Ontario has not met its goal of having the right number, mix and distribution of health-care professionals to meet its needs, Auditor General Bonnie Lysyk said in her 2013 annual report released this week.
This is despite $3.5 billion being spent on the government’s HealthForceOntario Strategy over the last six years.
The lion’s share of these expenditures have been on physician and nursing initiatives. Of the almost $740 million spent on the strategy in 2012-13, $505 million went to physician programs and $151 million was for nursing programs.
This is not to say that Ontario has not made progress in adding more doctors and nurses to the workforce. Ms. Lysyk noted that between 2005 and 2012 Ontario added 18 per cent more physicians and 10 per cent more nurses.
But she expressed concern that a significant number of new doctors are leaving the province, and many rural hospitals are permanently reliant on locum services to keep services going even though this is meant as only a temporary measure.
“It costs the province $780,000 on average to train a medical specialist, including up to five years of postgraduate residency training. But about a third of Ontario-funded graduates with surgical special¬ties—neurosurgeons and cardiac, orthopaedic, paediatric and general surgeons—don’t stay and practise here,” Ms. Lysyk said in a news release.
The report also included a follow-up of value-for-money audits on alternative funding arrangements for physicians. These were the subject of a highly critical report by the previous Auditor General in 2011.
That report found that family physicians were making millions of dollars in capitation fees without always making good on promised services such as after-hours care. It also revealed that the health ministry did not have a handle on the alternate funding it was providing to specialists.
Two years later, Ms. Lysyk said the ministry has made some progress in implementing recommendations in the 2011 report but it remains a work in progress “such as monitoring the frequency and nature of physician services provided to patients, tracking the average amount paid to a family physician participating in an alternate funding arrangement, reviewing the impact of enrolment size on patient access to care, and reviewing the impact of existing financial incen¬tives on hard-to-care-for patients.”
For specialists, Ms. Lysyk said incorporating performance measures into contracts will depend on future negotiations with the Ontario Medical Association.
The Auditor General’s report also surfaced a lack of coordination within the hospital rehabilitation system, an inconsistency in land ambulance services across the province, and a general failure of the province’s Health Schools Strategy. Many students are spurning healthier food choices in schools and heading for fast-food joints instead. The report can be found at www.auditor.on.ca/en/reports_2013_en.htm. HE
