"With the system broken it's just tough to get people to go into a haywire situation," Don Svanvik, a retired paramedic and chief councilor of 'Namgis First Nation, which is based on the island traditionally known as Ya'Lis and known to non-Indigenous people as Cormorant Island, said of the struggle to attract health-care workers. This comment came in response to the news that the one-nurse emergency room that serves the remote community of Alert Bay, tucked off the northeast coast of Vancouver Island, would be shut down until January because it had no available staff. This is not just a problem in other parts of Canada either. Emergency services and acute care beds in rural areas of Saskatchewan have suffered from temporary weekend closures to months-long closures due to a shortage of staff. Rosthern Emergency Room was temporarily unavailable according to sources at least twice during the month of December due to a shortage of staff to cover the ER.
The issues of our broken health-care system have been brought to everyone’s attention by the stresses the pandemic put on it. However, the cracks and fissures have been there for years and the pandemic just added the pressure needed to break those fissures which include poor workforce planning, inaccessible health data, fragmented technology, and the discouraging of innovation. Prime Minister Trudeau discussed the problems in the system and the need for a solution in his year-end interview with CTV National News Chief News Anchor and Senior Editor Omar Sachedina. Provincial health ministers have collectively called on the federal government to transfer more money to the provinces, but as the head of the Canadian Medical Association said this past summer, you can't fix something by just putting money into a broken system. And here in Saskatchewan, that truth was identified 22 years ago.
In April of 2001, Saskatchewan’s Ken Fyke released his commission’s report, Caring for Medicare: Sustaining a Quality System. Without significant reform, the report warned, the quality of services would continue to decline. "Pouring more money into a system with known inefficiencies will not improve it. Indeed, new money may provide yet more excuses for not becoming more efficient," the report predicted. "Without eliminating unnecessary and inefficient utilization, without reforming the delivery of everyday services and without realizing the effects of successful prevention and health-enhancing social and economic programs, expanding medicare will be unaffordable, however desirable it may be." Fyke went on in his report to say, "New funding must buy change, not time, and must buy quality and not merely more volume."
“We're going to send more [money],” Prime Minister Trudeau said in the CTV interview, “but we need to see real improvements. We need to see results and outcomes that means that kids aren't waiting in hallways, or being airlifted across the province, that seniors aren't continuing to face under-quality care.” The Prime Minister said that the solution the federal government has is to send more money to the provinces, but the provinces need to come to the table willing to be accountable for how the money is spent and how it will improve results for Canadians. Healthcare may be the responsibility of the provinces but when it comes to the health of Canadians one provincial system should not be guarding its data and solutions from another forcing the recreation of the wheel for every hurdle.
The premiers "want an unconditional increase in the Canada Health Transfer sent to their finance ministers," said federal health minister Jean-Yves Duclos at a news conference after a November meeting ended without achieving anything... "That is not a plan. That is the old way of doing things," he said. "The current crisis is the undeniable proof that the old way doesn't work." The Canadian Medical Association voiced their disappointment in a statement issued on November 8, 2022, by Dr. Alika Lafontaine, CMA President,
“We support the call for the creation of a robust, national health data system. Sharing data and solutions is critical for quality improvement and essential to address ongoing stresses on health systems like COVID-19. We cannot address the collapse happening in disparate parts of our 13 healthcare systems without a detailed, timely, data-driven understanding of existing challenges. We are also encouraged by the steps taken by some provinces and territories exploring regional licensure and team-based care.
The deterioration of our 13 provincial and territorial health systems continues. Healthcare providers are burning out at an accelerated rate. Patients continue to suffer from delayed access to the care they need.
We can overcome our shared crises with collaborative solutions. We have already presented a prescription for what needs to be done. We look to governments to act and renew our hope that change is coming.” (SOURCE: Canadian Medical Association)
Experts say that hospitals and family practices in Canada were built to operate at almost full capacity all the time. When the system experiences spikes in need, doctors and nurses simply work longer hours to meet the demand. But the system was operating at over-peak capacity for a considerable time during the pandemic and doctors and nurses started burning out. Canada has a well-documented shortage of doctors and nurses, and doctors say the problem is made worse by the increasing administrative burden they face.
Saskatchewan doctors in both urban and rural areas are either shifting away from family medicine, leaving the province, or simply quitting. The Canadian Medical Association says family physicians work an average of about 52 hours a week, but only spend 36 hours caring for patients and if these are average numbers then there are many who work more than those 52 hours. The rest of their time is taken up by administration and other non-medical tasks extending beyond paperwork to include arguing for beds in hospitals and arranging emergency transfers. The same is true of other doctors. Medical residents work about 66 hours a week but see patients for 48. Specialists work more than 53 hours a week but see patients for just 36. Surgeons work almost 62 hours a week and only see patients for about 46.
Speaking in a December 2022, interview with CBC, Dr. Andries Muller, the president of the Saskatchewan College of Family Physicians said, "Every patient deserves to have a primary physician who is looking after their care." Muller, who is a family doctor, continued, "We just don't have enough doctors to do that." Muller said the current primary care system isn't sustainable. He believes team-based care is the solution, because there are tasks he does that could be done by other medical professionals, freeing up more of his time. "There are nurses, pharmacists, social workers and physios that can help me deliver that care," Muller said. This is similar to what Fyke put forward as a recommendation in his 2001 report. He recommended a scenario that would see pharmacists working alongside doctors and other health-care professionals in 24-hour-a-day, seven-day-a-week clinics.
Improved health care at the primary level, doctors say, would mean fewer people being sent to hospital because of the sheer volume of work family doctors do. The burden on the hospital system could be significantly reduced, doctors say, if more healthcare services were delivered outside of a hospital setting. They also say that moving palliative care out of the hospital setting would free up beds and staff. Dr. Rose Zacharias, president of the Ontario Medical Association is quoted in a January 2, 2023, CBC article that, "An investment in community care, palliative care, and home care would help alleviate strain on the hospitals." (https://www.cbc.ca/news/politics/healthcare-crisis-doctors-hospitals-rethink-1.6695642) It has been said many times by healthcare providers in every genre, that preventing people from ending up in hospital requiring urgent or intensive care is the most cost-effective measure that can be taken. Investment dollars need to be directed to preventative rather than reactionary approaches.
For the last twenty years or so, governments have been focused on cost-cutting as the solution to healthcare issues, but that didn’t create any tangible solutions and merely pushed the system into a more critical state. Doctors and nurses did more with less, the less being the actual time they had to interact with patients. It is only now that the system is breaking down, that provincial governments seem to see that there needs to be some urgency in finding solutions. Unfortunately, some seem to think that throwing more money at the problem will make it go away. Fixing the problem in the longer term is harder than that though because it takes about five to 10 years to train a doctor in Canada; it takes a minimum of four years to train registered nurses. The Saskatchewan government has decided to address some of the shortfall by recruiting abroad, while many experts argue that quickly recognizing the foreign credentials of doctors and nurses already living in Canada would provide some remedy without “poaching” health-care workers from abroad. Beyond the immediate need, planners need to be looking ahead at what the system will need 10 years down the road. It’s no good identifying that a new hospital is needed and then spending ten years trying to pull together the funding to get it built, but building it to suit what was needed ten years previous. Similarly, it makes no sense to plan to fill ten new nursing positions in five years by creating ten new seats in nursing programs, when the system is not fully staffed presently and there are potentially ten nurses retiring in those intervening five years.
Carol Baldwin, Local Journalism Initiative Reporter, Wakaw Recorder