton for work, including health care workers. But what about further away?

SecondStreet.org recently collected data on the number of licences issued by states along the Canada/U.S. border to nurses and doctors with a Canadian mailing address.

This research builds on a previous SecondStreet.org report that discovered there are nearly 2,000 Ontario nurses who regularly commute to Michigan for work. It’s a very short drive from Windsor to Detroit, so this wasn’t particularly surprising.

However, the Michigan data also showed licences were issued to people with Saskatchewan mailing addresses as well as provinces like Alberta, B.C. and New Brunswick — too far for a commute. 

After investigating the number of licences issued by all border states — not just for nurses, but for doctors, too — SecondStreet.org calculated they have licensed almost 10,000 doctors and nurses with a Canadian mailing address.

However, this doesn’t mean they’re all commuting — some have likely moved to the U.S. altogether or may be planning to work in the U.S. in the near future. Considering it costs US$450 to have your nursing credentials confirmed in the U.S., it seems unlikely they would get their licence on a whim.

SecondStreet.org found states along the Canada/U.S. border have issued licences to 179 nurses and 11 doctors with Saskatchewan licences. Interestingly enough, the majority of those (140) were issued by New York.

This figure would, of course, increase if you included states far beyond the border — including sunny destinations such as California, Texas and Florida to name a few.

The number would also rise if you included health-care workers who moved to the U.S. long ago and no longer have a Canadian mailing address — not to mention those who have moved to other parts of Canada. 

So, how can health-care workers be convinced to stay in Saskatchewan?

When SecondStreet.org surveyed nurses in Ontario who work in Michigan, the top reason respondents noted they chose to work in the U.S was a lack of work in Canada; many noted there were only part-time jobs available in Canada.

Last year, the Leader-Post noted a survey that found 35 per cent of nurse practitioners were working part-time in Saskatchewan, but wanted full-time work.

Perhaps there’s a way the Saskatchewan government could offer more full-time work instead of nurses having to accept part-time work and constantly add more shifts to earn a full-time salary?

A second way Saskatchewan can retain workers is by continuing to partner with private clinics for surgery and other health services. The conversation often focuses on how these private clinics have reduced wait times.

But what’s not spoken about as much is how these facilities give more options to health-care staff. Perhaps these clinics could be more flexible and able to offer nurses and doctors what they’re looking for than bureaucratic, government-run hospitals? 

Ultimately, more choice is better for patients and workers. If we don’t want our health-care workers to leave for places where the grass is greener, we need to water the lawn at home. Listening to feedback from nurses and offering more workplace options is the refresher the health-care system needs.

Dom Lucyk is the communications director with SecondStreet.org, a public policy think tank.

This column was published in the Regina Leader-Post and Saskatoon Star-Phoenix on June 28, 2023.

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.