I’m buried in research and thought I had my book mostly written. But something bugs me.
Authors want to stand out, to say something new. So why do so many Medicare authors say the same things about healthcare?
I dug through Canadian authors: Taylor, Decter, Naylor, Rachlis, Simpson, Marchildon, Picard, Fierlbeck and even Martin, Furlong, Gratzer, Doig, Vertesi and others.
Aside from the last three, no one tears apart Medicare except to say we aren’t doing enough:
We do not have a system. We have 13 separate systems!
We need more services, more accountability and more regulation!
Everyone supports the pillars of Medicare, but no one supports doctors. They see docs as just another cog in the machine. Or they see docs as 30,000 spanners in the works.
Some authors are gentle. They suggest we help doctors make better decisions. Or we should lighten doctors’ heavy load and train other people to carry it.
But they all criticize doctors in their own way.
What Medicare Authors Say
Doctors cost too much. Doctors have too much power.
Doctors order too many tests. Doctors don’t work well in teams.
If only doctors would embrace other providers who seek to replace doctors.
Doctors need to care as much or more about the ‘system’ as they do about individual patients.
But family docs earn less, per patient, than nurse practitioners and less than teachers over a career. Regulations dictate everything from fridge temperature to sterilization techniques and hallway dimensions. Doctors work in teams with non-physician providers who order stacks of tests that docs are liable for. And in the end, teams rarely get successfully sued, only doctors.
The authors go on:
Doctors cause the massive increases in healthcare spending.
Doctors cause inefficiency in the system.
If doctors had only agreed to become salaried employees back in 1962, Canadians would be healthier, inequality and poverty would be less, and the system would have money left over.
Offered a free service, citizens find reasons to use it. Demand explodes. And it’s been said that one worker on commission can do the same job as 2.5 workers on salary, for the same quality of work.
Stephen Lewis, former NDP politician, was asked why he did not support offering all doctors a salary. He said, “We could never afford it.”
And yet we still hear, “If only doctors would give up fee for service (FFS) medicine and go on salary.”
Ontario created a pseudo-salaried model with Family Health Organizations (FHO) in the mid 2000s. Government followed Aneurin Bevan of the NHS to build the FHOs.
Bevan said, “We stuffed their mouths with gold” to attract doctors into a new model of care.
FHO docs are paid to keep patients out of clinics, to provide virtual care and to deal with multiple problems in one visit. Without surprise, patients seen in FHOs cost more than those seen by FFS docs, and doctors get blamed for it.
Many people say we should just replace doctors. Artificial intelligence can read chest x-rays and pap smears. Nurse practitioners can be family doctors and endoscopists. Nurses will soon do surgery in Britain.
A family doc has 10,000 hours of training beyond undergrad, and an allied provider needs only 500: Do doctors really provide value for money?
Criticize More, Not Less
Doctors are imperfect, faulty. We suffer from the same weaknesses as our patients. Many voters still honour doctors, but the medical pedestal is much wobblier than before.
As a doctor, it’s painful to receive rare praise and relentless criticism. But it’s good. We need more of it. Not more of it for doctors, more of it for everything else.
Where are the vivisections of Medicare itself?
Where are the journalists who examine other countries for solutions?
Where are the academics who teach something other than increased centralization and greater control?
Aside from think tanks and lone writers, no one in the royal court critiques the Emperor’s attire.
This week, Andre Picard reported on the bureaucratic mess in healthcare. Healthcare bureaucrats outnumber comprehensive care family physicians.
His article stands out for the courage it took to write it, and because it is so rare.
Maybe a new, Conservative government will unleash fresh critiques of government’s role in healthcare without journalists worrying about what their (often Liberal) editors might say?
Medicare authors are half right. They should criticize doctors. But they should criticize everyone else, too. All authors want to stand out. Why not use this opportunity?
Authors could extend their constructive criticism to management, unions, nurses, allied health providers, educational colleges, regulatory authorities and every other cog in system. Will anyone inside the royal courts of Medicare be brave enough to do it?
Do any of them refer the actual global evidence?
Evidence of what works and evidence as to what does not work?
The top rated health care systems of the world are all hybrid…public private…if there was an attempt to introduce a French or even a Swedish health care system into Ontario or Canada there would be a riot with the authors leading it.
You are right — a major riot. Our system has grown beyond reason and evidence. The leading authors all write about ‘values’ and our Canadian identity, as though values and identity trumped patient service and performance.
Thanks again for taking time to share a comment, Andris!
Cheers
Amen to that, Shawn. You said it much more cooly than most physicians would have.
Thanks Gerry!
The ‘Royal Courts’ Of Medicare/Healthcare.
Oh, how we’ve railed against them! Their power is absolute.
They squash dissent, implement grand schemes, hold press conferences where they announce sweeping visions, revise slogans to lead us into a new dawn of blah, blah, blah…
It’s exhausting.
Meanwhile front-line ‘new power’ leaders fight to have their voices heard at any level while they struggle with workloads that routinely crush the spirits of their co-workers.
“I give up!”, many of us cry, tired of screaming at the sky.
Who Will Lead Us, If Not Doctors?
The CMA just released a blistering, self-satisfied critique of American immigration policy.
Really? This is the battle to choose, when our own porous borders are being overrun?
These petty politics of distraction only worsen our own situation. Leadership. That’s what we need. Great article. Let’s get to work.
“These pretty politics of distraction only worsen our own situation.”
Well said, Don! It feels like everyone has bored with health policy and politics. I don’t blame them. Change comes so slowly and only after fighting and protest. Whatever happened to freedom and the opportunity to try new things?
Change is coming. It is painful to wait for it, but it will come.
Enjoy your long weekend!
Cheers
Well said Shawn. I’m sitting here in France, at our maison secondaire, where we recently had a conversation about health care with a neighbour. He told me that Germans come here for medical care, Britains come here as do other europeans from many other countries. Health care here is excellent, immediate, inexpensive and comprehensive. Supporters of Canadian medicare always want to compare our system with that in the US. It’s is well past time for comparisons with other systems such as exists in France.
Great comment, Ralph.
Study after study has shown that other countries do it better. People like you share firsthand experience. Healthcare has become a faith in Canada, a sacred myth that we must not question or alter. Saskatchewan has been the most innovative so far: Patients benefitted and the sky did not fall.
Thanks so much for reading and commenting while on vacation! I hope you have a great time.
Maybe the conversation will finally go in the right direction.
I’ve been talking about this for decades,and watched the liberals increase bureaucracy over the last 15yrs at the expense of front line workers.
Hopefully,Ford/conservatives will eliminate ALL the LHINS and sublhins,and go into EACH hospital and tell the CEO’s to reduce the admin staff by 30%….no one would notice.
You’re right, Ramunas. “No one would notice.” Hospitals would only struggle to manage the paperwork demanded by the LHINs et al. Patient care would continue unchanged.
Thanks again for posting a comment!
Faith inhibits critical thinking….there a near religious faith in the superiority of our monopolystic monosoptic health care system….the media fans it rather than questioning it as do our academic centres , dominated as they are by true believers.
Hopefully our colleague, Dr. Merrilee Fullerton, as Minister of training, Colleges and Universities will encourage free speech and promote the diversity of opinions which are so lacking in our present day academic centres as demonstrated by the Wilfred Laurier fiasco.
Ideologically blinkered believers cannot be allowed to maintain their current monopoly in our educational system and in our colleges and universities in particular.
I agree with much of what you said, Andris. I offer a gentle caution: We can place too much faith in markets, too. Fundamentalist free marketers also assume they have the solution that will lead us to utopia. We have to be careful at both ends.
Merrilee is fearless. I am certain she will share reason when nonsense gets raised.
Thanks again!
Whatley brings some important and well thought out points. One may consisder developing the theme raised by Stephen Lewis. If we cant afford something we must look for alternatives. The competition brought by a complimentary private care and insurance sysem may do just that , by helping to improve the public interface, streamline management, reduce wait times and providing acceptible options for care.
The public system has been trying to address waiting times for joints that exceed a third of remaining life expecancy and anxiety provoking cancer intervention wait times amongst others for decades but has only succeeded in creating more layers of non clinical management and spending money on fruitless endeavours.
The financial model for delivery of primary care has failed to the extent that any endeavour to improve access and continuity of care is dead in the water. Overhead and taxes now consume 15 of 20 days work for most family practices and there is little incentive for physicians to remain in the field which itself has been pared down in terms of scope of practice and regulated to the point of non viability.
Hey Neal,
Thanks so much for your comment! You are right: Docs spend most of the month paying for overhead and taxes. And then we get impugned for not providing information, counselling on healthy living, and….and….and… There is a better way!
Our high ground remains the doctor-patient relationship. From there, we can achieve anything. If we compromise that, we are nothing more than another special interest group. Your comments about wait times, framed in the doctor-patient relationship, cannot be ignored. They are dynamite. We need to keep saying exactly what you said.
Thanks so much for taking time to read and post a comment. I apologize for not approving your comment immediately (new posters need to be ‘approved’, but subsequent comments go live immediately.) I was at the cottage with my family for the long weekend.
Cheers