The status quo is not acceptable. We need bold, transformative action to save our health-care system

Emergency department waits are continuing to rise, access to primary care is becoming increasingly desperate, surgical backlogs persist, adult and pediatric mental health access remains elusive for many patients – all while patients’ medical and social needs are becoming increasingly complex. These problems are exacerbated in rural and remote settings.

It is no secret that access to quality, timely and sustainable health care has been strained over the past decade. Having 17 per cent of patients without access to primary care is not acceptable. We cannot accept our current situation as the status quo.

Today’s problems arise from yesterday’s decisions. We must demand bold action to transform health-care delivery and provide the care Canadians deserve.

We need a long-term focus on recruitment, retention and health human resources

While many provinces are creating incentives to recruit physicians to their jurisdictions – with many even sending staff to recruit in neighbouring provinces –we must not forget about retention. Whether it is unsustainable call burdens or patient loads, insufficient resources or administrative support or lack of autonomy in practice, the same conditions that contribute to difficulties in recruitment will hamper retention.

Having a short-term view is problematic for the persistent issue of health access. Often, the best time to recruit is when there is a stable complement of health-care providers. However, it is all too common for health authorities to wait until there is a calamity, sometimes from the departure of a physician, to focus on recruitment efforts when retention would have prevented it.

We need to remove red tape in recruiting and retaining physicians. Governments and health authorities need to work alongside physicians to ensure physicians are able to find suitable positions when finished training. According to a recent study, up to 20-25 per cent of physicians that graduate from Memorial University between 2003-2018 wanted to practice in Newfoundland and Labrador but faced barriers in doing so. These barriers included ineffective recruitment efforts, lack of transparency in new physicians’ communication with health authorities, inequitable distribution of resources and workloads proposed, as well as return-of-service agreements that were not honoured.

When services are successfully transitioned to the community, it reduces the strain on overburdened hospitals, increases efficiency and provides care closer to home for many patients.

Evidence-based health policy prioritizes primary care – we are not listening to those on the frontline

The evidence is clear that populations with adequate access to primary care have better overall health outcomes and health equity as well as reduced socio-economic disparities and overall health costs. The case for investing in primary care including team-based care is as simple as that.

Reduced access to family physicians contributes greatly to increased emergency department waiting times and has downstream effects on health-care delivery in other specialties.

The mass exodus of health-care workers during and immediately after the pandemic has exacerbated health access to primary care. The status quo for practicing full-scope primary care is unsustainable given high administrative burden, increased costs to run a family practice, more complex and elderly patients, insufficient support and stagnant fees despite the considerable increase in inflation.

We need a paradigm shift in physician-informed health systems policy

I was fortunate to be able to complete an inter-professional health systems fellowship through the University of Alberta School of Public Health along with other clinician leaders, administrative leadership and academics. In learning from international leaders from different health systems, I learned about the potential of community-based care, nimble governing bodies, interoperable electronic medical records (EMRs), responsive recruitment strategies and team-based care.

When we look at policies ranging from information needed for referrals, windows to deliver biopsy specimens, documentation standards, EMRs, patient access, laboratory and radiographic results and which medications are covered under provincial drug programs, for example, it is clear that physicians have insufficient input. We are often not consulted, or our opinion is sought “after the fact” on policies and procedures that significantly affect our day-to-day practice.

Our health-care system is in crisis, and we cannot expect better outcomes with yesterday’s approaches. We need health innovation that is informed by end-users who should be given the influence to inform health policy that their knowledge skills, and day-to-day frontline experience deserve.