Issue link: http://clhia.uberflip.com/i/354914
12 a vibrant private sector involvement in this market, it is important that no undue barriers to entry be created and that governments resist the temptation to apply price or cost controls on private facilities. That being said, there is a critical role for regulation and supervision of the quality of care delivered at all stages of the long-term care continuum in both public and private facilities. Patient safety must not be sacrificed. We fully support appropriate regulation of the long-term care market and, in particular, that adequate resources be put into supervision of long-term care providers. Health Care Practitioner Shortage There is a shortage of health care practitioners - physicians, nurses, physiotherapists, nutritionists, chiropractors, etc. - that work in the area of geriatrics. For example, there are currently about 200 geriatric medicine specialists practicing in Canada. 27 In contrast, Sweden with a population less than one-third the size of Canada's has 500 geriatricians. 28 The shortage is set to intensify over the coming years. Indeed, the number of internal medicine residents entering geriatric medicine programs has decreased dramatically over the last 10 years. The Canadian Geriatric Society reports that in 2007 there were only five trainees in English-speaking programs for the entire country. Similarly, care of the elderly family medicine training programs have many vacancies. 29 In contrast to the U.S., Canadian specialists in geriatric medicine do not provide primary care. They act as a short-term resource to primary care physicians, and health care teams in the community, in hospitals and in long-term care facilities. To fully address Canada's serious shortage of geriatrics health professionals, action is required to attract more practitioners, including younger practitioners, to enter the field of geriatric medicine. This plan must be supported by federal and provincial stakeholders and it will require resources to ensure successful implementation. Another issue discouraging physicians from entering geriatrics is remuneration practices. The standard fee-for-service billing system financially penalizes geriatricians compared to other specialists because geriatricians tend to take more time with each patient to look at the often multiple issues facing a patient in a more holistic and interdisciplinary way. It is important that compensation for physicians working with seniors be comparable to those working in other disciplines. In addition to the physician shortage, there is a looming nursing shortage, particularly in the geriatric specialty. For example, the number of registered nurses that work within the area of geriatrics/long- term care decreased by 3.5 per cent between 2006 and 2010. 30 As a result, as the need for nurses 27 Canadian Medical Association. Specialty Profile: Geriatric Medicine. 28 UofT Magazine. Care for the Aged. Summer 2009. Dr. Barry Goldlist, Director of geriatric medicine, University of Toronto. 29 Special Senate Committee on Aging Final Report. Canada's Aging Population: Seizing the Opportunity. April 2009. 30 Canadian Institute for Health Information. Regulated Nurses: Canadian Trends, 2006 to 2010. January 2012.