Members of the Canadian Association of General Surgeons are trying to break what they see as barriers to providing health care in remote communities.
Salmon Arm surgeon Stephen Hiscock is the B.C. rep to the association and says that while there is a surplus of general surgeons in Canada, getting them to where they’re needed is a bureaucratic challenge.
In order to practise, surgeons have to become licensed by each individual province and then get hospital privileges through the appropriate health authority.
Ultimately, what the association would like to see is a federal licensing system so the surgeons would be cleared to operate in any province.
“I’ve had licences in three different provinces and they all want the same thing effectively, so there’s a real hassle,” he says. “Imagine you’re going to do a locum in Fort St. John but you live in Toronto. You have to go to Vancouver for an in-person interview.”
Hiscock says doctors used to have to take all their documents with them and applauds one federal government move that eased the process somewhat through the establishment of a national data bank that contains diplomas and credentials.
He also salutes the College of Physicians and Surgeons of Manitoba, which now permits video interviews, provided a doctor has been in practice for five years.
“So that’s huge. When we talked to doctors we agreed this was a barrier not just an inconvenience, it’s blocking our way in getting under-serviced areas looked after” he says. “The hope was now that Manitoba has allowed it, will the rest of the provinces follow suit, and we’re working on that.”
Hiscock says the problem in B.C. is that there are no empty spots for surgeons to fill, but points out women in Fort Nelson have to drive to Fort St. John two weeks before their due dates because they cannot have a caesarean section in their own community.
“What if we set up a system where a community is serviced by six or eight surgeons who would rotate through the community,” he says. “And what we’re in the midst of trying to do, though we’re early in process, is to bring back caesareans to places like Mackenzie and other smaller communities.”
Within such a system, he says the community’s operating room would be functioning and anesthetists and nurses would keep their skills up because they’re not just doing an operation once every two weeks.
As well as providing a much-needed service to smaller communities, Hiscock says it would give newly minted surgeons the opportunity to get operating room time.
“New surgeons don’t have elective operating time, but they need it in order to have a full-time job, ” says Hiscock. “They’re all full in the bigger cities, so the established surgeons, they’ll get new surgeons to do on-call for them. Or some surgeons will work in a clinic that just does colonoscopies.”
The association initiated a project in Thompson, Man., which needed three surgeons but only had one. It was so successful they had to stop taking applications for people to go up and work, Hiscock says. He believes it would also work for small communities that only have enough work or one surgeon, but that one doctor could not be expected to be on call every day.
Hiscock says the first conversation he had about the issue was orchestrated by Neskonlith elder Louis Thomas, who organized a meeting with Shuswap MLA Greg Kyllo and North Okanagan Shuswap MP Mel Arnold – both of whom have been extremely supportive, he says.
“I’ve had dealings with B.C. People have returned calls and been helpful at the Ministry of Health,” he says. “All along the way, everyone has been encouraging.”
Shuswap MLA Greg Kyllo backs the proposal fully, calling the current licensing system antiquated.
“I think it’s high time we saw a centralized system,” he says, noting work is being done on equivalencies within the trades in order that a carpenter who earns a Red Seal in Ontario can work anywhere in Canada. “I’ve been told one of the biggest stumbling blocks is that the colleges of physicians and surgeons across the province have resisted.”
Kyllo says a national licensing system would be a more commonness approach.
“We’re one country and hopefully educational requirements are held to a high degree (across Canada) and there is consistency,” he says.
But North Okanagan-Shuswap MLA Mel Arnold has reservations.
“I think he has a great idea, but the challenge is, because there are basically four levels of government involved – federal, provincial, Indigenous and various local health authorities – funding has to flow through so many processes.”
Arnold says there would be many challenges in co-ordinating the different levels, which would eventually tie in to who is paying for the program.
“Another complication is we want to make sure communities are good with it,” he says, pointing out there needs to be open dialogue in what would be a painstaking process. “Some communities may want a full-time surgeon and may not be happy with rotating surgeons. It’s a better situation than no surgeon at all, but is it satisfactory; it almost brings in a fifth level of consultation.”