Time for doctors to manage patient care instead of wait lists, CMA president says
By Patrick Sullivan
When CMA President Brian Day appeared before the Empire Club in Toronto Oct. 12, his address included 12 different questions, and almost every one could be answered by a three-word phrase sprinkled throughout the 25-minute speech: "Put patients first."
Day, a Vancouver orthopedic surgeon who assumed the CMA presidency in August, acknowledged that some groups don't like his message about health care renewal. "Supporters of the status quo reject solutions proposed by the CMA," he said. "In fact they reject all solutions."
And he also acknowledged he has attracted many critics, including some who call him the "Darth Vader of health care" because he co-founded a private surgical clinic and contends there is a useful role for private medicine within Canada's universal medicare system.
"I went into medicine to manage patients, not waiting lists," he said. "In Vancouver we built our own place to work because the public hospitals would not let us work there - my own OR time [in public hospitals] had dwindled from 22 to just five hours a week."
Day said the private surgical centre he co-founded opened during the tenure of the "most ardent NDP government that Canada has ever seen," yet it thrived. Because of the clinic, said Day, "unions, some so-called consumer groups and even a single-issue doctors' group" have accused him of promoting two-tier, American-style medicine - a charge he considers outlandish. "Canada's health system has been ranked 30th by WHO. The US was ranked 37th. Why would anyone copy a system that ranks substantially below our own? I know I wouldn't.
"My goal, and the CMA's goal, is to help improve our universal system, not destroy it."
Day didn't shy away from his critics. "I understand why union-funded groups such as various so-called health coalitions continue to advocate for their members. . . . It is understandable - it's their job to advocate for union workers.
"However, as doctors our job is to fight on behalf of our patients."
And make no mistake, said Day, there are battles to fight on many fronts:
- within the 30-member OECD, Canada ranks 24th in terms of physicians per capita;
- the competition for health care personnel will grow because of insatiable demand in the US, which already employs more than 200,000 foreign-trained physicians;
- within Day's own specialty, the demand for knee replacements is projected to grow by 670%;
- there will be a 43% increase in Canada's over-80 population during the next four years - another portent of increased demand for health care.
Day says the fact personnel shortages are running head on into increased demand means the health care system has reached a pivotal point. As the federal government prepares to release its Speech from the Throne Oct. 16, Day said it must take action in five key areas.
First, solve the wait-time/access issue: "Governments need to understand that it will be cheaper to have no wait lists. . . . Patients will reap the health benefits, taxpayers will reap the financial benefits and governments will reap the political benefits."
Second, become self-sufficient in meeting demand for health care professionals or face worse problems down the road, said Day, who noted that up to five million Canadians do not have a family doctor.
Third, sharpen the focus on children and youth health by appointing a federal child health adviser: "Too many Canadian children face significant challenges in growing up healthy, and preventive measures generate their greatest rewards among children."
Fourth, set targets for reducing the health impact of climate change because "the environmental concerns that worry Canadians the most are those related to health."
Finally, support innovation and technology use, particularly in terms of information technology.
"Our system is not working well, but it can be fixed," Day concluded. "Let's fix it."
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© Canadian Medical Association or its licensors 2007
