Fixing health care means wholesale change
Only by working collaboratively will we see results, writes Michael Multan.
At this point, it's common knowledge that the Canadian health-care system is in crisis in just about every domain, every specialty and most regions of the country. Every day, a new union or specialist group comes out with a statement regarding underfunding, understaffing and an inability to provide timely care.
But flashy political gestures tied to elections that are at risk of being overturned next election season are not going to fix our disjointed system.
Canada needs a long-term plan that addresses capacity at a systems level, not at an individual level.
Take prolonged operating room waiting times.
It's not just about building more OR rooms or training more surgeons. A new hospital or a new surgeon in a community makes for a great headline, but does that actually increase a community's capacity to deliver more comprehensive surgical care? The answer is no.
According to the Canadian Medical Association, 2019 data shows that there are approximately nine physician anesthesia care providers per 100,000 people in Canada, well below other high-income countries. Operating rooms also require operating room nurses — a specialized skill that often requires additional training in addition to regular nurse training. Without a well-co-ordinated mix of the right providers, increasing capacity in one domain accomplishes absolutely nothing to reduce waiting times and improve care.
I am a resident in pathology, a specialty in medicine that looks at tissues and organs removed during surgery for definitive diagnosis and management of care. Even when a hospital increases its operating room capacity, administrators rarely think about laboratory capacity. Most laboratory physicians are salaried — meaning, if case volume increases, remuneration does not necessarily increase. More importantly, even if surgical case volume increases, a hospital will rarely think of hiring additional pathologists.
Again, without a well-co-ordinated mix of the right providers, increasing capacity in one domain accomplishes nothing to reduce waiting times and improve care.
Until a cancer patient undergoing cancer surgery has a pathology report issued — a report that helps a surgeon or oncologist decide on treatment — they are often unable to go on to biomarker-driven treatment or receive information regarding their prognosis.
It's well-known that a growing number of Canadians do not have a family doctor, leading to events such as delayed cancer diagnosis and overburdened emergency rooms. But even if we solely focus on increasing our family medicine workforce, more providers will generate more tests and referrals. If these tests and referrals are not linked to an appropriately proportionate increase in nursing, diagnostics, surgical and subspecialty capacity, we are at risk of not accomplishing anything.
Any government response or investment in health care should carefully consider health care as a team sport. We need to look to building capacity across all domains and working collaboratively to understand how increases or decreases in certain aspects of health care affect the system as a whole.
It's not about being the loudest voice in the room advocating for themselves. It's about putting aside personal agendas and grievances and working toward a sustainable system as a whole.