Mr. Speaker, I would like to talk about a few things generic to the north and will basically build on what the Secretary of State has said. I want to emphasize the problems that we have in rural areas.
I agree with a lot of the suggestions the minister has related to in serving rural areas because some of our problems are different. One of the main problems is the recruitment of health care professionals for the north, doctors, nurses and other specialists. I have mentioned this in the House and I have worked with the Yukon Medical Association to try to come up with ideas and plans as to how we might deal with that problem.
The Yukon Medical Association believes that all the elements in the Canada Health Act are threatened with the present pressures on health care system in the north. Accessibility, comprehensiveness and universality means something different to a northern resident. If the residents in the north expect to have the same advantage as the majority of Canadians, then some changes in how we train health care professionals and deliver the services have to occur.
The fragile nature of recruitment and retention of medical and other health care professionals puts the system under growing stress. Uncertain financial sustainability, new technologies, increasing expectations of patients and greater difficulty in accessing the specialized medical care outside Yukon add to this stress.
Yukon has a population of 30,000, for which we have about 45 physicians and a number of extended role nurses for carrying on their rural needs. Over the past four years, we have had a turnover of 24 physicians, or more than 50% of our physician population. Fifty per cent of our physicians are over 50 years of age, thus our turnover will continue to be high. Many of the physicians who left were very talented and over the years developed many skills to assist them in the delivery of medical care specific to the needs of the north. We have encountered a special difficulty in replacing these skilled physicians.
The medical needs of the north are unique and the skills and training required to provide for these needs are much broader than in the south. It would indeed be difficult to bring physicians from larger communities in the south and expect them to be comfortable quickly with family or specialty practice in the north. In fact we tend to recruit from a very small pool of physicians, the same physicians who would go to northern Ontario or rural B.C. Yukon does not have the funds to compete with most provincial jurisdictions when recruiting for medical talent. As well, many larger jurisdictions develop their own recruitment initiatives that they hope will give them an edge in attracting physicians to their areas.
Physicians for very small northern communities are especially hard to recruit. Frequently, the population base does not support the number of physicians necessary to allow a high quality of professional and personal life.
Governments have been slow to recognize the measures necessary to support physicians in smaller communities. Flexible primary care delivery models that enhance a physician's ability to both care for his or her patients and himself or herself are necessary. These programs frequently have to be tailored to the individual northern communities.
New technologies include everything from new treatments and cures for cancer, treatments of the unborn baby, brain implants that cure blindness, mechanical hearts, ears, joints, cloning, et cetera.
Patient expectations are creating major pressures on our health care resources. With the increase to direct patient advertising, medical websites, designer drugs and sensationalized medical miracles, physicians and other health care providers are under increasing pressure to try to meet escalating patient demands.
Patients are much more sophisticated about their health care needs and are becoming more directive about their care. They understand to a much greater degree the differences between various medical investigations and treatment options. With this sophistication comes an expectation by many patients that they have access on demand to outside specialists and advanced technologies at the expense of the local government.
Yukon, like most other isolated areas, does not have easy access to a lot of the most basic investigations and treatments, let alone cutting edge technologies. These treatments and investigations will be very expensive, probably far more expensive than most publicly administered health programs will be able to afford, should they be available at all. Should Canadians be allowed to access them in Canada under any circumstances? Will our only chance to access them be by leaving the country? This is what northerners are asking themselves.
Yukon has a small population. This has important implications when it comes to decisions on what health care services and technology should be available in Yukon, particularly if we are concerned about having an efficient and effective health care system. Specifically it means we must consider the population base, skills and support services that are required to acquire and maintain advanced technologies and services such as CT scans, cardiac stress testing, MRI scanners, hip replacement surgery, organ donation programs, full time internists, TB laboratory services, renal dialysis, autologous blood banking, et cetera.
The list can be endless. We can fall into some expensive and inefficient programs in response to pressures from various groups with a special interest in one disease or another. On the other hand, there may be some compelling reasons to provide some of these services in Yukon and avoid the need for travel to outside centres. It is clear that Alberta and British Columbia do not make decisions about their health care system with the needs of Yukon in mind. We must develop a plan to determine which of these services should be publicly available in Yukon, which should be readily accessible referrals outside Yukon, and ensure these services will be available when they are needed.
The medical association has some ideas and options as to what we might do to improve the recruitment in the northern and rural areas. First, it suggests that we form a board of relevant stakeholders to determine the physician resource needs and develop initiatives tailored to the recruitment and retention of needed specialists and family physicians.
Second, as a government we should acknowledge that the recruitment and retention of health care professionals in the north is difficult and offer enhanced funding to allow northern jurisdictions to compete for these skilled health care professionals.
Third, we should support the funding of training for northern specialists and health care practitioners to enhance their skills in training centres to the south. A lot of this training is not in the north and it is expensive to get out to them. These skills can be brought back to the territory.
Fourth, we must recognize that some isolated communities do not have sufficient populations to support the number of physicians necessary to provide a sustainable service. The alternate funding models and tailored primary care delivery models that enhance professional and personal quality of life must be recognized as necessary.
Fifth, we must develop guidelines as to what is affordable and what can be handled and delivered in Yukon.
Sixth, a board should be established to develop a plan to determine which technologies should be publicly available and which should be readily accessible and available by referral outside Yukon.
Seventh, the government in conjunction with the local governments should develop guidelines for reasonable access to advanced technologies with a specific view on how isolated, northern and first nation communities can access them in a timely fashion.
Finally, the local government should negotiate with individual hospitals, the private sector and other provinces for assurances of access to the necessary medical facilities, technologies and specialty services outside Yukon.
Certain things will be affordable and certain things that are not as essential or urgent will have to have a lower priority. One thing that is not negotiable is the length of the waiting lists. These must be cut down when life is at risk. It is intolerable for a person to wait for either a diagnosis or required surgery. I have had people come to me in relation to knee surgery saying it has taken far too long to get on the list and similarly in cases where there has been a diagnosis of a cancer. The longer one waits the more dangerous the situation becomes.
In the north we are totally different compared to the rest of the country in that we are sort of held hostage to southern systems. We do not have the major surgical or technical equipment and we must Medivac people at great expense to Alberta or British Columbia. Of course, this upsets their system. There is no organized guaranteed time that we have in those systems. I am hoping that as we review the system and fix it we will be able to determine some sort of system, either by purchasing time or some guaranteed schedule, so that Yukoners can have access to southern hospitals and specialists and can be guaranteed that in their times of need.