Beyond the healthcare crisis: Hard solutions for hard times.

A man, alone in a wheelchair in the waiting room at Chalmers Hospital Emergency Department in Fredericton, New Brunswick, dies.

Sitting in the chair. Waiting. Alone.

Heads need to come out of the sand. No point in the on-going circular conversations about what's wrong with the healthcare system, or who is to blame. The issues are across the country (and we are not the only country with unravelling healthcare). We need to lift ourselves out of the blaming tweets, the talk-show opinions, and government rhetoric. I've spent enough of my professional life dealing with shortages, cutbacks, administrative double-speak and excuses to have no patience with our current slide from crisis to full-blown disaster.

Rather than continuing to support the doom, gloom and hand-wringing that seems prevalent today, I would like to offer some hard solutions, and address the elephants in the room.

These are truly hard solutions. They force us to take a deep breath, to accept the fact that the very process of change produces anxiety. At the same time, however, the other side of this particular rough ride will enable us to ensure what we value in this country: accessible healthcare for all Canadians.

1.    Increase Primary Care providers: Replace fee-for-service with appropriate salaries (including vacation, benefits and pension) for Family Practitioners and Specialists.

In open and collaborative discussions with physicians themselves, develop a salary structure that reflects appropriate salaries based on levels (complexity of work, experience, location, etc). Other healthcare professionals are paid this way; why should physicians not be included in receiving benefits, pensions, etc.? Physicians want to care for their patients. They don't want to burn out. The current approach does not support work-life balance or sustainability of this resource.

Increase salaried independent Nurse Practitioner-led clinics with direct access to specialist/treatment referrals.

Develop and support salaried hospitalist (MD/NP) roles within hospitals rather than requiring Family MDs to provide hospital services in addition to their regular work in family practice.

 Revise regulations for Internationally Educated Physicians: Many IEPs have given up the hope of practicing medicine in Canada, despite years of education, training, advanced education and completing many of the requirements. We have a surfeit of these individuals who are eager to contribute. Rather than repeating Residency requirements, develop a one-year (at most) paid “shadow” residency position with appropriate supervision by MDs and evaluation via OSCE, etc. Base this on valid credentials, experience, and language proficiency (written and oral). Support and encourage these IEPs to locate in rural and remote settings where they can become part of the community as well as in locations where the immigrant population reflects their own language skills/background.

2. Create Community Health Teams (CHTs) to correct current physician shortage and wait-times for healthcare services.

While this has been done in various locations across the country (including the recent "Ontario Health Teams"),  CHTs need to replace the single MD practice (what happens to patients when the single MD relocates/retires/dies?). Solo-practice MDs need to be supported to join CHT practice.

CHTs are composed of multiple healthcare professionals in collaborative practice. "One-stop shopping" for patients provides timely and appropriate care, rather than waiting months for referrals. These group practices ensure that there are MDs (on salary), Nurse Practitioners, RNs, Occupational Therapists, Physiotherapists, Dieticians, Social Workers as well as specialists for specific demographics/issues: frail elderly, mental health, diabetes, etc. These settings can also provide a teaching/learning and research environment for Medical Residents, Nursing students and other healthcare professionals including IEPs.                                          

3.    Increase access to services for healthcare professionals and patients.

We live in a big country, with limited access to services in many places. Create access to virtual clinical appointments and follow-up (I was doing this with the Ontario Telemedicine Network 20 years ago). Develop a more robust (and national) Telehealth access 24/7 for physical and mental health concerns, available in multiple languages. Engage with communities to support and implement travelling clinics (e.g., mammography, diabetes, foot care, etc).

In Emergency Rooms, have embedded Geriatric Emergency Medicine (GEM) RNs/SW and Mental Health Youth/Young Adult counsellors for immediate support and follow-up in urgent care.

 We've ignored the big-ticket items for long enough. It's time to stop complaining and blaming. This is an opportunity to make changes that will ensure our Canadian healthcare mandate survives and thrives.

Feel free to copy this post, share it, talk about it. Let's get to work!

This post reflects my personal opinions.

Constructive discussion: contact [email protected]