Sask. Health Authority should be able to assign where and when doctors work, says policy analyst

Steven Lewis knows his solution for fixing health care won’t be popular, but he says it’s necessary for filling massive gaps in the current system.

“The solution sounds simple. It is,” said the longtime policy analyst. “We need to actually create a primary care system that is attached to the rest of the system, meaning all the other services.”

Specifically, Lewis is suggesting all physicians in the province work under the Saskatchewan Health Authority as contracted employees, similar to the way teachers work under the Saskatchewan Teachers’ Federation.

Under that model, Lewis said doctors could be assigned to locations that need care, instead of choosing when and where they work, and what kind of patients they accept. 

LISTEN | What might improve Saskatchewan residents’ access to health care?

Blue SkySaskatchewan’s primary health-care system is broken — what would fixing it look like?

Health policy analyst Steven Lewis has ideas for how to fix Saskatchewan’s struggling health-care system. But how realistic are they? We convened a panel of healthcare professionals including two doctors Ryan Meili and Darcie McGonigle and Nurse Practitioner Michelle O’Keefe.

According to the Canadian Institute for Health Information, 84 per cent of people in Saskatchewan over the age of 18 had access to a regular health care provider in 2023. 

But as the population grows, so does the need for physicians. 

According to SaskDocs.ca, there were 153 family physician jobs posted in Saskatchewan on Aug. 25. More than two dozen were for positions in Regina and even more in Saskatoon. Centres like Moose Jaw, Prince Albert and Estevan also had multiple positions to fill.

Lewis said there needs to be a better distribution system. 

Steven Lewis is a Vancouver-based health policy consultant who says there needs to be a better way to distribute doctors within the Saskatchewan health-care system. (CBC News)

“Some doctors have literally rosters of a few hundred patients and others have over 2,000 patients,” he said. “We don’t know much about why that is. And is that a good thing or a bad thing? Are some doctors over-serving their patients? Are some doctors under-serving their populations, their roster, because they just don’t have enough time to serve them adequately?”

Lewis said it all goes back to something called the Saskatoon Agreement. In 1962, doctors were on strike for 23 days, after which the government made concessions: doctors would not be employees; they could opt out of medicare; they would choose how to be paid; and they could practise when and how they saw fit.

That is how fee-for-service and private clinics became the norm.

But as doctors age and retire, and times change, Lewis said so have the desires of up-and-coming doctors. He said they don’t  want to be entreprenuers; they want to work as part of a team. That’s where primary care multidisciplinary clinics may solve some problems. 

It’s working for Dr. Ryan Meili at the Westside Community Clinic in Saskatoon. The former Saskatchewan NDP leader has leaned back into medicine after his time in politics.

“One of the things that I enjoy the most about that is when a patient comes to see me, they see me, but they also are really seeing our whole team,” he said. “And it’s whoever is able to provide the best care for that patient at that time, that’s who we reach out to and connect to.”

Dr. Ryan Meili works at the Westside Community Clinic in Saskatoon, where he says his patients benefit from being able to see the whole team of health-care providers there. (Peter Mills/CBC)

The clinic offers counsellors, physiotherapists, visiting specialists such as psychiatry, obstetrics and infectious diseases, as well as a group of family physicians and nurse practitioners all working together. Similar clinics exist across the province.

“I have some bones to pick with some of Mr. Lewis’s approach,” Meili said. “But I think the general assessment that there is a need for a systemic approach to primary care is absolutely bang on. And, the goal of getting people timely access to care is No. 1. We’re not achieving it at the moment.”

But Meili said centralizing the assignment of doctors wouldn’t solve the problem. In fact, he said it would push them away. 

“If you suddenly came in tomorrow and said, ‘This is the system and you’re working in or get lost,’ they’ll get lost. You need to actually build the kind of jobs that people want.”

He said new doctors do want to work where there’s need, but that positions have to offer economic benefits and work-life balance.

A report released in January shows that 17 institutions offer medical doctoral programs in Canada and family medicine residencies are capped at 1,557 total positions. 

Some of the programs saw small increases during the four-year period examined. Family physician training spots increased by just 2.5 per cent, for example. But nurse practitioner training positions grew the most at 13 per cent. 

Michelle O’Keefe, president of the Saskatchewan Association of Nurse Practitioners, said they’re one of the answers to the problem.

“Ideally, having a robust system that has enough providers is the solution,” said O’Keefe. “But, that is kind of a dream.”

In June, the Government of Saskatchewan asked for expressions of interest from nurse practitioners who want to deliver publicly funded primary care. The plan was to select some of those people to apply and, if successful, they’d sign a contract with the Ministry of Health and function as independent contractors.

At the time, Health Minister Jeremy Cockrill said the government was committed to ensuring every resident had access to a primary care provider by 2028.

O’Keefe is the only primary health care provider in Grenfell, about 120 kilometres east of Regina, after the town’s doctor retired. A nurse practitioner for 12 years, she said it can be stressful to have an entire area rely on her alone.

“Practitioners, whether they be physicians or nurse practitioners, are getting burnt out with the amount of workload and trying to keep up with the pace,” she said. 

“So you have to put off the things that you might do for your own self care.”

The provincial government is working to recruit more primary care workers. It launched the “Saskatchewan is Calling” campaign earlier this year. It has been placed in provincial, national, and international markets, including the United States, trying to encourage people to make Saskatchewan home and a place for medical practice.