Canada's doctors need to stop resisting change in health care by recognizing that other professionals can help fix the ailing system.

I write to you as grown-ups in a time of chaos. I begin by saying, sincerely, that I’m your ally. I’m distressed by your malaise.

I want you to have rewarding practices, work-life balance, good pay and great support. I want you at key decision-making tables. I want to lessen the burdens that create antibodies to practising full-service family medicine among so many graduates of family medicine programs.

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I’m baffled by your resistance to impending changes to the health-care system. Ontario wants to expand interdisciplinary primary health-care teams, recommended in every report for the past 40 years.

The Ontario Medical Association has drawn a line in the sand: teams are fine, but teams have captains and the captains must be doctors. There will be no messing with how doctors are paid. Primary care is our house; we will decide what others get to lead and do. It is all very 1950s.

Alberta has authorized independent nurse practitioner (NP) clinics. That offers hope to the 700,000 Albertans who don’t have a regular source of care. To the doctors of Alberta it is a desecration of the temple of medicine.

Why? NPs aren’t doctors (true). NPs can’t do what doctors do (false, according to 50 years of research and evaluation). Independent NP practice will fail (NP-led clinics thrive in Nova Scotia, New Brunswick, Ontario and BC).

The move is disrespectful of doctors (yet leaving 700,000 Albertans medically homeless isn’t disrespectful of citizens). Doctors aren’t valued (so when another profession is fully valued, by definition you aren’t).

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Let’s review a little history, not to relitigate the past, but to avoid its missteps, as the system teeters on the verge of collapse under an avalanche of high costs, poor access and a demoralized workforce.

By and large, doctors, you tend to get what you want. When governments tried to limit the numbers in the big cities to ensure a reasonable supply in rural and remote areas, you waved the Charter, went to court, and won.

Then governments offered all kinds of financial incentives to practise in rural areas and none worked. Most doctors in rural Canada are from developing nations — thank you, and Nigeria, we’re sorry for your loss.

Canadian-trained doctors have abandoned rural Canada for decades. Organized medicine has refused to own any of the problem. Is it any wonder governments have finally turned to Plan B?

Twenty years ago you convinced governments there weren’t enough doctors. They doubled medical school enrolments. We have never had so many family doctors per capita, yet over six million Canadians don’t have one.

The latest response to the failed strategy has been to double down on it: three new medical schools and at least three new satellite campuses of existing schools are in the works. I don’t have to tell you that a misdiagnosis rarely leads to effective treatment.

And then, of course, there is money. You persuaded governments that lousy pay explains why so many doctors say no thanks to family medicine careers. Last year, the B.C. government boosted the average family doctor’s billings by an astonishing 54 per cent.

Yet nothing in the agreement makes doctors accountable for taking on any of the million or so doctorless British Columbians. Incredibly, there are no targets for reducing the unmet need.

Getting what you want hasn’t solved the system’s problems or made you happy. And when you focus on illusory threats to your futures, you risk being blindsided by the real ones.

NPs and interdisciplinary teams are mere tremors. Machine learning, robotic surgery, remote diagnostics, behavioural change software and ChatGPT are shockwaves that signal the mega-quake to come. If you panic over the gentle movement, you won’t survive the seismic shifts that will break your ground apart.

As health care changes at warp speed, health system reform lumbers in the slow lane. Doctors have big brains and most have big hearts. We need you to be collegial team players with eyes trained on the future.

Don’t become casualties in wars waged to defend the indefensible. Fight the real enemies — poor access and indifferent quality. NPs and teams are the public’s allies; they are yours too.

Steven Lewis spent 45 years as a health policy analyst and health researcher in Saskatchewan and is currently adjunct professor of health policy at Simon Fraser University. He can be reached at slewistoon1@gmail.com.

With some online platforms blocking access to the journalism upon which you depend, our websites are your destination for up-to-the-minute news, so make sure to bookmark TheStarPhoenix.com and LeaderPost.com. For Regina Leader-Post newsletters click here; for Saskatoon StarPhoenix newsletters click here.

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Steven Lewis: Dear doctors, Canadian health care needs help to evolve

15 0
15.12.2023

Canada's doctors need to stop resisting change in health care by recognizing that other professionals can help fix the ailing system.

I write to you as grown-ups in a time of chaos. I begin by saying, sincerely, that I’m your ally. I’m distressed by your malaise.

I want you to have rewarding practices, work-life balance, good pay and great support. I want you at key decision-making tables. I want to lessen the burdens that create antibodies to practising full-service family medicine among so many graduates of family medicine programs.

Subscribe now to read the latest news in your city and across Canada.

Subscribe now to read the latest news in your city and across Canada.

Create an account or sign in to continue with your reading experience.

Don't have an account? Create Account

I’m baffled by your resistance to impending changes to the health-care system. Ontario wants to expand interdisciplinary primary health-care teams, recommended in every report for the past 40 years.

The Ontario Medical Association has drawn a line in the sand: teams are fine, but teams have captains and the captains must be doctors. There will be no messing with how doctors are paid. Primary care is our house; we will decide what others get to lead and do. It is all very 1950s.

Alberta has authorized independent nurse practitioner (NP) clinics. That offers hope to the 700,000 Albertans who don’t have a regular source of care. To the doctors of Alberta it is a desecration of the temple of medicine.

Why? NPs........

© Saskatoon StarPhoenix


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