The government’s latest health-care reform has lots of pieces that may fail or simply enrage its critics. The elements of Bill 60, the Your Health Act that are most likely to still be causing the Tories political problems at the next election are undoubtedly the decision to spend public money to deliver care through private health-care clinics and the various pieces of legal scaffolding that help support that decision. But those aren’t the only important things that Bill 60 does — and, precisely because they’re so politically contentious, it’s possible they won’t outlast the next election.
Another important part of Bill 60 is the government’s decision to start recognizing the credentials of health-care workers in other provinces. This is not a novel idea. Fifteen years ago, the Liberal government under Dalton McGuinty pledged to “fast track, simplify and streamline the registration process for doctors already practicing elsewhere in Canada.” Three premiers of two different parties have so far failed to make that happen.
The hold-up is that, strictly speaking, the government doesn’t license medical professionals in Ontario. Rather, the legislature grants the legal monopoly for licensing medical professionals to medical colleges, which in turn determine who’s qualified to practice medicine and who isn’t. Then, for good measure, the province makes it illegal to claim to be a doctor, dentist, nurse, or homeopath (yes, we license homeopaths) if you haven’t been properly licensed. This isn’t unique to Ontario — the same basic structure applies both in other provinces and at the state level in the United States.
But with Bill 60, that’s going to change: while, for example, Ontario’s laws currently define a doctor solely as someone accredited by the College of Physicians and Surgeons of Ontario, the proposed law from Health Minister Sylvia Jones would allow the government to add to that definition by regulation, meaning the minister of health could declare that anyone licensed by the medical colleges in Canada’s other provinces or territories is automatically licensed to practice here.
The reason for the change has to do with the widely held perception among policymakers — both under the Liberals then and the Tories now — that the medical colleges have little incentive to make it easier to become a health-care worker in the province, as doing so would dilute their own bargaining power. While there’s undeniably been work done to make the process for accrediting out-of-province workers easier, the changes in Bill 60 will simply make an end-run around the colleges and their privileges. That’s the kind of thing a government does only if it thinks the record has been pretty dismal.
Of course, just because everyone believes something to be true doesn’t make it so, and it’s possible that opening up Ontario’s health-care sector to anyone licensed in another province, from sea to sea to sea, will actually pay pretty marginal dividends. (If nothing else, plenty of nurses will have second thoughts about paying GTA housing costs unless the pay premium for moving here is very generous.) This would be kind of amusing simply because it would disprove something that’s been taken as a given for years now at Queen’s Park.
Things get more interesting, however, if the government is right and this reform actually works — because there’s still only a finite number of health-care workers in the country, and nowhere in Canada would say they’ve got more than enough right now. Ontario, meanwhile, has both a very large population (larger than every other province except Quebec, combined) and one that’s approaching a point of rapidly escalating health-care needs as it ages. That’s a heck of an enticing market for health-care workers, including and especially those who might be looking for somewhere they can build a longer-term career — precisely the people that other provinces are banking on to keep their systems functioning as older workers retire.
So what happens when Ontario officially fires the gun that Bill 60 represents and lets anyone trained from British Columbia to Nova Scotia work here? Back in 1992, a U.S. presidential candidate famously described the effect NAFTA would have on American jobs as a “giant sucking sound,” and it’s not hard to see how Bill 60 could do the same with HCWs across Canada, not least because the government is simultaneously pushing more procedures into private clinics, where wages won’t be constrained by laws restricting public-sector pay increases.
For Ontario, this would represent the plan working as intended: we could reinforce a health-care sector that’s been badly depleted of needed workers. For the rest of the country … not so much. Other provinces could implement their own policies to retain workers (or poach Ontario workers back), but a bidding war between the provinces could quickly get expensive and create acrimony among the premiers.
A chaotic scramble for health-care workers is the kind of thing that could end with pleas for the federal government to step in and negotiate a ceasefire. It’s not a job any prime minister would want — the provinces’ jurisdiction over health care is sacrosanct, and there’s little Ottawa could do except offer even more money than it is offering already. Which just means that this week’s news of a $74 billion, 10-year deal between the feds and Ontario may not be the last time the federal Parliament is asked to get its chequebook.
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