In mid-January of 2015, the Government of Ontario announced that it would no longer negotiate with doctors. It would unilaterally make cuts. Government cut fees for all service by 2.65% and announced 9 targeted cuts that will mostly effect family physicians, especially those new to practice, physicians providing on-call services in hospital and chronic disease management for cardiologists, nephrologist, gastroenterologists and specialists in General Internal Medicine.
The upfront costs are obvious. There will be a direct impact on physicians. Especially as these cuts follow previous cuts in 2012/2013. It will also have a negative impact on the patients. These people are also called tax-payers. They are also called voters.
But what are the hidden costs? What are the costs that follow the rupture of a working relationship between the elected Government, the Ministry of Health and the Ontario’s Doctors?
It’s fairly clear to people who practice medicine in Ontario, people who run health care organizations and people who need health care services that there are major problems in the way health care is organized and delivered in this province.
We need change.
Nine-hundred-thousand Ontario adults do not have a family physician. If we include children, a million is likely a better number.
Wait lists to see specialists are far too long. Once a specialist is seen there is still a long wait for treatment. In effect we have wait lists to get on wait lists.
Too many people are in hospital because they cannot get care in the community or cannot get spots in long-term care. We expect too much care from family, some of whom have their own health issues.
Access to palliative care is not universal. Too few people have discussions about the kind of care they want when they get an illness that will likely end their lives. Over half of us will die in hospital even if most of us would prefer to die at home or hospice.
We do too many tests, use too many drugs and do too many procedures without clear evidence that people will be better off.
These are a few examples of why we need major transformation in our health care system.
Who is going to drive the needed changes? Government? Ministry? Hospitals? LIHNs? Health providers? Doctors? Patients?
Well none of these groups can possibly drive the kind of major changes that are needed. We need all of these groups, acting as a team if we are going to get anywhere. One could fill many tomes with examples of changes mandated by government that failed because government failed to engage a coalition of interested parties. Top down does not work.
So good luck to government as they march forward with their transformation agenda. They will find individual physicians who are eager to help. I’ll be one of them. But to make real changes they will have to engage the rest of the 25 thousand. And how do you think that will go over after four years of cuts, disrespect and bullying?
Scott Douglas Wooder, MD