Funding inequity leads to difficulty in health recruiting

While some inroads have been made in recruiting Aboriginal health care workers to First Nations communities, a great need for physicians, dentists, diagnostic technicians and a host of other practitioners remains. With only three First Nations communities in Alberta serviced by Indigenous physicians, Saddle Lake, Siksika and Fort Chipewyan, there is a pressing need to recruit more Aboriginal physicians, said Dr. James Makokis, who recently returned to Saddle Lake to practice.

Despite the 1999 recommendation  from the Report of the Royal Commission on Aboriginal Peoples to train 10,000 health professionals over a 10-year period, a shortage of health care workers remains.

“We need an increased number in every single field,” said Makokis, a board member of the Indigenous Physicians Association of Canada.

The biggest hurdle is the inability to recruit and retain physicians in Aboriginal communities.

“Only a handful of those who graduate from the University of Alberta Aboriginal medical program return to the community,” said Makokis. Yet it is important that Aboriginal physicians come from the community culture. “They understand the complex social dynamics of the community. If patients have a certain amount of trust, comfort and safety, they are likely to come back and share information about health.”

Another factor drawing physicians away from reserves is incentives and bonuses.

“Off reserve positions for physicians offer incentives, recruitment and retention bonuses, housing, opportunities for spousal employment and other benefits,” said Makokis.

Evelyn Johnston, health director, Health and Wellness, at Saddle Lake Cree Nation agrees. “We need to be competitive in salaries. We are competing with oil companies able to pay a better rate,” she said.

Johnston has noticed a decrease in community health representatives, those who work with different clinics in diabetes, home care, and home support.  Nevertheless, with the increased number of role models, Johnston says, more young people are encouraged.

Tyler White, CEO of Siksika Health Services, agrees. “It is extremely important to have our own First Nations people in those key positions. Building capacity is a top priority for our organization.”

He, too, believes the cultural component is important, as well as an understanding of the area and the trust and confidence Aboriginals have in their own people. Encouraged by the growing trend, White said, “We are seeing more and more of our own people.”

White says the great partnerships they have with Alberta Health Services and Health Canada through student placements and practicuum, particularly in nursing, expose both First Nations and non-First Nations practitioners to Aboriginal health care.

He believes more physicians and nurses would be helpful, as well as practitioners in emerging fields like diagnostics and specialty fields, particularly,  dentistry and optometry.

Although post-secondary institutions hold a certain number of places for Aboriginal students, the recruitment problem persists.  Makokis attritubes the limited options to structural inequities in funding between First Nations and provincial school systems. As a result of less funding on reserve Aboriginal students fall short in the sciences and math, he says.

 “The level of funding on reserve schools is 50 per cent of provincial schools, resulting in fewer labs in science and chemistry. Low high school completion as a result of racism and trauma from residential schools, diseases manifesting as a result, and different social issues,” said Makokis.

For Makokis the biggest problem is the lack of funding on reserves.

“Funding for First Nations is substantially less for reserves resulting in more health inequities, more disease, and more deaths. With less resources, it is difficult to come to any sort of equity when there is so much inequity to begin with,” he said.