Health System by The Greatest Canadian: Tommy Douglas
In October 2004, CBC Television aired the first portion of The Greatest Canadian television series to acknowledge the radical contributors to Canada’s upbringing as a refined modern society. Although the final shortlist featured the likes of David Suzuki, Terry Fox, Sir John A. MacDonald, and Pierre Trudeau, no individual amongst this quartet of eulogized Canadians participated in the formation of Canada’s most esteemed system; Medicare. This healthcare system was so revolutionary that it still remains an integral piece of Canada’s national identity, and perhaps the reason why Tommy Douglas, the man accoladed with its successes, was deemed The Greatest Canadian. Douglas won the honor for his belief that all Canadians deserve the right to quality healthcare, irrespective of their social or economic situation. Douglas’ Medicare system, however, was fashioned specifically for the past four decades and has not evolved to cope with the uprise of urbanization. Increased emergency wait times sparked by horrendous bed management in hospitals, lack of emergency doctors, and the selfish attitude of family practitioners remain the overarching issue. Although Canada’s Medicare structure continues to rank among the top in the world, there must be a significant reform to emergency wait times to appropriately serve aging and increasing population efficiently. Such a transformation commands a restructure in first-hand patient care, economical efficiency, and the employment of medical teams. The implementation of such a fluid system would not only allow healthcare to become progressively accessible to all Canadians, it would also ensure that emergency wait times are no longer a healthcare barrier.
While highly regarded around the globe, Canada’s health system is unable to meet the standards that other first-world countries consistently define. The Medicare system itself has several issues that must be addressed. An ongoing medical issue that irritates Canadian patients is the lengthy emergency wait times, which are on average, four hours. According to a poll reported by the Commonwealth Fund Survey that measured emergency wait times, Canada ranked “below average and bottom of the pack” when compared to its international peers including Holland, Britain, New Zealand, and other European nations. Although it is true that waiting is common in tax-funded healthcare systems, a delay of care often translates to worsening conditions. Such conditions require more complicated procedures that regularly yield poorer outcomes. The article “The effect of wait times on mortality in Canada” discusses the many repercussions of waiting, including strained personal relationships, indignity associated with increased reliance on others, embarrassing consequences of the untreated medical condition, mental anguish, and even death. With its inconvenience to patients and terrible repercussions, waiting long periods of time for treatment remains a gaping hole in Canada’s medical system.
In chemistry, the limiting reagent determines how much product can be formed when synthesis takes place. This means that all of the limiting reagents must be used up in order for the reaction to be considered complete. Similarly, the amount of patients a hospital can assist is solely dependent on the number of beds they possess. So in theory, the beds are the limiting reagent and the rate-determining step of a patient’s visit. Simply put, the majority of hospital wait times are induced by the unavailability of beds. The importance of hospital beds often go unnoticed by patients, yet, it is the key to accessing hospital-based services. According to the Canadian Institute for Health Information, there are roughly 57,000 hospital beds in Canada (excluding Quebec). Of those 57,000 beds, 13% are utilized by patients who no longer require acute care, meaning that 7,500 beds are occupied by patients who could be discharged or relocated. “Alternate level of care” or ALC, however, refers to patients who have been approved by their physician to be discharged, yet they are unable to access the recommended post-acute care for their condition (this is mainly for older individuals). Such patients disturb the efficiency of hospitals since they occupy staff time, hospital resources, and beds that could benefit individuals waiting in the emergency room. The inability of Canadian hospitals to strictly enforce a flexible bed management system highlights another contributing factor to increased wait times and unacceptable service in general.
A second contributor to high emergency wait times in Canadian hospitals is the shortage of emergency doctors. According to Roger Collier’s article “Canada’s emergency medicine shortfall”, Canada holds an emergency physician shortage of around 487 doctors, a statistic projected to skyrocket to 1,518 in 2025. Additionally, Collier establishes that nearly 40% of all urban emergency departments bear a staff shortage, a number that rose to 63% in rural areas. Patients can identify that a lack of doctors increases mortality (as described above); however, rarely does one think about the stress put on a single doctor. A case study completed by CBC News on the ER of the Queen Elizabeth Hospital manifested the adversity P.E.I doctors are facing. Dr. Trevor Jain expressed that since the hospital lost two doctors from the original 14, him and his colleagues have had to work more shifts to carry the remaining load: “Physicians are doing more night shifts, we know that is extremely detrimental to their health and their well-being and their work-life balance”. Neither the patient nor the physician is benefiting in this situation and more importantly, neither party is satisfied with the result of a depleted staff. Without a reasonable ratio of doctors to patients, wait times in the emergency room are only going to rise.
Another culprit of Canada’s long emergency wait times relates to the lack of involvement of family doctors towards emergency medicine. In a CBC National interview in late December 2015, Danielle Martin, a family doctor at Women’s College Hospital, described her protocol when a patient with acute issues approaches her office: “If I see a patient in my office that has a condition more acute than I can deal with in a fifteen-minute visit in my office, pretty much the only option that I have had, at least in the past has been to send my patient to the emergency room”. Martin’s intentions through these words seem clear; if the issue is time-consuming, it would be better suited for the ER. Referring a patient to the ER, especially with minor injuries, will force that patient to spend what will seem like an eternity in the ER (their sustained injuries would not be a priority), further clogging the system. Family doctors also have a tendency to enforce what they call a “one problem per visit rule.” The fundamental idea here is to achieve balance in patient satisfaction, funding capacity, and productivity. This method of action taken by family doctors has caused quite the controversy, as many patients enjoy the quickness of the overall checkup whereas others feel it is “restricting the patient-physician interaction”. The obvious flaw of the “one problem per visit rule” is the dilemma that occurs when more than one issue must be assessed. In such a case if the family doctor refuses care, then the only location for an individual to receive care would be found in the ER. Thus, the usage of family doctors must become much more tactical and efficient if Canada’s wait times are to decline.
Though the Canadian Medicare system is not completely broken, emergency wait times are currently the most prominent downside. To repair this issue, a reformation on three levels must take place; restoring first-hand patient care, economical efficiency, and the relative responsibility of family physicians. On the topic of patient care, one solution that will most definitely decrease wait times would be the implementation of a national seniors’ strategy. At the moment, 17% of Canadians are above the age of 65, and by 2031 Statistics Canada predicts that one in four Canadians will be a senior. With an aging population, the demand for a senior plan is higher than ever, especially since older bodies require more medical attention. Perhaps, seniors can have their own publicly-funded hospitals (through slight tax adjustments). This would vacate many public hospital beds and clear some time for doctors to get to each patient and completely full, thorough checkups. In the age of digital technology, it would also be useful to utilize virtual consultations instead of physical appointments. The use of Skype or FaceTime would make the passage of information regarding symptoms incredibly smooth. Additionally, virtual consultations could be done in the comfort of one’s home, therefore no travel would be necessary. In terms of wait lines, booking a ten-minute video call with a doctor allows them to condense the information given, as well as sending YouTube videos to display the application of certain medicines or drugs (which would save incredible amounts of time). Therefore, doctors can maximize the number of patients they attend to per day, while still providing thorough examinations. Since Canada is in preparation of serving an aging population, establishing hospitals solely for seniors would lower patient wait times drastically. Similarly, the implementation of virtual consultations would allow a patient to call during a given time and have their needs fulfilled quickly if the issue is minor, completely avoiding the ER in the process.
The second piece of the solution to decrease emergency wait times would be to restructure the economical background of Medicare. According to the article “How Canadian Health Care Differs from Other Systems”, Canada is the only country of nine to prohibit private financing for health-related services. Fraser Institute also identified that Canada spent 11% of its GDP in 2018 on healthcare, a number that translates to approximately $190 billion. Holland is one of the closest nations to Canada in terms of GDP spending on healthcare, spending 10.3% of its GDP. However, the Dutch healthcare system maintains much shorter wait times than the Canadian Medicare system, with almost identical results. In contrast to Canada, the Dutch system makes use of universal coverage by means of an insurance premium-funded system; which features competition among private insurers. If Canada were to integrate some replica model of the Dutch system to work alongside the current health system, there could be a massive breakthrough in regards to waiting times. Insurance companies would likely compete for head to head with each other (increasing Canada’s GDP in the process with their profits), and citizens would reap the benefits of reduced wait times, seeing as no insurer would want to lose a client over decreased prices. Although much of this plan still remains hypothetical, Holland possesses one of the most efficient healthcare systems in the world, so structuring the Medicare system around the positives produced by the Dutch would undoubtedly shrink the emergency wait times.
The final piece of the solution that must be considered to lower emergency wait times is the future role of medical teams. Dr. Don Melady, a geriatric emergency physician, participated in the same CBC National interview as Danielle Martin (mentioned above). Melady claims that the emergency department is not merely a front door for patient care but more so a front porch. He states that this ‘porch’ is a “place where people can come...and have their acute issues addressed, so as to avoid admission into the hospital”. He further explains a flaw that he has witnessed in the emergency department: “One of the things emerge[ncy] departments probably haven't been very good at is mobilizing an interdisciplinary team of people to look after the patients”. This interdisciplinary team would consist of therapists, pharmacists, social workers, nurses, and physiotherapists, to name a few. The purpose of this team is to assist individuals who would come into the emergency department with several issues that require attention. These issues could be physical, emotional, or psychological. Though Melady briefly hinted that its implementation would be difficult, the effect that these teams could have on individual patients would be astonishing. With several workers participating in the help circle, it is no doubt that the patient would be taken care of very quickly (unless the issue is severe). Since the patient is assisted quickly with minimal delay, the usage of an interdisciplinary team in hospitals would be a turning point for healthcare efficiency.
As the 2020s are fast approaching, the healthcare system must be adequately equipped to handle an aging population. The health system itself must be precise, fast, and thorough to care for as many individuals as possible. The implementation of senior-only hospitals, virtual consultations, insurance premiums, and medical teams will ensure that emergency rooms follow a fluid system that avoids patient congestion. Therefore, if Canada executes the newly efficient model of Medicare described above, it is no doubt the Canadian health system will flourish for decades to come.
