Canadian physicians suffering a Promethean fate

A 4.5 metre wooden trojan horse has been touring Ontario as an imposing backdrop for a series of public meetings conducted by the Ontario Health Coalition (OHC) who are speaking out against physicians in privately run clinics providing more surgeries and diagnostic tests using public funding. The OHC is implying that public healthcare is being attacked by stealth. But the realities in our collapsed public healthcare system are plain to see. There is no stealth attack, rather a stark reality of the challenges of meeting healthcare demand for a growing and aging population with a system designed for the young and healthy over 60 years ago. Time has moved on, and medical needs are outpacing the ability of state-run healthcare bureaucracies to keep up.Instead of a trojan horse with its hidden soldiers, I suggest a more compelling Greek mythology image for Canadian healthcare is that of Prometheus chained to a rock. We live in a time and age when physicians looking for new ways to deliver healthcare services are often being punished by the powers that be for their ingenuity and drive to serve a greater number of patients. Read: Dr. Merrilee Fullerton: Complexity in Canada’s failing monopoly healthcare: Is it fixable?Our most valuable resources in healthcare are the people, the professionals who provide the care. They make the system work. Obviously, healthcare infrastructure is needed but without the people, it can’t function. Being chained to an inflexible healthcare system isn’t a productive existence. We need our healthcare providers to be innovative and adaptable, to be free to develop new ways to provide the services they are trained to give. Instead, physicians—especially family doctors—are being restrained and punished for their pursuits of greater efficiencies and effectiveness. Truly, they are the Promethean tragi-heroes of our day. In Ontario, a family doctor in Kingston, Ont. received the Ontario College of Family Physicians’ Award of Excellence in 2021, partly because of her efforts to organize vaccination clinics during the height of the COVID-19 pandemic. Approximately a year later, the doctor was given notice that OHIP planned to recoup the money she had billed, with interest, since she was not allowed to delegate tasks outside her office and without written approval based on a bulletin from 20 years ago. At a time when all Ontarians were being urged to get their vaccinations, this physician organized others to help with a drive-thru COVID-19 vaccination clinic that served thousands of people. For her extraordinary effort she was recognized and celebrated. But now that the services have been provided to individuals and families who wanted the vaccinations, the bureaucracy’s focus is on recovering costs.In Quebec, the recent proposal to reserve family doctors for vulnerable patients leaving healthy patients to fend for themselves was met with derision, for good reason. The Quebec premier then doubled down (on a related matter), saying his government is considering using the notwithstanding clause to force doctors trained in Quebec to stay. He is reported to have said, “We’re short of doctors. The doctors we train at taxpayers’ expense must practice in Quebec.” He concluded that the government would have to use the notwithstanding clause to override section 15 of the Canadian Charter of Rights and Freedoms. This is how far Canadian healthcare has fallen in that province. What other group of health professionals is treated in this Draconian way? What other professional group of any kind is treated this way in Canada? Not one. Our single-payer system limits care that could be provided and is falling woefully behind in its ability to meet demand due to financial realities impacting Canada’s human health resources especially physicians. The effect on access to care is significant—including in the emergency room of hospitals. Unfortunately, politicians are wedging themselves in the middle of the muddle. This does not help matters. In Healthy Debate from Nov 6, 2024, “Patients, not politicians, decide what is an emergency,” Drs. Alan Drummond and Raghu Venugopal decry the efforts of Ontario Premier Doug Ford to encourage people to go to their family doctor first instead of going to the emergency department. The Canadian Association of Emergency Physicians contributed that: “ED crowding is due to hospital crowding and the inability to move admitted patients to the floors” not due to “low acuity visits.” The OMA reminded Ontarians that patients should not feel discouraged from seeking help “when and where they need it.” The reality is that it is getting harder and harder for patients to find the care they need.The Canadian Institute of Health Information in its February 2024 report, “The State of the Health Workforce in Canada, 2022,” confirmed a national shortage of 60,000 registered nurses and an anticipated shortage of 78,000 doctors by 2031, and a shortage of 117,600 nurses by 2030. In CIHI’s release from Nov. 7, “National Health Expenditure Trends, 2024,” Canada is expected to reach a new high in healthcare spending in 2024 with total health spending expected to hit $372 billion or $9,054 per Canadian and the Canadian dental and pharmacare plans are likely to result in even higher levels of healthcare spending. Even with billions more in spending, our current system can’t keep up, not with human resources, and not with health infrastructure.In the C.D. Howe Institute report, “Another Day Older and Deeper in Debt: Fiscal Implications of Demographic Change for Canadian Governments,” a financial shortfall for Canada’s healthcare system is estimated at $2 trillion with healthcare costs as a percentage of GDP expected to double by 2067. In the Ontario Hospital Association’s recent publication in conjunction with the Dalla Lana School of Public Health, “Projected patterns of illness in Ontario,” the number of people living with major illnesses is reported to have doubled in the past 20 years and by 2040 it is expected that 3.1 million people will be living with major illness in Ontario alone, more than tripling from 2002. It reports that the number of seniors aged 65 to 85 and 85 and older will reach unprecedented highs in the coming decades as the Baby Boomer cohort ages and that multimorbidity is also rising, a major driver of health service utilization. Shortages of healthcare professionals, a shortfall of trillions of dollars, and an older, ailing population—we are living in a perfect storm, and the clouds are growing darker on the horizon. None of this information should come as a surprise to anyone who follows healthcare policy. However, the takeaway message must be that we need to move on from trojan horse fearmongering about necessary change. We must also move on from punishing Promethean physicians for their industry, ingenuity and service to patients. We have a volume problem that is beyond the current healthcare system’s ability to address. Physicians have solutions, if only the powers that be would listen.While artificial intelligence holds promise for improved care and treatments, it is far from being a solution to replace physicians and we can expect upfront costs from research and implementation to be another cost, at least in part, to government. In Psychology Today, “The Cognitive Disconnect Between Physicians and AI,” it is reported that simply providing physicians with access to an advanced AI tool does not guarantee enhanced performance. Deeper complexities in the collaboration between humans and AI exist with trust being a significant factor. More than ever before, new ways of approaching Canada’s healthcare volume problem require the ingenuity of physicians and others who understand the significance of the patient-physician relationship—with or without AI. According to data from SecondStreet, 47% of Canadians have avoided visiting a healthcare provider because they don’t want to face “overwhelming wait times.” SecondStreet president Colin Craig commented on data from the survey conducted by Leger in October showing that the majority of respondents, 61%, said that: “Canada should keep its government-run system but also allow patients to pay at local private clinics if the public service cannot deliver timely care.”Of course, Craig is right in his observation, if only the powers that be and well-meaning groups like the OHC could look beyond their limiting notions of our current healthcare system. Having Canada’s single-payer healthcare system ably meet the demands of our country’s growing and aging population is mythology. Other countries provide better access to care at lower costs within universal healthcare systems. Canada could learn from them.Today Canada’s healthcare system is in crisis even with record spending by provinces. Meaningful reforms are needed that can help build Canadians’ confidence that access to care will be there when and where it is needed. The top-down bullying approach to addressing healthcare demand hasn’t worked in the past and won’t work now. The ingenuity of physicians is what is needed. We need to unchain Prometheus.Dr. Merrilee Fullerton is an Ottawa physician and former MPP for Ontario from 2018 to 2023. Dr. Fullerton’s book “A Physician in the Political Arena” can be read here. This item originally appeared on her substack blog site.

Canadian physicians suffering a Promethean fate

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