Canada’s doctors ask for public input, but that can’t be an end in itself

Why do physicians need average folks’ help?


I have to admit to being a bit skeptical at the outset about the Canadian Medical Association’s announcement yesterday that it’s launching an elaborate consultation with the general public about the future of health care. My first thought was that it’s properly the government’s job to try to engage citizens in a debate; what we need from the doctors’ lobby are clear proposals on the hard issues and then vigorous arguments in favour of them.

With that in mind, I asked Dr. Jeff Turnbull, the CMA’s president, if physicians don’t know enough already to present a set of precise recommendations. And don’t the docs cumulatively understand the system far better than the average folks they’re proposing to consult with anyway? Turnbull framed the CMA’s outreach plan as a way of building a coalition, or, as he put it, a consortium. “Once we get a consortium of individuals,” he said, “other allied health professionals, doctors, patients, community members, then we’ll actually have clout, then we’ll have our decision-makers listening.”

It’s not a bad strategy for amplifying the influence of the already powerful doctors’ organization. Hence, the CMA’s new website, where it hopes to attract many comments from Canadians, and its plan to hold town-hall meetings across the country in 2011. As well, Turnbull said the CMA will eventually appoint “a blue ribbon panel to look at resourcing options”—I take it he means how we’re going to pay for care going forward—and deliver a “final action plan” next fall.

The timing is crucial here, since the agreement under which Ottawa funds about 20 per cent of the provinces’ health care costs runs out in 2014. So Canada has about three years to work things out. The CMA’s general inclinations are already clear: not only should universal health insurance be preserved, coverage should probably be extended to cover prescription drugs and long-term care.

The CMA sees the need for big change within the existing framework. The key paragraphs in the background document the group released last summer, Health Care Transformation in Canada, are the ones that sketch ideas for injecting efficiency into what would still be universal, publicly insured care:

“The system should be guided by properly structured incentives to reward efficient provision of timely, high-quality patient care. This would include incentives such as activity-based funding of hospitals (i.e., paying on the basis of services provided), and pay-for-performance measures for health care providers, with competition based on valid measures of quality and efficiency. The system would utilize both public and private service providers, and put uniform requirements and regulations in place for measuring quality.”

Importing such market-like efficiencies into the system without sacrificing its egalitarian merits would be a landmark policy achievement. It won’t happen, though, simply because the CMA reached out to Canadians. The fact is that most of us don’t ever see the system as a whole—we glimpse the organized chaos of an emergency room, sit in a doctor’s reception area praying we aren’t breathing in worse germs than we came with, wonder when the specialist’s office is going to call back, if ever.

So let’s hope the CMA conceives of its consultation process very much as a means to a political end—a way to bolster its case, the better to sway governments. The physicians should keep in mind that when it comes to really hard public policy issues, consultation processes too often devolve into exercises in putting off the difficult job of moving beyond generalities to workable, concrete proposals for reform.


Canada’s doctors ask for public input, but that can’t be an end in itself

  1. We KNOW how to fix the system, we just don't have the political will to do so.

    Instead we've spent years still arguing over the original premise of 1966, instead of getting on with it.

    • Okay. I'll bite. How?

      • I think we've done this before.

        Our biggest problem is a lack of doctors, because our various colleges of physicians and surgeons bottleneck the system as an act of job protectionism. Fewer doctors, more pay.

        We need to eliminate the colleges, and graduate as many doctors as possible….and accept more foreign doctors.

        Having to wait for hours in an 'emergency' room is absurd.

        • Ah, I remember now, and you're right, we have. Always good to have a nice, concise refresher though.

          I like the idea in general, but the devil is in the details, of course. Who do we get to train new physicians and surgeons if not the current physicians and surgeons? And if they don't want to train more than X students, how do we get them to do it anyway?

          I suppose we could make it a condition of their medical license, but do we really want every doctor training — because I know some doctors who, while they might be suitable for practice, I really would not want them trying to train anybody.

          • Same incentive we've always had…money.

            It's why they're bottlenecking in the first place.

          • Biggest problem isnt the lack of docs. Doctors are PRICEY (and thats because the CMA has so much political power- they proiritized a fee for service basis for the docs convenience, not for quality of care!), but look at the evidence on nurse practitioners; they have just as good (sometimes better) patient outcomes than physicians do! I believe our "ER wait times" problem stems from the fact that we have nowhere to put our aging population. As a nurse, on medical, surgical, telemetry (you name it) floors you see elderly patients whose medical reason for this visit is fixed, but it is not safe to send them home, and there are no nursing homes available so they stay in the hospital in a surgical bed while a patient in the ER with a broken leg waits and waits for a bed to become available!

  2. no, the docs do not cumulatively have a better understanding than the average folks who use the system. they see it from the vendor's perspective. "average folks" see it from the patient's perspective. if you care about sick people more than making money, go to the patients for input.

    there are many good canadian doctors. there are also many arrogant and/or incompetent doctors. naturally the cma wants government to subsidize as much of the system as possible so that people will pay nothing for the service, demand will always outstrip supply, and doctors will always be sought after. this may not be best for the patients though – wait times are a serious and sometimes fatal health issue.

    • Wait times can be addressed without switching our health care system to a private one though! The CMA just wants more money (what else is new). There are other solutions, urgent care centres, preventative approaches, nurse practitioners to get people through the ER quicker, increase lab turnover time. I work in health care and know that this huge radical change is not necessary, the biggest problem in our system is that the CMA is controlling it ! why do they still get paid on a fee for service basis when our health care funds are SO limited? Why dont pharmacists write the prescriptions (they understand drug interactions far more then any doctor)? We just need to use our resources more effectively.

  3. It does my heart good to see Mr. Turnbull full of such idealism. To think that he might get the Conservative party to actually listen… ah, the naiveté of youth — it's so endearing watching it in action. Brings back happy memories.

  4. "The system would utilize both public and private service providers…"

    The Liberals have clarified somewhat their position on consumer-driven healthcare today, Dec. 14. Now we know where Maclean's stands on that. Wonder why Wherry didn't mention this speech in this piece? Because Maclean's lobbies for private healthcare and that's why they give the Liberal's no media play. That is a HUGE DISSERVICE to Canadians and Wherry should be ashamed to call himself a Hill Reporter today.


  5. That's how much attention I pay to this read. I'm reading Geddes! Author of that sexist tripe the other day "slap-down' "glamourous women" no mention of Guergis. This mag is a rag.


    Well I was too hasty to judge Wherry. Now I see he did report. However the Editorial Board here is a lame group of independents and they should have sent Geddes piece back to the Table to include the Liberal response before publishing. Or, if this is already in the print version, Wherry or Geddes should have updated the online offering. Again — this mag is a rag! If I was in charge this sh__ would never happen.

    • You know, you shoulda just kept quiet after the first rant.

      "Better to remain silent and let others think you may be a fool, than open your mouth and remove all doubt"

    • Along with BCer in Mtl, I have to wonder whether one rant, one half-a$$ed apology with continued rant, another half-a$$ed apology with continued rant, really speaks to your credibility about the 'rag' you so despise.

      • And now I remember why I don't really miss the commenters on this blog either…Still I have to come here and read every once and a while to get the full picture. Yet somehow I think that won't be necessary once gets up to speed…

    • You claim things would be different if you were in charge, yet you can't even get the author's name right. If you were in charge, things would be a disaster.

      Carolyn B, you're not in charge, thank goodness. Go back to your doll-stomping.

      • Wrong Carolyn, the doll stomper was Carolyn Parrish.

        So, you were saying about getting names right?

        • I never said I don't get names wrong. I also never said I should be in charge. I never said I'd do better than the Maclean's editors.

          You seem to be implying I said those things. In fact, I said the opposite, that someone who claims to be better should not be showing otherwise.

          Anyway, that's good to know it's not the same Carolyn.

  7. I suspect the consultation will be something along the lines of "you may choose between one option we present to you, and another slightly different option we present to you which has been worded to make it less palatable", followed by announcements of "[number of visitors to our website] support the option presented! Government must act!"

  8. Two tier.

    Public care for all, and private care for those willing and able to pour more of their own money into the system for their particular care. Any one of us would forgoe a vacation to pay to get a CAT scan for a loved one, or to pay for a private hospital bed with a nicer room.

    More money, more doctors, shorter cues.

    It's simple, but we've foolishly allowed any change to full "public" healthcare to be a political taboo.

    We don't want Tommy Douglas turning over in his grave, now do we?

    • Anyone who can do some basic math knows that two-tier can't work. There's a set number of doctors which have graduated and a set number of doctors in the workforce. You could argue that a two-tier system would allow us to retain more doctors within the country, but the wages in Canada would still be less than in the United States. Public healthcare is far more efficient than any private system, and it provides every Canadian with cost-effective care.

      Hiring more doctors is only one option, and it's not a particularly efficient one. Our emergency rooms need to streamline the entry processes for new patients and they need to consider hiring other (lower-wage) professionals such as nurse practitioners and physician assistants.

      • Wow Ryan, you're one of those know-it-alls. I guess my graduate level math is not basic math, because it's obvious two-tier can work, in fact it says so right here:

        The 5 two-tier systems are all rated better than the 2 one-tier systems.

        Here too, Europe's two tiered systems are all superior, by a long shot:

        Don't let the facts get in the way of your ideology.

  9. I want private health care.

    Our country will be bankrupt by the time the boomers are done with the public medical system, and the CMA is trying to add more public care!.

  10. I bet the CMA is licking their chops over the IMF report…

  11. As a registered nurse I strongly feel that a two tiered system is a recipe for disaster. Think: If you were a nurse or a doctor, would you want to work in a publically funded system where you will likely get paid less, be working in an older building, with a higher patient load, more complex cases, in a unhealthy work environment? OR- would you want to work in the privately funded system, where the CMA can advertise the private system to favourable patients (young, non-complex cases), and you will recieve more money for the work you do, and work in a state of the art building with high levels of staff to support your patients with you? If your thinking what I am, then you will realize that many of our health care providers will opt to work for the private system leaving the free (public) service even more understaffed. How would this affect the quality of care you would recieve? How would this affect the wait times in the public sector? I am STRONGLY AGAINST A TWO TIERED SYSTEM. It would benefit nobody but the rich and the health care providers, and is against our values we set in the Ottawa Charter and Lalonde Report. This is not a solution.

  12. And actually… What Ryan said is a decent idea. I actually work in the ER, the issues that cause our long wait times can be drawn back to the aging population and lack of long term care beds available (this leaves the elderly occupying "ALC" beds in the hospital). Nurse practitioners are underused. I see patients triaged level 4 (not very crititcal) and they wait 5 hours for the doc to pick up the chart, write a prescription and send them home- a nurse practitioner can deal with the stable cases and open up ER beds for the unstable ones who walk in the door or come in by bus. GREAT IDEA! Other ideas: advertise urgent care centres as an alternative for non-urgent cases, increase lab turnover time (half the time patients are waiting for lab results more than anything else in the ER), and figure out a place to put our aging population. We can discharge an elderly patient home where they cannot care for themselves and have nobody else available. After their health is restored they need to go to a nursing home or assistive living area where they can safely be discharged and come back "Failure to cope". Oh- and while im ranting- lets stop paying doctors on a fee for service basis, its unneccesary, motivates them to do as much as they can as quick as they can, give em a SALARY and with extra few bucks hire a few more nurse practitioners. Another approach people have is to move towards is investing in ILLNESS PREVENTION- great idea! heres a cost effective solution: stop selling the garbage in grocery stores that leads our society to diabetes, obesity, and cardiovascular disease! You'll decrease the demand for health care, and reduce the number of chronic illness people have- thus reducing the stress on our system!