CALGARY HERALD COLUMN: Everything’s bigger in Texas — even its herd of Canadian health workers

Texas and Alberta have a lot in common. Cattle ranches, rodeos, a booming oil and gas sector, and thousands of Canadian health-care workers.

That last item on the list might be a bit of a surprise to some. But it’s true.

Considering many Canadian provinces, Alberta included, are coping with a shortage of health-care workers, it’s a good idea to look at different ways our country can keep hospitals and clinics staffed with the doctors and nurses needed to take care of patients. 

SecondStreet.org decided to examine the number of Canadian doctors and nurses with licences to work in the U.S. The research started by looking at states along the Canada/U.S. border and then expanded to popular states deeper into the U.S.: Florida, California, Illinois, Massachusetts and Texas. 

The results were wilder than a buckin’ bronco. 

Texas was, by far, the most attractive of these states for Canadian health-care workers. There were 5,620 nurses and 443 doctors with a licence to work in the Lone Star State. Unfortunately, a majority of the nursing licences did not have a province specified, so it’s not clear which part of Canada they came from.

In total, the 14 states had issued licences to just over 18,000 health workers with Canadian mailing addresses. For perspective, that’s almost enough to pack the Saddledome full of health workers for a Flames game. It’s important to note that figure doesn’t include the thousands of Canadian doctors and nurses who have moved to the U.S. and no longer use Canadian mailing addresses.

While not every one of the 18,000 licensees is currently working in the U.S. (some may have retired, returned home, etc.), it’s clear that the brain drain to states such as Texas is contributing to the staff shortage in Alberta and the rest of the country.

So what can be done to convince these essential health workers to stay home?

For one, more choice. This is something the Alberta government has taken some positive steps toward. At the beginning of the year, it pledged to complete 3,000 orthopedic surgeries through publicly funded, privately run clinics. Not only does this have great promise for patients, but it’s also good for staff as well. If a nurse or doctor doesn’t enjoy working in a government-run hospital, they might be attracted to working at a private facility instead of leaving the province for work.

While it’s great to see Alberta take this step, it could go further. Why not keep the public health-care system but allow Albertans to pay for their care at local private clinics, instead of making patients leave the province if they want to pay for surgery? Quebecers have the right to pay for their care locally. If they can do it, why can’t Albertans?

It’s also important to improve the government-run system. When surveying nurses who lived in Ontario but worked in Michigan, SecondStreet.org heard many interesting reasons as to why they chose to work in the U.S. The top reason was actually the availability of work: many nurses were unable to find full-time jobs in Canada and had to deal with juggling different part-time shifts.

It looks like this could be happening in Alberta. According to the federal government, 31 per cent of Alberta nurses work part-time, substantially higher than the 19 per cent average for all other jobs. Perhaps there’s an opportunity to combine some of these positions into full-time work to potentially convince some health workers to stay home.

It’s common sense that for a health-care system to work, you need staff to keep it running. Convincing staff to stop running south of the border can play a major role.

The Calgary Stampede’s a lot better than the Houston Rodeo, anyway.

Dom Lucyk is the Communications Director with SecondStreet.org, a Canadian think-tank.

This column was originally published in the Calgary Herald on October 5, 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.