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VANCOUVER — Doctors’ walkouts in British Columbia and discontent among physicians across Canada point to critical problems that will lead to a severe doctors’ shortage if current trends continue, say medical officials.

“We have fewer physicians per capita in Canada than almost any other industrialized country right now,” said Dr. Peter Barrett, president of the Canadian Medical Association.

Barrett said there are fewer doctors now partly because of a 10 per cent reduction in medical school enrolment that was imposed across the country in 1993.

Dr. David Hawkins, executive director of the Association of Canadian Medical Colleges, said there were 1,599 medical school graduates last year, down from a peak of 1,835 in 1985.

All provinces — except British Columbia — have recently increased enrolment, but not enough to meet demand, Hawkins said.

He said Canada ideally needs 2,500 new graduates a year but even if medical schools could increase enrolment to that figure immediately, it would be years before those doctors are practising.

Hawkins said that although Canada has traditionally attracted doctors from South Africa, Britain and Australia, more of them are going to the U.S. for better pay and working conditions.

But other factors also account for the lack of physicians.

They include federal government barriers that have prevented foreign-trained doctors from practising in Canada and an exodus of Canadian doctors to the United States.

According to a recent Statistics Canada study, 19 doctors emigrate to the U.S. for every one American doctor who comes here.

Fewer doctors, combined with the lack of nurses, will further erode a medical system already in trouble, Hawkins said.

According to the Canadian Medical Association, the national shortage of doctors is especially worrisome for rural communities, which must deal with one-third less family doctors per capita than urban areas.

The association says the number of rural physicians has decreased by 15 per cent since 1994, while the population in those areas has increased by four per cent.

Doctors in all provinces are dealing with tremendous pressures, Hawkins said.

In B.C., rural doctors have been withdrawing services since June to protest long on-call hours and lack of funding to retain and recruit physicians.

Doctors in at least 14 rural communities are currently off the job and the list is expected to grow.

In June, the B.C. government offered doctors in Prince George, B.C., a $10-million settlement package to return to work.

That was quickly followed by another deal with doctors in nearby Williams Lake, B.C., who received $1.7 million.

The two deals sparked a chain reaction of doctors’ walkouts in other communities, which demanded similar offers.

Dr. Margaret MacDiarmid of Trail, B.C., where 50 specialists and family doctors are off the job, said rural physicians have been scrambling to provide adequate care to patients as their colleagues are leaving for better working conditions elsewhere.

She said the region’s only kidney specialist has announced he is leaving for a bigger centre where he will no longer have to be on call 365 days a year.

The community’s only plastic surgeon, originally from South Africa, is expected to leave for a position in Chicago, she said.

“The implications are huge” when one specialist leaves a small community, MacDiarmid said.

Withdrawing services was a last resort for frustrated doctors because the action means patients have had to be “shipped all over the place,” she said.

Earlier this week, the B.C. government approved a $40-million settlement package for rural doctors, who had already rejected the offer because they want a deal similar to what’s already been negotiated in Prince George.

Doctors say $40 million isn’t enough money for up to 49 health regions across the province to dole out and that more of them will seek better jobs elsewhere.

And they say even a $250-million cash injection by the B.C. government last week for hospital equipment won’t do much if there aren’t enough doctors to serve a community.

They also say the money will be used to cover current and projected deficits and will have little impact on patient care.

Mike Farnworth, B.C.’s health minister, said he’s prepared to go to mediation to settle the ongoing dispute.

“We clearly don’t have enough physicians in the rural parts of the province, and that’s not a situation unique to B.C., it’s all across the country,” Farnworth said.

He said he wants to compare the $40-million package to what doctors in other provinces are making, despite the fact that doctors want the Prince George deal as a benchmark.

“We do have the second highest paid physicians in B.C., after Ontario,” he said.

Dr. John Cairns, dean of medicine at the University of B.C., said the province’s only medical school enrols only 120 students a year, half of what every other province takes in per capita.

“Currently we have to find about 75 per cent of the physicians for practise in B.C. in other provinces and other countries,” Cairns said.

“There’s no other province that’s anything like this in terms of the approach that’s taken.”

Cairns said the government has agreed to provide more funding to increase enrolment by September 2001 but so far hasn’t committed any funds.

“The province will descend into even more turmoil in the medical part of the health-care system” if it doesn’t become more self-sufficient by producing more of its own doctors, he said.

If B.C. doctors have it tough, their colleagues in the Maritimes have it even harder, said Dr. Bill Goodine, immediate past president of the New Brunswick Medical Society.

Goodine said the lack of doctors, pay levels and workload in that province means its health care is in a “state of crisis.”

He said most of New Brunswick’s family doctors staged a one-day walkout last week to protest increasing workloads.

Family physicians also said they will no longer fill out paperwork for patients who want drugs that aren’t approved by the province.

Instead, the family doctors said that starting Oct. 2, they’ll only write down the name of the prescription drug for patients and leave it to pharmacists and the province to sort out payment.

“The issues are that our doctors see more patients, as in more work hours, than most doctors in the country,” said a frustrated Goodine.

He said New Brunswick doctors have been without a contract since last January and have asked for a 30 per cent increase.

The Tories have offered doctors a 1.5 per cent wage hike over three years, Goodine said.