BUSINESS IN VANCOUVER COLUMN – We need to apply new thinking to keeping doctors and nurses in B.C.

Imagine you were hit by a car tomorrow and were rushed to the emergency room. You fade in and out of consciousness, finally awakening to find the janitor is helping out with your operation. While you lay there confused, he winks, smiles and says two words.

“Doctor shortage.”

Canada’s health care system isn’t quite there, but we routinely hear about shortages of staff across the country. Over six million Canadians don’t have a family doctor. From coast-to-coast we hear about shortages of nurses. Ultimately, these shortages hurt patients. 

This is a problem widely acknowledged across the political spectrum. While governments, including Premier Eby’s, often focus on recruiting more doctors and nurses from abroad, there is another place to look for health care staff: within B.C.’s borders. 

A new study from SecondStreet.org examines the number of Canadian doctors and nurses who have an active licence to practice in states along the U.S. border – Washington State, Idaho, etc. 

Across the country, there were nearly 10,000 such cases. Border states had issued licenses to 901 doctors and nurses with B.C. mailing addresses. 

There are a couple of important points to note. For one, it’s uncertain how many of these workers are commuting across the border, how many have moved to the U.S., and how many are planning to move in the future. However, it’s not a simple process to become accredited to work in the U.S. The paperwork is one thing, but there’s also a $450 US fee for accreditation on top of general licensing fees (which vary by state) for nurses. Thus, these workers are unlikely to be casually playing the field.

It’s also important to note the true total is likely much higher. This report focuses only on states along the border. The top state to issue licences to B.C. nurses was, surprisingly, not Washington (354) – it was actually New York (427). If one were to seek out the data for other far-away states, such as California, Florida, Arizona, etc., one would likely find hundreds more workers who have left.

So, what can be learned from this?

For one, governments could listen to health care workers to learn more about what would convince them to stay in the province. 

While SecondStreet.org was unable to survey health workers in B.C. who have licences in the U.S., insight into this matter can be gleaned from our survey of Ontario nurses who work in Michigan.

Intuitively, one might think that compensation is the main reason nurses are leaving to work in the United States, but that’s not what the data shows. The top reason Ontario nurses indicated they chose to work in Michigan was actually availability of work. Many noted they were offered part-time shifts in Canada, but chose the U.S. as they could secure full-time positions with more predictable schedules. 

Compensation was the second most common response, but right on its heels was “working conditions.” A common complaint was that there was more modern equipment and higher standards of care south of the border. Perhaps B.C. could reduce the province’s health care bureaucracy and use the savings to modernize hospitals, further helping to attract doctors and nurses to stay in the province. Does the province really need 64 vice-presidents across the province’s six health authorities (each making generous six-figure salaries)?

Another option would be for B.C.’s government to work with the nurses’ union to loosen seniority rules in scheduling, allowing more new health care workers to access consistent, reliable hours. Another option would be to simply reduce the number of part-time roles and create more full-time positions.

As you can see, two of the top three reasons why Ontario nurses chose to work in Michigan didn’t even involve compensation.

A second way Canada could retain more health care workers is through private clinics. 

Private clinics have less bureaucracy and aren’t unionized, so they have the potential to be more flexible and responsive to what workers’ are seeking – whether it be predictable hours, better compensation or other workplace matters. Most importantly, private clinics give workers more choice in terms of where to work.

To be sure, convincing B.C. health workers to remain in the province is not a be-all and end-all solution, but it could help address the province’s shortage of health care workers.

Dom Lucyk is the Communications Director for SecondStreet.org, a Canadian public policy think tank.