Yukonomist: The Yukon health system’s megaproblems are fixable – Part 2

This is Part 2 of a series. Last week’s column looked at surgery at Whitehorse General Hospital

You may be one of the thousands of Yukoners without a family doctor. The Yukon government’s “Find a primary care provider” waitlist webpage does not disclose how many people are on the waitlist, but the Yukon News reported in 2023 that the number was well over 3,000.

And that’s just people who have heard of the waiting list and signed up. Yesterday, the Yukon News obtained statistics from the Canadian Institute for Health Information that 22.5 percent of Yukoners aged 18 and over do not have a regular health care provider. If that percentage applies to people of all ages, that’s over 10,000 Yukoners.

If you do have a family doctor, you may have noticed appointments are hard to get. Your doctor may only be working in the clinic a few days a week.

The reason for this is that, the way the government has set up the incentives in our health system, being a family doctor is relatively unattractive compared to other jobs doctors can choose to do.

A good way to understand this is to look at two skilled trades that are in high demand across Canada: family doctors and electricians.

In both cases, it is common for the professional to operate as a small business, employing themselves plus some support staff.

When you call an independent electrician to your house, they might charge you $120 per hour in Whitehorse these days. A doctor might have four fifteen-minute appointments at the government rate of $56, which adds up to $224.

That’s double the electrician’s hourly take, which sounds great.

However, this is where it gets complicated and less attractive for the doctor. 

The doctor has student loans from at least eight years of university, while becoming an electrician takes half that long and much of that is during paid apprenticeships.

Then we get to the question of overhead. The Ontario College of Family Physicians estimates the average family doctor spends a shocking 19 hours per week on administration.

Can you imagine if we made electricians spend 19 hours on paperwork each week, before letting them get to the wiring around midday Wednesday? People would say that was nuts.

The electrician uses Quickbooks or a bookkeeper to quickly send you an invoice for time and materials. The doctor has to employ a finance specialist to navigate arcane government billing codes and processes. As reported in the Yukon media last year, there are persistent delays in the government paying doctor invoices; reportedly 90 days or longer in many cases. 

Try getting the electrician to come back for a second job if you are months late paying them.

Electricians can do business out of a van or small shop in a cheap part of town. Doctors need expensive office real estate with waiting areas, private rooms, and room for mounds of paper files. Doctors see more people per day than an electrician so need more schedulers. They must hire someone to weigh you and measure you before your appointment, then people to clean your germs out of the exam room. And so on.

Doctors must also keep your medical file up to date, and also coordinate follow up with your specialists and testing facilities. When I was diagnosed with cancer, my family doctor not only gave me great medical service but also acted as a full-time project manager dealing with all my testing and specialist complications. When your electrician rolls out of your driveway, they don’t need to think about your wiring again.

This is a simplified example. Doctors get paid additional amounts for other kinds of services. The government also has various programs to subsidize overhead costs.

However, one family doctor in town told me the overhead relief programs were so complicated that they required more overhead to manage the applications and reviews.

Meanwhile, a Whitehorse doctor can avoid all this by working in emergency or one of the many other medical contract jobs available. The family doctor I spoke to loved their patients and their practice, and felt it was important for a doctor in a small town to have a family practice. But they said they felt almost sheepish about working as a family doctor since it consumed so much of their time and contributed relatively little to their family income after overhead.

They said the rational thing would be to shut down the family practice and focus on emergency and specialist contracts.

This doctor is established and has personal connections to existing patients. A new doctor starting out would not, and would be less likely to go into family practice. That’s why a Yukon doctor survey mentioned in Dr. Kmet’s letter is so alarming. It indicated that 41 percent of the Yukon’s current family doctors “plan to close their practices in the next five years.” Dr. Kmet estimates 64 percent of patients in those practices could be left “orphaned” without a replacement doctor.

BC faces similar issues and, unlike the Yukon government, decided to take major action on the problem in 2022. It announced a new payment model for family doctors, raising the expected annual payments to a typical full-time family doctor to $385,000 from $250,000 (that’s revenue before overhead, not take-home pay).

It didn’t solve the problem but it made a big dent. A year later the BC government reported a 16.5 percent rise in the number of practicing family doctors.

Solving this megaproblem, and the Operating Room issue covered in Part 1, will not be cheap. But the Yukon government gets a gold-plated transfer payment from Ottawa. And it might seem that few things would be a higher priority for a territorial government. Yet if you scroll through the capital budget or Yukon government press releases, you will see many things the government apparently thinks are higher priorities.  

On October 3, the Yukon government announced plans to hire a consultant to do a study on the territory’s long-term health infrastructure needs. While this will eventually update Cornerstone’s findings, it may also mean that getting shovels in the ground building new ORs may have to wait until yet another consulting report is completed.

Until Yukon voters make it clear to their politicians that things need to change, things are likely to remain the same at the hospital and in your doctor’s office, if you have one.

Keith Halliday is a Yukon economist and the winner of the 2022 Canadian Community Newspaper Award for Outstanding Columnist. His most recent book Moonshadows, a Yukon-noir thriller, is available in Yukon bookstores.