Editorial: The Beginnings & Endings Issue

When walking through the hospital, there is a unified sense of exasperation toward an overburdened healthcare system. This permeates through all departments, all employees. That scares me.Those are the words of a new-to-practice family doctor in one of this issue’s articles where physicians at the beginnings and endings of their careers talk about their hopes and fears. We know that we’re facing crises in health human resources and access to care, so it is sad but understandable that so many newly minted physicians are expressing these concerns. “I’m fearful for a system that isn’t capable of caring for a co-morbid aging population,” said another. We end the pandemic a nation that just hit a population of 40 million this past summer. In Canada, we deliver healthcare primarily through 13 provincial and territorial healthcare insurance plans—and yet doctors from all parts of the country are seeing a healthcare system that is struggling. So we know it isn’t as simple as the “politicians in my province are dummies.” Many people will tell you that the system is underfunded. But health spending in this country is about 12% of Canada’s gross domestic product, which is roughly in line with other rich nations (the U.S., of course, is an outlier and spends a high percentage of GDP on healthcare).In Canada, we have an aging population, so we surely do need more money in healthcare, but this is a holistic problem that requires innovation and new thinking about how the healthcare system operates and what it delivers. Patients at the beginning and at the end of life are often the most vulnerable to a sputtering system. We have created a special section on births and deaths with articles about physicians caring for patients at both ends of the human lifespan. This issue also contains profiles of the 2023 Medical Post Award winners, which recognize Canadian physicians’ accomplishments in community care, media engagement and importantly, innovation. These physicians, and the many more across the country who are putting their heart and soul into the healthcare system, give me hope.It’s easy to feel discouraged about health systems, but humans have proven themselves to be very crafty primates: We have an incredible ability to cooperate and find solutions, and sometimes, bright minds can help turn things around quickly. That is my hope for the system and for the new doctors starting out in their medical careers.

Editorial: The Beginnings & Endings Issue

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