Healthcare Uncertainty Threatens Entire System

Moviegoers love watching actors gape in panic. Fear makes people freeze just before they flail in terror.

Ontario faces healthcare uncertainty of superhero proportions. People hate uncertainty in real life. With political unrest, people seek safety and avoid risk. They put projects on hold, limit new debt, and even put off personal milestones like getting married or pregnant.

Uncertainty freezes progress. It stifles innovation and undermines even basic system functions.

Healthcare Uncertainty

Predictions about the negative impact of Premier Wynne’s attack on doctors have already started to show up. Even where patients have not experienced change, they are starting to worry about it.

Patient uncertainty

In my new rural practice, patients often ask, “How long do you plan to stay?” They have seen many others leave. Will this doctor be able to survive and take care of us?

A colleague shared how his elderly parents worry about their rheumatologist retiring. They’ve seen him for years. Who will take care of them when he closes his practice? There’s no one else around.

Staff Uncertainty

At two separate offices I visited, staff asked a bit too hopefully, “Are you going to come and work with us?” They know their jobs depend on physicians having somewhere to work.

Landlord Uncertainty

An MPP called me in a panic, “Four doctors just left our building! That office has been there for 30 years. The pharmacy depends on them. My office is in a unit in the same mall. The landlord doesn’t know what to do. Any suggestions?“

Program Uncertainty

• Palliative Care – 2 years of work at the provincial and national level have been virtually frozen. Yet patients desperately need palliative care.
• The Medically Complex Patients project started important work for our most vulnerable patients. Where will money come from to continue with a fixed physicians’ services budget?
• Over 3 million patients currently get enhanced care at Community Health Centres and Family Health Teams. Nearly 10 million patients do not. Will FHTs be expanded as promised? They cost 60% more per patient. Will FHTs be cancelled to save money? How can the government uphold the commitments they’ve already made?

Student Uncertainty

Despite waiting lists, cardiac and other surgeons went unemployed recently. That drove trainees into other fields leaving residency positions open in CV surgery. A heart surgeon told me that it’s already becoming hard to find new surgeons again. Even a few years of students avoiding his speciality has made recruitment worse and promises even longer wait-times for surgery.

New grads have to be extremely careful where they set up practice, if they happen to find a job in Ontario. Even in rural areas, the government could close the hospital like they did in Penatanguishene and promise to do in Midland next door.

Physician Uncertainty

A physician group west of Toronto signed a mortgage on a new building just before Wynne’s cuts.  Their current clinic was beyond repair. The cuts mean they probably cannot afford the mortgage. What now?

Doctors cannot hire new staff, renovate, purchase new equipment or sign new contracts. They’ve no idea how big the promised clawbacks will be.

Expert Advice

In uncertainty, we look to wise advisers. Fortunately, only a few say things like I heard from a couple doctors attending the Ontario Medical Association Council meeting this weekend:

“You get paid well. You should take the cut and be quiet.”

“We need to raise taxes to stimulate the economy.”

More sophisticated advisers say, “We need greater system accountability.” But they usually mean ‘physician’ accountability.

“In a system where government is the steward, governor, manager, regulator, funder, negotiator, evaluator, planner, distributor, executioner, paymaster, surveyor, policy-leader, procurement regulator, implementor, vendor…Maybe we need more government accountability?” (M. Lister)

Healthcare Uncertainty on Purpose?

Politicians are smart. Perhaps they want people to act out of fear? Maybe politicians need panic? Maybe they need it to get public support for increased taxes, or to inspire demands for federal health transfers, or to justify taking more control?

A small amount of uncertainty is a fact of life. We take a risk getting out of bed. But we need stability from which to take risks.

Wynne’s bureaucrats demanded fiscal predictability. They bet on cost certainty and sacrificed certainty for everyone else.

Their bond rating was sinking. They’d run out of room in their fiscal lifeboat. Wynne thought she had guaranteed safety by boldly kicking out new graduates to swim on their own. Instead she’s created massive healthcare uncertainty that’s only just starting to surface. Voters love panic at the movies; let’s see what they think of it in healthcare.