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

Candidate for President-Elect, Doctors of BC

I am running for President-Elect at this pivotal time, as our health system is in crisis, and not serving physicians or patients well. When I started practice, if patients needed a test, a specialist referral, or a procedure, they did not wait. If patients needed surgery, we operated more - or took on more surgeons. Now, layers of bureaucracy consume resources and make decisions. Frontline physicians must regain their vital influence on the system.

Physicians have the expertise to be at the forefront of creating a strong universal system, without access problems. We are innovators - trained to diagnose and solve problems. Bureaucracy is stifling innovation. Personal satisfaction in our profession is eroded when our ability to influence positive change is lost. I have worked as a salaried university teacher, and in public and private practice. I have participated in and chaired many committees, both academic and administrative, at local, national and international levels. I also travel extensively as a visiting professor and speaker in many other countries. I am a Past-President of the Arthroscopy Association of North America, the world's leading academic society in my field. I have acquired a broad international outlook on health policy issues. These perspectives provide the motivation to work with Doctors of BC towards real health care transformation. I believe physicians can lead reforms, and I know that politicians want that leadership.

The Canadian Health System

Our system is expensive and inefficient compared to other universal systems. Doctors, patients, and governments accept that the status quo is not an option. Chronic disease is rising and responsible for over 70% of health costs. We have the highest percentage of over 65 year olds in Canadian history, and 70% of them suffer from 2 or more chronic diseases. In a recent 20 year period, a 400% rise in health costs paralleled a 25% rise in population. That is unsustainable. As our health monopoly consumes more of the budget, other important determinants of health, such as education, affordable housing, and youth programs, suffer.

BC doctors have historically taken a leadership role in health policy. After my CMA tenure, I recognized that health transformation must start at a provincial, not national level. Our constitution dictates that medical care is primarily a provincial responsibility. As CMA President, I led an effort to persuade governments that global hospital funding - treating patients as cost items – should be replaced with patient focused funding. The BCMA pioneered this policy, which empowers patients and realigns priorities in their favour. It was supported by Senator Kirby's Committee, the Castonguay Task Force in Quebec, the OECD, and the CMA. We need to reassert our commitment to changes that encourage the system to serve patients, not the reverse.

Rationing and waitlists led me, in 1995, to help establish our surgery centre. My OR time had dwindled from 22 to 5 hours a week (10 below the minimum recommended for competence). I went from being able to offer grateful patients timely care, to having to explain unreasonable waits to frustrated patients. Our group's wish was to treat patients (initially treating workers) rather than manage wait lists. It is time to make universal healthcare accountable and sustainable. This will require continued innovation in delivery methods and the incorporation of best practices of universal systems that outperform us. WorkSafe BC is an example of a successful hybrid model; all patients should have the same access that injured workers and the RCMP receive. I don't favour privatizing Medicare, but I believe the private sector has a role within a universal system – as in WCB and extended care programs.

The Commonwealth Fund ranked Canada 10th of 11 developed countries on health care. We rank last in value for money and low in quality compared to 29 European systems. We actually spend more to keep people waiting. In Canada, the Wait Times Alliance and CIHI have identified BC as the worst province for access. Society has a legal, moral, and economic duty to deliver timely care. I would propose that Doctors of BC create a task force that includes rural and city based family physicians and specialists, university and hospital based doctors, and residents and students. The mandate would be to define a path to successful health reform through innovation that includes the incorporation of best practices in other jurisdictions. The views of all BC physicians would then be solicited and the results presented to government and the public. We can and should lead this effort.

Government Relationships

We must cooperate with government leaders at national and provincial levels. I believe I am qualified to help lead such an effort. I have addressed federal MP's and ministers within Canada's parliament. I was the Premier's keynote speaker at the BC Provincial Conversation on Health, and I have interacted positively with provincial and federal political leaders over many years. I know that governments want and need our help. They know that supply is not keeping up with demand.

Our Profession

Physicians from all disciplines and all areas of BC and Canada want a system that works for all. Senior members of our profession practised when access to excellent care was taken for granted. To achieve that again we need a plan for reform, and must convince governments, the public, and the media that success is achievable. In my year as CMA President, I conducted 300 media interviews, attended over 100 meetings, and met with more than 20 newspaper editorial boards, eliciting 39 supportive editorials. I engaged with colleagues, the public, and the media in positive and rewarding dialogues. 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.

New Graduates and Students

Our young colleagues are inheriting a system that is not working. They are the future and bring a vital perspective. We have a critical doctor shortage and 5 million Canadians don't have a family physician. When I came to Canada in the 1970's we were 4th in the world in doctors per population. Government policies reduced us to 26th. There are 3500 young Canadians in foreign medical schools, forced to leave the country for medical training, and 50% never return. Despite very long waits, over 170 young orthopaedic surgeons are denied hospital privileges. Similar examples apply in other areas of practice. Despite overwhelming demands, governments have cut access to physicians.

The current crises in Ontario and Alberta, where doctors are scapegoats for broken systems, are a taste of what is in store if we don't act. Doctors are the reason the system has lasted this long. We must work with governments to achieve our goals, but at the same time oppose policies that are contrary to our mission. Front line physicians have witnessed the deterioration of our health system. We have the trust, knowledge and professional responsibility to lead necessary reforms, but we must start now.

To those who encouraged my candidacy, I thank you for your support. To all BC colleagues, I ask for your support and your vote. Together, we can build a world class health system here in BC.

See my thoughts on leadership.