Canadian Doctors Like Me Are Starting To Look For The Exit?

Canada, and especially Ontario, has become an increasingly unattractive place to practice as a doctor.

The preceding caption was used to introduce a commentary from a young Canadian doctor, Adam Stewart, providing his perspective on the challenges of being a practicing MD in Ontario, the most populated province in Canada. To read the entire article posted by Dr. Stewart, please visit: https://www.huffingtonpost.ca/adam-stewart/canadian-doctors-like-me-are-starting-to-look-for-the-exit_a_23077616/

I felt compelled to respond but Huffington limits the length of commentary so I had to break it into five (5) separate segments. I have included the complete response below. We each have opinions and bias resulting from our experiences and perspectives and I would love to hear from you and in so doing, learn. My hope is that Dr. Stewart took the time to read my response to his narrative... I have yet to hear from him.

Response to Dr. Stewart, August 20, 2017 (Huffington Post)

I am heartened to see this article which provides one young, practicing MD's perspective on what I have been suggesting for years is an incapable healthcare system in Canada with a structure that is not aligned with the needs of Canadians today and tomorrow. 

Fixing is not the solution... redesign is a must, but as a former Federal Minister of Health for Canada recently told me, "We don't have the appetite for the radical change needed". We refuse to address this crisis at the political level and Canadians, who foot the bill (60% of all tax dollars go directly or indirectly into healthcare), have yet to rise up and demand that the Federal and provincial governments sit down and devise a national strategy for our universal healthcare system. Instead, they quibble over transfer payments and funding, "equity of the system", and protect the model of redundant provincial ministries who invest in their own healthcare care systems, including electronic health records (EHR). 

Why isn't there ONE nationwide EHR and a similar nationwide pharmaceutical management and registration system? How much has this cost Canadians in terms of delays, cost and fraud??

MD's are not just vendors (yes, Dr. Stewart, you are suppliers so let's remind ourselves of this, and also, that we are customers who pay for that service). But... MD's are also, like the public, beneficiaries of this failing system... they, too, have healthcare needs and loved ones, both young and old, that depend on a high-quality system that provides "just in time" access and high quality services and technology, no different than the rest of the population of Canada. Many remote locales, including First Nations, indigenous communities, including those in Canada's far north, suffer the worst.

You cite how unfavorable it is for MD's in this province but I see no mention of how unfavorable the conditions are for the population (and Canada as a whole) when trying to access quality healthcare support.

I have been on the physician wait list with Health Care Connect for over six years, having been asked to find a new MD by my then-physician, a young, inexperienced MD right out of residency who had grown frustrated with my challenging of his poor lack of care for my ailing wife. His letter to me read;

".. a physician-patient relationship is based on trust and obviously you and I have trust issues so it would be in your best interest to find another physician... The good news is that (my home town) has an excellent emergency department if you need anything." 

Back to the issue at hand... What IS Canada's long-term health care strategy? I don't think there is one other than "keep bailing the boat". And that... is only delaying the inevitable.

Dr. Stewart... I too, am an entrepreneur. Soon to be 59, I have no pension and have to fund my own retirement. I do contribute to the economy by hiring employees/consultants, pay taxes, pay rent and overhead costs. I, and my family, have made immeasurable (and in hindsight, some regrettable) self-sacrifices. I do not have the education you speak of and as a result, do not carry the burden of that cost, but my compensation over my lifetime has reflected that decision, similar to the lessons learned in Hasbro's popular board game, "Game of Life".

These are the choices we have made and life does not offer guarantees... our hope is to live, laugh and leave a legacy. Your legacy, Dr. Stewart, will be the lives of those you have touched positively over the years of your practice, realizing that every encounter you have will not be a home run and you will make mistakes... you are only human. Your children will inherit your world and it will be very different than the one you grew up in. 

The "American Dream" was just that... a dream, and North Americans are starting to come to the realization that their equity has been based on a "Ponzi scheme" of global proportion (another story). But back to healthcare...

I have had the privilege of working with various levels of health care over the last two decades, collaborating with teams across Canada in continuous improvement efforts spanning primary and tertiary care as well as provincial and Federal administration. I am extremely appreciative of the great work done on the front line by dedicated, passionate and caring people who do whatever they can to provide care to their patients and clients while supported by processes that are far too dependent on the person doing the "right thing", those processes painfully inadequate - either poorly designed or simply having evolved that way.

The problem, Dr. Stewart, is that you are part of a system that long ceased to be capable and the erosion you are seeing is the same experienced by everyone in this country. You are NOT suffering alone and we are all making sacrifices.

You, your colleagues, and the respective colleges can either play a productive role in helping this country find a solution or, to your point, you can catch the next train out of dodge and find a better location to practice medicine.

Sadly, the majority of Canadians in need of healthcare today cannot board that train with you... they must get in line with the rest of the crowd and wait and hope that the care they need, whether primary, tertiary, or quaternary, is available when it is needed... something that becomes more and more unlikely with each passing year.

And let's not get started on the tsunami of elderly population with escalating needs for alternative levels of care, another crisis directly impacting health care and families across Canada.

If you are open to it, Dr. Stewart, I would love to meet with you for a respectful discussion to exchange ideas on how Canada's healthcare system can be transformed to the benefit of all stakeholders, including the MD's and other professionals working on the front line. Rather than fighting change, let's embrace it and help to shape a positive future, accepting that the world we create will be very different and some of the professional paradigms will have to be abandoned.

We need to be "all in" on this and not simply cherry-pick the changes that we feel are best for the individual or select group... we must consider the greater good and, more importantly, future generations... our children and theirs.

We all deserve better and I think we can do better... we just need to all work together, starting with a re-visioning of what healthcare means to Canada and Canadians... the governing principles... and go from there.