Doctor retention needs focus in year ahead

It’s time for Manitoba’s annual check-up: the provincial government’s speech from the throne. Physicians watch closely because this is where government sets its priorities for improving health-care quality and access.

This year’s throne speech comes at the midpoint of a mandate built on a promise to fix health care. The government rightly began by focusing on recruiting the doctors, nurses and allied health providers Manitoba desperately needed after the pandemic and the years of restructuring and restraint that preceded it. We’ve seen real progress. Two years ago, Manitoba faced a record shortage of 445 physicians, an imbalance decades in the making. Today, that gap has shrunk to 246, far faster than experts predicted.

This success can be summed up in one word: collaboration. Government ensured that all key players — including physicians — had a role in rebuilding the workforce. Manitobans are now benefiting from that shared effort.

But recruitment is only half the story. While Manitoba leads the country in bringing new doctors in, it ranks near worst in keeping them. Independent data from the Canadian Institute for Health Information shows Manitoba loses more physicians to other provinces than we gain. Doctors Manitoba’s own monitoring suggests up to 710 physicians — about 21 per cent of the workforce — are considering retiring or relocating over the next three years. Among medical students and residents, only 60 per cent plan to stay after graduation.

Physicians overwhelmingly list the doctor shortage as their top concern. We want recruitment efforts to continue, but we also want government to prioritize retaining the doctors we already have.

Retention must be approached with the same collaborative spirit that is making recruitment successful. Fortunately, there is strong evidence about what keeps physicians working where they are, and much of it starts with addressing burnout.

Burnout, described by the World Health Organization as “chronic workplace stress,” is now affecting nearly half of Manitoba physicians. It is not a personal weakness; it reflects system pressures. Burnt-out doctors are two to three times more likely to leave practice. This is our clearest, early warning signal and the most actionable.

There are three immediate, cost-effective steps government can take in the year ahead to improve retention and tackle burnout: reduce paperwork, invest in team-based care and strengthen meaningful engagement with physicians.

Administrative burden is one of the leading drivers of burnout. Physicians report spending over 10 hours each week — essentially a full workday — on paperwork. Nearly half of that is unnecessary but still must be completed, diverting time away from patients.

Doctors Manitoba has supported solutions ranging from responsible AI scribe use to national initiatives to reduce insurance and federal paperwork. But provincial action is also needed.

The fastest step is to eliminate sick notes. These outdated HR tools do little to verify illness-related absences and consume thousands of unnecessary physician appointments each year. Eight other provinces have already taken action to limit sick notes. Manitoba could also prohibit insurers from requiring physician authorization for paramedical benefits — such as physiotherapy or massage therapy — a step taken elsewhere. Together, these changes could free up more than 300,000 physician visits annually.

Inside the health system, referrals and test requisitions remain trapped in an almost entirely fax-based workflow. Thousands of faxes are sent daily, many misdirected, incomplete or never received. Manitoba urgently needs digital tools that securely connect doctors’ electronic medical record systems and ensure patient referrals reliably reach the right test or specialist the first time.

The province made an important commitment during the election to invest $25 million to add 250 nurses, physician assistants and allied health providers to physician practices. This will expand clinic capacity, increase access for patients and reduce workload for physicians.

Other provinces are already investing heavily in team-based care, and Manitoba would be wise to catch up. Doing so would make community practices more sustainable and significantly improve retention. We hope to see a clear implementation plan for this election promise in the government’s agenda for the coming year.

One of the strongest predictors of burnout is whether physicians feel valued and heard. Today, only one-third of doctors say they have meaningful opportunities to provide input into system changes that affect their work, and only one in four feels valued by the health-care system overall.

Yet, when physicians are consulted early and treated as partners, burnout decreases and system performance improves. Doctors Manitoba has developed practical tools to support meaningful engagement, including mechanisms to seek physician feedback and regular reporting on progress. We hope to see government extend and deepen its engagement efforts across the health system this year.

You may have noticed one thing I haven’t emphasized at this moment: simply paying doctors more. Competitive compensation is important, but that alone will not solve the retention problem. Manitoba cannot afford to rely solely on financial incentives while ignoring the working conditions that are driving physicians away. The most urgent priority in the year ahead is to better support physicians in their work, meaningfully engage them in solutions and reduce the pressures that lead to burnout and relocation. These are the foundations of physician retention.

The year ahead is a critical window. Manitoba must act now to retain the physicians we have, before we lose the ground we’ve fought so hard together to gain.

Doctors Manitoba is ready to continue collaborating with government — just as we do on recruitment — to ensure Manitoba becomes a place where physicians choose not only to come, but to stay. Frontline physicians are no strangers to hard work.

We’re ready to do our part in tackling this challenge together.

Dr. Nichelle Desilets is president of Doctors Manitoba and a rural family physician practising in Neepawa.