Last week, Globe and Mail health columnist Andre Picard sparked something of a firestorm on Twitter. Shocked by a tweet from my colleague Dr. Joy Hataley that showed a 4.5-year wait for a neurology appointment, he requested that people post their stories of unduly long wait times on Twitter, along with #CanadaWAITS.
— André Picard (@picardonhealth) November 6, 2017
In short order #CanadaWAITS started trending on Twitter. Patients and physicians started tweeting out stories of ridiculously long wait times. Do you have lung trouble? You could wait a year to see a respirologist. Have a child with autism? Eight months seems to be the minimum to get services. Live in Nothern Ontario? One community has been waiting 12 YEARS for a new family doctor to arrive, another tweet suggests. I encourage you to check out #CanadaWAITS yourself on Twitter for the full list (or better yet, contribute your story if you have one).
The frustrating part for physicians like myself is that we have been telling our various governments this for years. A clear picture of far too few physicians, nurses and allied health-care providers has been evident to those of us in the health-care field for at least a decade. We've been summarily ignored by politicians.
The situation in Ontario is almost comically inept. Faced with the obvious data that there are too few medical specialists to look after the population, what did Ontario Premier Kathleen Wynne do? She CUT the number of medical training positions so that there would be fewer specialists (you could not make something like this up).
How about a 12+ year wait (and still waiting) to get a GP in NW Ontario? Even the basics can take an eternity #CanadaWAITS
— Dr Lisa Habermehl (@NWOdoctor) November 2, 2017
Armed with the knowledge that wait times for orthopedic surgical procedures is increasing exponentially (214 days on AVERAGE!), what was Wynne's solution? To starve orthopaedic funding to hospitals to such an extent that we have scores of UNEMPLOYED orthopaedic surgeons. That's right, Premier Wynne's government has created an Ontario first — a time when a physician is unable to get work (even though the patient demand is there).
Finally, knowing that there is a shortage of comprehensive care family physicians in Ontario, her solution was to stop funding family health teams that pay physicians by capitation (capitation is a salary + performance bonus) that is preferred by both family physicians and multiple experts who feel the old fee-for-service style of paying physicians is antiquated. That helps explain why, as I've observed before, newer graduates of family medicine residencies are not going into comprehensive family medicine.
What's worse from the perspective of a Canadian citizen is that we spend a LOT on health care. The most recent estimate is $228 BILLION per year. That's $6,300 a year for every man, woman and child. Surely for that amount of money there should not be a 4.5-year wait to see a specialist. And please remember, that's NOT government money — it's YOUR money, paid for by YOUR tax dollars.
So what can be done? The Canadian public should not have to put up with such flagrant mismanagement of OUR tax dollars. It's well past the time to ask good hard questions of our leaders and ask them why they cannot manage the health system properly.
Unfortunately, of course, what politicians usually do is simply throw money at the problem. A good example is in Ontario, where months before an election Health Minister Eric Hoskins has thrown money at hospitals, on a temporary basis (guess what happens after the election) rather than fix the underlying issues facing health care.
The first thing politicians need to do is to acknowledge that there is a problem. Look, I get that that the primary goal of politicians is to get elected. That's why Ontario Premier Kathleen Wynne tweeted out how happy U.S. Senator Bernie Sanders was with our one payer system. (BTW when he came to Canada — do you think she showed him a newly renovated hospital, or did she show a hospital like the one in Brampton, where patients admitted to hospital lie for days in stretchers?) But at some point, politicians like her need to admit that the system is broken.
— Kathleen Wynne (@Kathleen_Wynne) November 2, 2017
The next step is to make a commitment to work with front-line health-care workers. In Ontario, that hasn't happened for years. The relationship with physicians and the Ontario government in particular is currently at the lowest levels since the David Peterson government of the mid 1980s. Yet it's precisely the front-line health-care workers that know where the flaws and inefficiencies are. It's time for governments to connect with them in a true meaningful way and empower them to help fix the problems in health care.
Politicians also need to stop cherry picking reports. I wrote recently of how Ontario introduced the flawed Patients First Act, rather than implement the full findings of the Price-Baker report. Wynne's goal was clearly to pick the recommendations that allowed her to bury the scandal plagued CCACs. Politicians need to have the guts to implement the FULL reports they get, instead of only picking politically expedient recommendations.
We deserve much better health care than we are getting.
Finally, it needs to be repeated that there are simply too many health-care organizations funded by the government. Politicians have been talking about "health-care silos" for decades and have failed to do anything to address it. Silos refer to the fact that each health-care organization (whether a hospital, your family doctors office, public health, home care, etc.) work independently, with their own software, data and information, and simply don't share information enough to provide optimal patient care. Nine YEARS after piloting information sharing via electronic records, my area of Georgian Bay remains virtually the only one in Ontario to do so.
One thing that is undeniably certain after reading the #CanadaWAITS tweets: we deserve much better health care than we are getting. Will this campaign be enough to convince politicians to do the right thing, and take a good long look at what's needed to transform the health-care system? For the sake of Canadians, I certainly hope so.
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