AG - The Terrace Standard, Wednesday, February 25, 1998

Tight budgets a factor

Specialists hard to find and keep

IT WASN'T the kind of response local anesthetist Dr. Phil
Lin was expecting.

While calling a Calgary hospital to find temporary or
permanent help to fill a gap in his specialty here, he be-
came the target of a recruiting allempt instead,

It’s but one sign of a growing problem in finding medical
Specialists across Canada and in particular for more remote
and rural places,

The anesthetist service here is a good example because
there should be two fuli time and one half time one based
here,

But the specialty has been one full time person short for
a year and the gap is to grow. ;

The half time person has been working full time but
wants to revert back to half time and Lin is leaving this
fall.

Although the Terrace and Arca Community Health
Council has four anesthetists interested in working here
(one paid a visit three weeks ago), Lin doubts recruiting
will be an easy task.

‘I think that’s very optimistic,’’ he said on the prospect
of meeting the goal of two full time and one half time

anesthetists.

Quality of life, the number of days each week a specialist
has to be on call in anticipation of being needed, the kind
of medicine that can be practised here and the ability to
make a living given ever increasing cost controls all play a
factor, Lin said.

He came to Terrace nine years ago in anticipation that
the hospital and region would grow to the point an ade-
quate number of anesthetists would be located here,

A key definition of adequate comes from the Royal Col-
lege of Physicians and Surgeons standard which says a
specialist should only be on call once every four days in
addition to regular duties, i

That’s been a problem here for a number of reasons, says
Lin.

One of those is the complex nature of medicine in the
north where hospitals and communities regard specialis*
services as prizes to be won and coveted,

What happens is that specialist services which migl
more rationally be grouped together as a regional servic
are split up between various communities, says Lin,

Lin uses his specialty as an example by pointing to th

Northern medicine under threat

A MOVE io stop what might be considered preferential
treatment for white medical specialists immigrating to
Canada could hurt the north.

For years the north has relied on bringing in foreign
specialists because not enough were being trained in Cana-
da or because Canadian ones didn’t want to leave ibe
south.

But the foreign specialists — mainly from Great Britain,
Ireland or South Africa where medival training is equiva-
lent to that of North America — have tended to be white.

And because of that the Royal College of Physicians and
Surgeons in Canada, which provides credentials to im-
migrant specialists by checking their training, wants to
change its approval process.

It wants to restrict credentials to any specialist unless that
person comes from a recognized specialist school in North
America.

But other health care officials say cutiing off the foreign
supply would leave northemt areas without crucial
specialist services.

Pierette Leonard of the Royai College of Physicians and
Surgeons said it was being put ‘‘morally into a difficult
posilion”’ because the foreign specialists receiving creden-
tials were predominantly white.

Leonard said the college also didn’t want ‘to be accused
of, we'll call it favourtism’’ because the dominant skin
colour of foreign specialists was white.

Aside from the colour issue, the college was also being
asked to provide credentials to specialists who went to for-
eign schools it didn’t have any information on.

‘We're in the business of standards. All we need is to
have something backfire,” said Leonard.

‘*So last July we decided to say ‘no more’ in assessing
credentials because we are just unable to do so.”’

Leonard said as few as 20 foreign specialists a year
would be affected by the restriction to approve those com-
ing only fram North American schools. - wo

. Yet Jan Courtice, an anesthetist-and- president of the...

provincial specialists’ society is worried that the college is
going to harm the north,

“They have a problem they are trying to correct but they
are creating a new problem in addressing that other prob-
lem,” he said.

While there’s merit in streamlining the system of giving
credentials and ensuring that specialists are equally
trained, Courtice doesn’t think the college has thought out
the impact on smaller communities,

“There's a physician supply problem globally and some-
thing like this doesn’t help out atall,’’ he said.

One possible solution is to set up a formal system of

providing locums — specialists and physicians willing to
work in femote areas for short periods of time, said
Courtice.

“There’s a physician supply problem
globally and something like this doesn't
help out at all.”

Oiher ways of dealing with the problem of specialist
supply are being taken up by a cross-country committee
consisting of provincial governments and the royal college.

It was established after prolests were made about the
royal college's ban on accepting specialists outside North
America.

One suggestion that may be fleshed out by the committee
is to admit foreign specialists to Canada but require them
to go to school here and to work under the supervision of a

; specialist before receiving full credentials.

“What we want to be is an honest broker of quality
care,’’ said the royal college’s Leonard.

‘In the end we want (o have an assessment process that.
everybody will be OK with,”’ she said.

The committee is to. repart by the end of the year.

Kitimat where there is an orthopedic surgeon and an
anesthitist.

It would make sense to move that combination to Terrace
in order to boost the anestethist complement here and still
provide adequate regional coverage, he says.

“What would be perfect is a sufficient number of
specialists to support each other,” adds Lin. ‘‘But that is
balanced against political considerations.”

Developing and keeping the right mix of specialists also
worries Lin as should one specialist leave, the ability of the
remaining ones to practice is affected.

Combine that with tight hospital budgets which can
restrict operating room time and specialists here won’t
have the chance to make a living, he adds.

Lin’s not the only specialist planning to leave this year,
Two others have also given notice,

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