I took great interest in the original Barer-Stoddart report of 19911 that without question has helped shape the physician workforce in this country. In their recent editorial, Greg Stoddart and Morris Barer suggested that sections of their report were effectively ignored, which has helped lead to the impending crisis we now face.2
As chair of the Canadian Urological Association's Manpower and Economics Committee, I know that we are headed for an enormous staffing crisis in the medical and surgical specialties within the next 10 years. Today most specialty groups are beating the same warning drum because half of our specialists will retire in the next 10 years. We immediately need either an enormous increase in the number of training programs for medical and surgical specialists or a reduction in the barriers facing foreign specialists trying to enter Canada. Physicians who leave Canada immediately after graduating already represent an enormous loss. If there was financial assistance for physicians during their training, with a commitment to practise a minimum number of years in Canada, an enormous benefit would result.
What concerns me most about the editorial is the mention of nurse practitioners. At present there are few convincing data to suggest that they will provide more economic delivery of primary care. We have a 24-hour toll-free service in New Brunswick that allows patients to discuss health concerns with nursing staff. Since its introduction, the number of emergency room visits has not changed appreciably and the cost of each phone call is approaching that of a visit to a physician's office.
Most health ministers realize that there is now no more efficient way to deliver primary care than through the physician. Unfortunately, doctors are aging and there are few new ones to replace them. The growing number of female physicians makes the matter more urgent, because they will inevitably have family commitments that will affect their professional productivity.
In summary, a crisis looms and health ministers must make bold policy changes now. If they don't, their window of opportunity will close.