How to Solve the Healthcare Staff Shortage to Prevent Disastrous Breakdowns
The eye-opening patient partnership program
With all due respect to my downstairs neighbor (aka USA), I think that life in Canada, and especially in Québec, is the best in North America.
No mass shootings, no divisive politics, no ex (and maybe future) president accused of 88 criminal charges, bilingual cities, rich culture, great winters, and free healthcare.
Who wouldn’t want to live here?!
Despite all these wonderful traits of living here, we are currently facing an important problem. We are on the edge of a healthcare crisis.
The problem is generalized in Canada, but I will mainly focus on my province because I know the current details best.
Québec is a very large province (2.3 times bigger than Texas). However, we are less populated. There are currently 8.5 million people living in Québec. In comparison, Texas has a population of 30 million. This means fewer people spread over a larger area, creating significant challenges for regions far from big cities like Montréal and Québec City.
The healthcare workforce shortage is so severe that many hospitals are shutting down their emergency departments at night due to a lack of nurses and medical personnel.
It’s shocking that a G7 country is closing parts of its hospitals due to insufficient staff.
Although I don’t work in a hospital, this crisis is currently affecting my job. I work at a non-profit crisis center and suicide hotline. We run a hotline and a shelter, working closely with the government healthcare network.
Try to imagine where they send mentally ill individuals when they can’t properly run their psychiatric divisions. Yup, to us.
Healthcare shortages mean that we have to take care of more people. But the staff shortage also affects us. So we have to do more with less. I know that this saying is very popular in finance, but in mental health services, doing more with less means doing less.
It means doing less because everybody quits or goes through burnout. This is a very emotionally demanding job, and when workers don’t feel that they can properly help others, they rapidly descend into despair.
As a future PhD student in public health, I searched for all the evidence that could make this situation better. I registered for a symposium about the healthcare workforce shortage. Here’s my key takeaway or this very insightfull day.
1. The origin of the healthcare workforce shortage
First of all, this crisis didn’t happen overnight. For decades now, politicians have watched the situation deteriorate, criticizing former ministers of health while continuing to shovel problems into the next minister’s backyard.
To address immediate needs, politicians have decided to hire health placement agencies to find healthcare staff to work in various regions. Typically, an agency offers nurses and healthcare professionals better salaries to work for a couple of months in different regions. Instead of working for $50 per hour, they can offer up to $150 per hour.
Needless to say, many healthcare staff saw a rightful opportunity to make money. However, in order to make money, the agency charges the government more than the employee’s salary. I’m no mathematician, but I can easily understand that the healthcare bill quickly tripled.
Unsurprisingly, we have arrived at the breaking point. The government now wants to get rid of agencies that act like parasites in the healthcare system. Let’s be honest, if an agency can find people to work, there’s no reason to think that the healthcare network couldn’t do the same thing.
Naturally, the agencies want to keep their (very high) revenue and are protesting. There are many stories of patients being transferred to another hospital four, five, or six hours away from their homes. Physicians are deploring the idea that they can no longer do basic medicine. They have to transfer patients who need basic rehydration by plane because they lack nurses.
Result: people are suffering the consequences of years of political inaction.
Oops.
It’s not just politicians we can point the finger at. As a society, we have trivialized and made invisible the importance and value of “care.” We have glorified precision medicine and forget about the essential work of nurses and beneficiary attendants.
Many healthcare workers are proclaiming to want a sense of purpose, to be performant and efficient, to be self-sufficient, and to preserve their life balance. In reality, they are faced with bureaucratization, no self-sufficiency, no time to do preventive care, and feel that they have to create an entrepreneurial identity.
Everything is about optimization and efficiency.
We forgot about caring.
2. Statistics on the current situation [1]
- 1/4 of vacant jobs in Québec are in the healthcare sector (62% have been active for more than 90 days)
- Increasing salary is not the solution. Despite raising salaries by 27% in the last four years, the staff shortage has never been this high.
- The health sector has the highest level of psychological demand in all industries
- The health sector has the lowest level of decision-making authority
- The health sector has the lowest level of perceived support from superiors
- After the education sector, the health sector has the lowest perceived level of job recognition
- After the education sector, the health sector has the highest level of psychological distress
Fair to say that the current situation in Québec’s health sector is not optimal.
3. Solutions to solve this alarming problem
Fortunately for me and my mental health, the symposium wasn’t just about how catastrophic the situation was. They also offered some advice and possible solutions.
These solutions fell into two categories: the obvious and the interesting.
The obvious solutions are the usual suspects: fostering benevolence at work, ensuring psychological well-being, reducing bureaucracy, promoting continuous learning, providing coaching, offering opportunities for advancement, and ensuring psychological and physical safety. Better induction and integration processes and not leaving employees to their own devices or blaming them when they start work also made the list.
Of course, we already know these solutions would improve the crisis. It’s not rocket science.
The interesting solution was unexpected. The best talk was from an expert patient, Vincent Dumez, who manages the patient-partner program at the Université de Montréal’s Faculty of Medicine. In short, he encourages people to rethink their usage of health services.
In a free healthcare system, people can literally go to the emergency room every day, and the hospital is obliged to see the patient in a reasonable time. The goal of the health minister is always to optimize how we offer health services to the population.
The main idea from Mr. Dumez was simple: why don’t we optimize the demand? Why don’t we massively invest in prevention and health education to help people take control of their health?
Here’s a perfect example of how absurd a free healthcare system can become. If an 80-year-old man has lung surgery to remove a tumor caused by smoking and continues to smoke after his surgery, he would be authorized to return to the hospital for complications and potentially another surgery.
The point I’m trying to make is not to remove free healthcare. This is one of the best foundations for a free society, and we must keep this at any cost.
However, there’s some irony.
According to Mr. Dumez, at some point in the care process, the patient or the patient’s family will become a caregiver. However, they’ll probably become a bad caregiver (to themselves or their family) since we don’t give them the tools as a society to be competent.
50% of North Americans have a chronic condition. 50% have little or no adherence to medical prescriptions. [2]
The irony is becoming clear.
The proposition is that hospitals should also become environments to learn for the patient. We should invest massively in prevention. The patient has an essential role in this healthcare staff crisis.
4. My reactions to this day
I couldn’t help feeling that this day was slightly ironic.
During the symposium, speakers repeatedly said that we have all the solutions. They told us that it is now time to act.
I was sitting in the beautiful glass tower, with important people, learning about the solutions that we already have and that we don’t implement.
Fair to say that I felt uncomfortable.
But the revelation of the patient-partner program made it worth it. We must improve the way we teach about health. We must make our healthcare sector an education sector as well. And most importantly, we must massively invest in prevention.
We, current or future patients, must take responsibility and play this vital role to stop our healthcare sector from collapsing.
About me
Thank you for reading and commenting!
I’m a master’s student in epidemiology at the Université de Montréal and a part-time counselor at a suicide hotline. My research focuses on suicide, mental health, and cannabis.
Here’s another of my stories:
