shawn whatley md

Canadian Medicare: Toronto MD smacks down U.S. Senate

Toronto doctor smacks down U.S. Senate question on Canadian waitlist deaths | National Post.

I appreciate Dr. Martin’s quick wit in deflecting a question with an attack on the questioner.

Nice move.

The Toronto Star gushed about Dr. Martin being best suited to represent the values of the Canadian health care system. Apparently, the Huffington Post said she just became Canada’s newest hero.

Debates like this make change almost impossible. They entrench discussion into a debate about Canadian distinctiveness compared with our southern neighbour, completely missing the point.

We need to debate what’s best for patients.

Has ANYONE in the world copied Canadian Medicare?

If our system was as great as Martin says, don’t you think someone – anyone – would have copied it?

No, ideological devotion blinds Dr. Martin, the media, and most of the rest of us to the need for change in our beloved Medicare.

Healthcare Leadership – Hiring Our Own to a Fault?

Medicare hires from within; we generally don’t look for outside talent. Even when we try, it’s usually from crown corporations or government bureaucracy. Other industries hire talent from outside. Why don’t we?

Leadership career paths for senior hospital administrators seem to be very similar, almost identical.

Does this make Medicare stronger?

Healthcare Leadership Career Paths

Clinical path:

Start in clinical field: nursing, allied health, etc. Become a clinical educator, then clinical coordinator, then clinical manager, then administrative program director, then VP, then Chief other-than-executive Officer (COO, CFO, etc.).

Finance path:

People seem to come into the finance department from business school or accounting programs. Then they work their way up through the manager, director, VP, Chief streams ahead of them.

Facilities path:

From the little I know about facilities managers, they seem to follow a similar path up through the hospital system.

IT path:

Similar to finance, up through the hospital.

HR path:

Up through the system like the others.

There are notable exceptions, and everyone knows them because they are so rare. (Over the last few years, some physicians are applying for VP positions in Ontario, but MDs rarely hold more than 1 or 2 of the VP positions, and in many hospitals there are no physicians on the senior team.)

Healthcare Leadership Fact:

Medicare hires its own.

Nearly 100% of Medicare leaders have all their experience in a publicly run organization.

Would Medicare benefit from outside talent hired from other industries? Selection committees often hire what they know, people with shared experience. Should we change selection and interview processes to increase the chance of outside talent being successful?

Rebuttals:

It doesn’t matter if leaders come up through the system; all that matters is how they think. Then how do we encourage staff to not think like everyone else in similar positions?

The system determines behaviour and approach; it doesn’t matter where staff come from. I agree. System change requires new thinking. Do we really want change in Medicare?

Medicare leadership requires extensive knowledge, it’s fundamentally different. I disagree. If that were so, Medicare would pay for more physicians in senior leadership positions. Smart nurse leaders know a ton about nursing. And just as physicians don’t understand nursing like nurses do, nurses don’t understand medicine like physicians.

What do you think? Should healthcare leadership hire more talent from outside? Should bureaucrats have business experience from competitive industries? What will happen to Medicare if we continue to foster a ‘crown corporation’ mentality?

(photo credit: exchange3d.com)

Medicare Trilemma – Care vs Cost vs Technology

Society is stuck in a medicare trilemma. Attempts to control cost through price setting and rationing leave patients disappointed. People used to getting what they want end up with less than they need. We elevate patient autonomy but eliminate meaningful choice.

3 Points of Medicare Trilemma

1. Great clinical care meets the needs of individual patients. Patients have individual needs beyond clinical guidelines. Cookbook care gives everyone exactly the same care for the ‘same’ diagnosis (even though diagnoses are rarely clear and singular).

2. As medicare eats up 50% of provincial spending, payers try to decrease spending by setting prices and targeting the lowest cost for care. Medicare pundits pressure physicians to provide the same, low-cost care to all.

3. Technology continually advances and always costs more overall. The best technology improves diagnosis and management of disease decreasing morbidity and mortality.

Trilemma

Consider a classic trilemma about communism:

You can be honest.

You can be smart.

You can be Communist.

You can only be 2 of these at the same time. A trilemma exists when you have 3 possible options such that any 2 are true when taken together.

Medicare Trilemma

If we want individualized care and the best technology, we can’t have set or low costs.

If we want individualized care and low costs, we can’t offer the best technology.

If we want low costs and the best technology, we can’t offer individualized care.

Voters need to grapple with this.

If patients want the best technology and care individualized to their needs, costs will escalate.

Medical ethics rests on patient autonomy and choice, but our system can’t offer the best treatment options and makes it illegal to buy care privately. Offering second-rate medical technology is not an option. Costs cannot be controlled and will exceed the public purse. Something has to change. Which point of the medicare trilemma will we abandon?

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(photo credits: wikipedia.com)