The news never ends on the challenges we face with a public health care system that, on too many fronts, appears in crisis. The pandemic only increased the cracks in the system. Overworked health professionals are exhausted and many who are able to are leaving the professions, most notably nurses.
I read as much as I can to try and understand the complex picture that is our publicly funded health care system. It’s not easy and we sigh with relief at what we see south of the border, where costs can be astronomical for those not well insured or without any coverage at all. That reality often masks our own critical analysis because an MCP card is our ticket for free health care…for most services anyway. But let’s be clear – we have a system in need of change and the remedy is not all about money or people.
A Globe and Mail column recently posted by Andre Picard pointed out some facts that give pause for reflection. If you think we have less doctors than ever you would be wrong. He said “Canada has more doctors per capita and in absolute numbers than at any other time in history – 92,173, including 46,797 family doctors.” Despite this, five million Canadians do not have a primary health care provider which is 15 per cent of the population. This is the same percentage as in the late 1990’s.
Today, however, a few things have changed. First, unlike years ago, family doctors are no longer willing to be the workhorses in health care they once were. Women, who are increasingly making up a larger proportion of the family physician workforce, are not inclined to work the ungodly hours that their mostly male counterparts did years ago. Work-life balance is increasingly important to these professionals. They need a life and I don’t blame them.
Also, the structure for the practice of family medicine needs overhaul. Doctors are trained for health care…not to be small business operators. Fee for service compensation (that roughly amounts to $30 – $40 per doctor visit) pushes doctors to see patients in numbers that ensures they cover administrative salaries and office overhead. Doctors do their best but fee for service (which accounts for about 70 of physicians) creates a rushed patient environment that is not always conducive to optimal patient care. Many patients are older with chronic conditions and need service beyond a 15 minute clinic appointment. Doctors who work independently in this fashion do not have benefits such as maternity leave or pensions. This needs fixing. The fix is not straightforward but is doable.
Another aspect to the delivery of primary health care is allowing allied health professionals to use the full range of skills they are trained for. My understanding is that pharmacists have training that should allow them to independently deliver some services that they are well equipped to offer. Some movement in this direction has taken place but from what I hear there is more potential here. This would relieve family doctors of some tasks that a pharmacist can capably provide.
Likewise, a similar case can be made for registered practical nurses (RPN’s) who cannot practice independently and bill their fees directly to MCP. I understand some RPN’s have set up private practice in Corner Brook. Their services are not covered by MCP and the patient pays fees directly from their own pocket. RPN’s are well trained professionals with two years additional training beyond the Registered Nurse designation. Their scope of practice, if fees could be covered by MCP, would help support the front line delivery of primary health care. It potentially would reduce physician wait times and bolster service to patients without a family doctor and/ or have health conditions that do not need the care of a doctor.
God knows there has been lots of study on the health system and the points raised above have been discussed extensively. The challenges we face by virtue of an aging population and longer life span makes change of the system imperative. New models of providing health care exist in many provinces and they should be examined. You would think by now the merits and pitfalls of each should be known.
This little piece I write here may be considered simplistic and leaves out a larger discussion of the new ways for physician compensation and health care organization that would help better deliver services. Newfoundland and Labrador is not alone in the problems being experienced but because we have 13 health care systems across the country (10 provinces and three territories) each tackles the problem in their own way. The premier of Nova Scotia won a provincial election largely on the state of health care. Premier John Horgan of British Columbia is feeling the heat for the lack of family doctors there. Quebec, in the meantime, is strong arming its doctors to see more patients. That is not likely a great solution.
I live in Ontario and there is lots going on here that is all too familiar to that of other jurisdictions. As an aging boomer I keep my head down and do the best I can to manage my own heath situation. I keep praying that my genes will keep me going for a while yet. The alternative is a lightning strike that takes me out fast.