Dr. Brian Day @DrBrianDay Twitter

  • Past President Canadian Medical Association
  • Past President Arthroscopy Association of North America
  • Honourary Associate Professor University of British Columbia
  • 2014 Doctors of BC Don Rix Leadership Award

It’s time for a real leap forward

By Dr. Brian Day

The CBC news story of the suffering of a young child (one of many who had their surgeries postponed at the B.C. Children’s Hospital) adds to the reality that we are facing a healthcare crisis unlike that in any other developed country. The public needs our expertise to help solve the shortage of resources and address rationed access.

To solve a problem, one must first admit that it exists. Governments have turned a blind eye to the crisis. In the frenzy that consumed Mao Tse Tung’s communist China more than 60 years ago, millions were led to believe they were living in an evolving Utopia. Zhuang Pomin, a volunteer during that period of the “Great Leap Forward,” later explained, “When we look back it seemed like madness …at the time it seemed completely normal.” Our children and grandchildren will, I believe, look back on our current health system with similar sentiments—unless we make the necessary adjustments now.

When I started my practice, patients who needed a test, a specialist consultation, or a procedure did not wait. If patients were lining up for surgery, we simply operated more or took on more surgeons. Family physicians were available to all and enjoyed being able to practise their profession without the obstacles that limit them today. Unbridled growth of health bureaucracies has led to them taking control of both resources and clinical decision-making. Frontline physicians need to regain their past influence.

Our system is expensive and inefficient compared to other universal systems. There is not a health or finance minister in the country who believes the current level of rising costs is sustainable. Despite those escalating costs, the system is not fulfilling its promises to the public. It is also clear that the important determinants of health, such as education, affordable housing, and youth programs, are suffering because of the “black hole” of healthcare costs.

During my tenure at the Canadian Medical Association, I led an effort to persuade governments that global hospital funding—which treats patients as cost items—should be replaced with patient-focused funding. This empowers patients and realigns priorities in their favour. It is supported by Kirby’s Senate Committee, the Castonguay Task Force in Quebec, and the OECD. It is official policy of Doctors of BC and the CMA. We need to forcefully reassert our commitment to this change. Transformation of this nature must occur at the provincial level and our associations need to pressure governments on this. Long-term health and financial benefits will repay short-term costs many times over. Unfortunately, governments tend to focus on three- to four-year financial cycles (as far as the next election).

Preston Manning describes the often-used political strategy of “extremism” that is used to attack the policies of opponents, even when they are reasonable. In the political arena, the quickest and most efficient way to discredit an opponent, or any idea that they’re putting forward, is to label it and its proponents as extreme. Then one argues, not against the position but against an extreme caricature of that position. This strategy has been used against me. I have stated many times that I believe the private sector has a role within a universal system, as it does in social democracies in Europe and elsewhere. Despite my unequivocal position on the role of the private sector, some have tried to distort my position as “privatizing medicare” and promoting a “two-tier American-style” health system. I do not believe many physicians are fooled by this.

What about facts and data? The Commonwealth Fund ranked Canada 10th of 11 developed countries on healthcare. Within Canada, the Wait Times Alliance identified B.C. as the worst-performing province, ranking last in value for money and low (23rd) in quality alongside 29 European countries. Economic data show Canada is actually paying more in order to keep patients waiting.

I would like to see physicians organize their own task force that would include members representing rural and city-based specialists and family physicians, university and laboratory-based doctors, residents and students. The mandate would be to objectively evaluate best practices from other jurisdictions. As physicians we will present solutions to government. In the past, many (probably hundreds) of millions of dollars have been spent (wasted) on more than 300 government healt care task forces and commissions. We have the expertise to do better.

Physicians from all disciplines and all areas of Canada want a system that works for all. Senior members of our profession (including me) practised when access to excellent care was taken for granted. We must convince governments, the public, and the media that success is achievable. Many years before the introduction of Medicare, Canada’s doctors developed a template for a national universal health system. We led then and we should lead again.

Our young colleagues are inheriting a system that is not working. They are the future and bring a vital perspective. Thanks to government policies of the 1990s we have a critical doctor shortage and five million Canadians don’t have a family physician. When I came to Canada in the 1970s we were fourth in the world in doctors per population. Those government policies reduced us to 26th. There are 3,500 young Canadians in foreign medical schools, forced to leave the country for medical training, and 50% never return. Despite very long waits, more than 170 young orthopedic surgeons are denied hospital privileges. Similar examples apply in other areas of practice.

Governments must not be allowed to use doctors as scapegoats for their failings. We must work with them to achieve our goals but, when necessary, confront and oppose policies that are contrary to our mission. We have witnessed the deterioration of our once excellent health system. It has declined to the point that innocent sick children are being denied access. It’s time to act now and not have a Zhuang Pomin of the future look back and opine, with reference to our current Canadian health system, “When we look back it seemed like madness … at the time it seemed completely normal.”

See my thoughts on leadership.