Pan-Canadian licensure: Potential impact on the rural physician workforce.

ABSTRACT: Proposals to establish pan-Canadian licensure for physicians have broad support amongst medical groups to address physician shortages in underserved rural communities. The concept has also elicited concern from some stakeholders that its implementation could exacerbate rural physician workforce shortages by prompting an exodus of rural physicians to urban centres. An environmental scan of reports from key medical groups published within the past 10 years was conducted to determine factors influencing rural physician practice patterns. Data from membership surveys of the Society of Rural Physicians of Canada and the Canadian Medical Association - conducted in fall 2022 - were reviewed to determine whether licensure is a factor in rural physicians' decisions to leave or stay in practice in rural Canada. Factors contributing to physicians' decisions to leave rural practice identified in the environmental scan included lack of infrastructure support, inability to find locum coverage, inadequate support for team-based care and effects of high workloads on wellness. A common theme found in responses to the membership surveys was the recognition of licensing restrictions as barriers preventing rural physicians from practising in multiple provinces or territories. Survey respondents also voiced strong support for national licensure implementation. Pan-Canadian licensure holds promise as a strategy to enhance the recruitment and retention of physicians in rural communities. It could also provide physicians flexibility to work in multiple jurisdictions to address the health workforce needs of underserved communities.Les propositions visant à établir un permis d'exercice pancanadien pour les médecins bénéficient d'un large soutien de la part des groupes médicaux afin de remédier aux pénuries de médecins dans les communautés rurales mal desservies. Ce concept a également suscité des inquiétudes de la part de certaines parties prenantes qui craignent que sa mise en oeuvre n'aggrave les pénuries de médecins en milieu rural en provoquant l'exode de ces derniers vers les centres urbains. Une analyse environnementale des rapports des principaux groupes médicaux publiés au cours des dix dernières années a été effectuée pour déterminer les facteurs influençant les modes de pratique des médecins ruraux. Les données des enquêtes sur les membres de la Société de la médecine rurale du Canada et de l'Association médicale canadienne-menées à l'automne 2022-ont été examinées pour déterminer si le permis d'exercice est un facteur dans la décision des médecins ruraux de quitter ou de rester en pratique dans les régions rurales du Canada. Les facteurs contribuant à la décision des médecins de quitter la pratique rurale, identifiés dans l'analyse de l'environnement, comprenaient le manque de soutien en matière d'infrastructure, l'incapacité à trouver une couverture de suppléance, le soutien inadéquat des soins en équipe et les effets des charges de travail élevées sur le bien-être. Un thème commun ressorti des réponses aux enquêtes menées auprès des membres est la reconnaissance des restrictions en matière de permis d'exercice en tant qu'obstacles empêchant les médecins ruraux d'exercer dans plusieurs provinces ou territoires. Les répondants à l'enquête ont également exprimé leur soutien à la mise en place d'un système national de permis d'exercice. Le permis d'exercice pancanadien est une stratégie prometteuse pour améliorer le recrutement et la fidélisation des médecins dans les communautés rurales. Il pourrait également permettre aux médecins de travailler dans plusieurs administrations afin de répondre aux besoins en personnel de santé des communautés mal desservies.

The Carriage of Death: What Kind Does Canada Have?

Using a carriage of death metaphor, based on Emily Dickinson's poem "Because I Could Not Stop for Death", the authors highlight the development of the last 40 years of the Canadian legal landscape and end-of-life decision making. Beginning with the Canadian Criminal Code, moving through the Rodriguez decision and ending with the recent 2015 Carter decision, they explore how the evolution of time has influenced Canada's highest court. The authors conclude with an exploration of advance care directives and what we may expect as Canada continues its travels down this road.

Resource allocation decisions in Canada's health care system: can these decisions be challenged in a court of law.

This paper explores how the Canadian courts have responded to resource allocation decisions that have impacted on patients. While there have been few Canadian cases, those that exist fall into two categories. In the first part of the paper, we discuss recent cases that fall into the category of traditional negligence cases where a patient has been harmed and is seeking redress from the providers of care. What is emerging is that individual defendants, either physicians or institutions, are raising economic factors in their defence. The issue, we examine in this context is whether economic arguments can be successful in justifying the level of care that was provided and we conclude that, to date, courts have not been receptive to these arguments. The second part of the paper discusses those cases where patients have used legal arguments to try and change a governmental/policy decision, or to seek redress from harm caused by such a decision that has affected their access to care. In this context, patients have used principles of administrative law, constitutional law and tort law with varied degrees of success. We provide an analysis of these cases and conclude that it is difficult for patients to succeed when challenging allocation decisions at the policy level.