The NWT is registering more doctors than ever. So why the shortage?

According to figures provided by the Northwest Territories’ medical licensing office, the number of doctors being registered to practise in the NWT has surged over the past 10 years.

While the territory’s population has remained relatively static for decades, with a population of 41,699 in 2002 and 45,602 as of October 2022, the number of doctors licensed to work in the NWT has skyrocketed.

In 2003, 236 doctors were registered, according to the professional licensing body of the territory’s Department of Health and Social Services. By 2013, that number had grown to 403.

As of July 20, 2023, 664 doctors are registered to work in the territory.

According to the licensing office, as many as 150 more are expected to complete their registration by the end of the year.

Not counting the additional 150, that’s already an increase of 166 percent since 2003. In comparison, the NWT’s population has grown nine percent.

So why is the territory continuing to report physician shortages?

Locum explosion

One explanation is simple: they aren’t here. At least, not most of the time.

Judging by numbers provided by the NWT’s health authority, it’s not resident doctor rates that are booming. It’s locum physicians.

Just 55 of the 664 doctors registered to work in the NWT actually live and work here.

596 of the remaining 609 registered physicians provide locum services, either on a regular or temporary basis.

These figures rarely appear in nationally distributed databases. Organizations that distribute healthcare data, such as the Canadian Institute for Health Information, exclude locum physicians that operate in the territories.

“The number of physicians per 100,000 population in the territories includes only those who reside in the territory,” the organization said in a statement on the release of its 2022 physician report. “If itinerant physicians were also included, this would provide a more comprehensive estimate of the total physician supply. CIHI has been working with the territorial governments to this end.”

To work in the NWT, all physicians must obtain the same licence. But the work they end up doing can be quite different.

“Contracts for locum physicians can be anywhere from weeks at a time to a few days,” said David Maguire, the health authority’s communications manager. 

According to Maguire, post-pandemic trends such as shorter locum commitments and higher nationwide demand have presented challenges, making it harder to secure long-term or consistent coverage.

“While we have many physicians registered to practise in the NWT, this is not a marker of actual capacity,” he said. “Our system depends on locum physicians to fill leaves, gaps in service, and for specialized services that are not offered on a full-time basis in the NWT.”

How do locums and resident doctors compare?

Speaking in the territory’s legislature this past March, Hay River South MLA Rocky Simpson questioned health minister Julie Green about the department’s use of locum physicians. He wondered whether they might be compromising care in his district.

“Has there been an assessment or a study completed to determine if there’s a gap in the quality of healthcare delivered by locums versus that of permanent physicians?” he asked.

“There has not been a specific quality review of locums versus resident doctors,” said Green in response. “They all have to obtain the same kind of licensing, so locums are not second-best to resident doctors – they have the same qualifications.

“With a vacancy rate of 45 percent for doctors throughout the NWT, most of us are seeing locums for our doctor needs.”

Data collected by the Harvard Business Review in 2017 found that locum physicians did not have a significant impact on mortality or readmission rates. But that study did find that locums created higher costs of care and longer lengths of stay for patients, which the review speculated may be attributed to a lack of familiarity with the work environment and local systems, leading to less efficient service.

A study published in the Royal Society of Medicine’s journal added: “Inefficiencies related to locum working included increased workload for the healthcare team if patients returned to their usual doctor after initially seeing a locum, resulting in duplication and waste of resources.”

Researchers also found that locums were less likely to be aware of the local context necessary to deliver safe, efficient and effective care.

In the NWT, resident healthcare workers have previously suggested locum staff are routinely prioritized by authorities.

“They’re treating locums significantly better than staff that have lived and worked here for years and provided to the North for years,” one nurse said, describing pandemic policies in a 2021 Cabin Radio report.

In the same report, nurses said new locum workers need longer to learn the territory’s medical system and see patients.

At the time, a spokesperson said Stanton has always needed locum nurses and doctors to cover vacancies, vacations, and services local staff are not able to deliver.