By BERNIE BELLAN As president of Doctors Manitoba for the past year, Dr. Michael Boroditsky maintained a high profile within the media, often being called upon to react to various issues, especially the pronounced shortage of doctors within Manitoba.
Doctors Manitoba is an advocacy group for the more than 4,000 physicians in Manitoba – both active and non-active, engaging in policy development. As Dr. Boroditsky, now the Past President of Doctors Manitoba, said, “We’re more of an advocacy group than a union.
“Our main mission is to strengthen and support doctors in Manitoba,” although not just in the area of “renumeration,”, he explained.
According to its website, Doctors Manitoba “advocates for our physicians, so that they can stay focused on providing exceptional care to Manitobans.
“We strive to work collaboratively with partners to help develop a better health care system for Manitobans. We work to improve health policy so patients have better access to physicians across Manitoba, and so physicians have the supports they need to meet their patients’ needs.
“We regularly connect with the provincial government, Shared Health, regional health authorities and other organizations to ensure the physicians’ voices are heard and have an impact on decision-making.”
On Thursday, May 23, Dr. Boroditsky, who started in practice 25 years ago as an obstetrician gynaecologist, spoke to over 40 attendees at the weekly Remis speakers luncheon group at the Gwen Secter Centre. The focus of his talk was the “physician shortage” in Manitoba.
Using a series of slides that showed graphs detailing just how much Manitoba has slid almost to the bottom of all Canadian provinces when it comes to the number of physicians per capita (only Prince Edward Island has a worse ratio), Dr. Boroditsky was candid in describing the challenges that Manitobans face when it comes to finding doctors.
While the total number of physicians in Manitoba has grown by 21% in Manitoba over the past 20 years, this is actually the lowest growth of any province. Dr. Boroditsky explained that growth hasn’t kept pace with the growth in Manitoba’s population, nor has the number of physicians here per 100,000 (215) kept pace with the national average, which is 247/100,000.
To give an idea how far Manitoba has fallen in terms of physicians per capita, in 2002, we had the fourth highest ratio of physicians/100,000 population, while in 2023 we had fallen to ninth. Manitoba needs 445 more doctors just to get to the Canadian average.
To add even more gloom to the picture, Dr. Boroditsky said that, in a 2023 poll of physicians here, to which one third of active physicians responded, 12% of physicians said they were likely to retire within the next three years; 14% said they were likely to leave Manitoba; and 26% said they were likely to reduce their hours.
He did offer a glimmer of hope though, when he said that preliminary results from the 2024 Annual Physician Survey showed a slight improvement with physicians intending to stay in practice here in Manitoba.
Dr. Boroditsky cited six different reasons that doctors gave in explaining why they were either thinking of retiring or leaving the province. They included: frustrated by the “system”; feeling “burned out” or “distressed:”; don’t feel “valued”; “personal reasons”; “red tape”; or too heavy a “workload”.
While “burnout and distress are still high,” Dr. Boroditsky observed, the situation is “improving.”
“We’re seeing a different tone in government.”
Yet, in another moment of candour, Dr. Boroditsky said, “News flash: It’s hard to recruit (physicians) here in Manitoba.”
When it comes to physician retention, he described the number of years a physician needs to put in before they can begin practising as a doctor (beginning with three years of pre-med studies): For a family physician – nine years; for a specialist – 12 years; and for someone who undertakes a fellowship – 15 years.
Dr. Boroditsky touched upon the area of immigrant doctors – and why doesn’t Manitoba allow more of them?
There are two types of International Medical Graduates (IMGs), he explained: Canadians who have gone overseas for their medical education, to such jurisdictions as Ireland or Australia; and physicians from abroad looking to relocate to Canada.
Until now, the Manitoba government has only offered 20 training spaces for IMGs each year, Dr. Boroditsky explained, but that figure will double to 40 this year. Unfortunately, we need to add 445 doctors here altogether even if we were just to meet the national average, so adding 20 more IMGs to the total isn’t enough on its own to fix the shortage.
Still, there was some good news in the area of physician retention. The average net gain in doctors in Manitoba over the past five years has been 60 a year, Dr. Boroditsky noted. Putting some more flesh on that figure, he said that, on average, 213 new doctors have begun practice here each of the past five years, but 153 have either retired or left the province. This year, however, of the UM medical school graduating class, 79 have committed to doing their residencies in Manitoba, he said. (Manitoba does not have mandatory residency requirements for graduating medical students, he added.)
Turning to other areas where there has been much-needed change to the system, Dr. Boroditsky noted that “cloud storage” now allows doctors anywhere in the province to access the results of blood tests and imaging sessions e.g., CAT scans, MRIs. The one crucial area that still remains to be accessible by doctors, however, remain “clinical notes,” but that’s coming, he predicted.
In the question and answer session that followed, I asked Dr. Boroditsky about a recent Maclean’s Magazine article which analyzed in some detail the dire state of the Canadian medical system. That article noted the increasing privatization of medical services, the proliferation of nurse practitioners in many areas where there are severe doctor shortages, and the advent of what is known as “virtual medicine,” especially in areas where patients find it difficult to see a doctor in person. (I had written an article about a service that began in Manitoba in 2022 known as QDoc, which describes how successful a foray into “virtual medicine” by two Winnipeggers, Dr. Norm Silver, and Dave Berkowits, had been. You can read that article at https://jewishpostandnews.ca/faqs/rokmicronews-fp-1/qdoc-a-new-venture-that-promises-to-change-the-way-patients-interact-with-doctors/)
I asked Dr. Boroditsky whether Doctors Manitoba had a problem with the expanded use of nurse practitioners and what he thought of virtual medicine?
He said there’s been a “significant increase” in nurse practitioners (who are allowed to see patients, diagnose and prescribe in certain limited areas) and fully agreed “that team-based care with providers working with physicians is the way to move forward.” As for “virtual medicine,” Dr. Boroditsky said, “its’ a game changer.”
It was toward the end of his talk that Dr. Boroditsky talked about the heightened antisemitism of which many Jewish doctors have expressed deep concern. His comments can be read in another article on our home page at https://jewishpostandnews.ca/faqs/rokmicronews-fp-1/jewish-physicians-in-manitoba-form-association-in-response-to-antisemitism/