Is health care in Ontario a disaster?

Disaster is probably too strong a word, although many would say it is not strong enough. I think the Ontario Health Care system (OHIP) has serious issues and no longer serves the best interests of patients, doctors, nurses, or other staff.

Premier Doug Ford continues to spend money foolishly which could be better spent on the health care system - or other important priorities like the environment, K-12 & post-secondary education, public transit and child care. The ways in which Doug Ford wastes money are long, but let's start with three. Number One - Removing the fee for license plate renewal costs the province $1 billion. Positioned as a cost-of-living action, every citizen in Ontario qualified. This means, for example, residents of Rosedale, living in multi-million dollar homes and driving $100,000+ cars no longer have to pay to renew their license plates. Really? Why not target these savings at low-income families who need the break? Or eliminate license plate renewals for owners of electric or hybrid-electric cars to ensure the reduction of greenhouse gases? Or put the money into public transit to give people reliable options and encourage less car use? Number Two - Sending out a $200 cheque to 15 million Ontarians will cost $3 billion and is an attempt to influence an early election call. Again, our friends in Rosedale will get this cheque even though they probably don't need it. What would the impact of $3 billion be on healthcare, low-income housing, child care, homelessness or public transit? Huge - but of course Doug Ford is more concerned about buying the next election. Number Three - Highway 413 will likely cost at least $10 billion, damage the environment and minimally improve commute times if at all. I won't repeat myself but what could $10 billion be spent on? See the list above.

So, what are the problems with the Ontario Health system? Let me start with issues relating to family physicians, as I firmly believe they are crucial to a successful healthcare system.

• There is a critical shortage of family doctors in Ontario. The Ontario College of Family Physicians says that 1 in 4 Ontarians will be without a family doctor by 2026. That is 4.4 million people.

• Family physicians are the lowest-paid doctors in all of Canada. Medical students are assuming huge debts, likely over $300,000, as tuition for medical school increases. It takes 10 to 14 years to finish med school, at which point many individuals also want to get married, buy a home or start a family. This debt becomes a significant factor when choosing a field of practice. Fewer students choose a career in family medicine as specialists get paid more. Although many people do not go into medicine for the money, this is not something we should rely on to make the system work. Given my belief that a family doctor is key to ensuring positive outcomes from the health care system, this income issue is significant.

• Family physicians should be respected more by both the healthcare system and patients. Income is only one indicator of the lack of respect toward family physicians. Being on the front line of the medical system, family doctors have insight into what improvements the government could make to OHIP. Likewise, disrespect and in some cases, outright abuse of doctors by patients is on the rise. Whether it is people's frustration with the system, requests for unnecessary and in some cases dangerous prescriptions like opioids, or general entitlement, doctors are increasingly at risk.

Outside of these issues around Family Physicians, there are other problems in the Ontario healthcare system:

• Long wait times: Wait times for specialist care, surgery, and diagnostics are often longer than acceptable standards. Ontarians may wait 20 - 50 hours in the ER to see a doctor or nurse.

• Understaffing: Hospitals are understaffed and struggling to keep up with demand. The number of staffed beds in the province has dropped to 2.23 per 1,000 people.

• Lack of focus on preventative actions to avoid illness

• Hallway health care: Patients are being treated in hallways and storage closets.

• Mental health and addiction programs: These programs are inadequate.

• Home and community care: This is insufficient.

• Privatization: Some believe the province is funnelling public dollars into private, for-profit clinics.

• Disorganized care coordination

• Lack of integration of digital health tools

• Closures of operating rooms, hospital units, and emergency rooms

There are many problems, but I want to touch on a couple before describing two personal experiences with the healthcare system and some possible solutions.

Privatization of Healthcare - Despite all the issues, Canada, and by extension Ontario, has one of the best public healthcare systems in the world (ranked anywhere from 4th to 30th in various reports). Our system must be protected. It can be a slippery slope to allowing the breakdown of the public healthcare system. Having said that, I think the opposition parties in Ontario often make general statements that are meant as scare tactics and don't specifically articulate the real problem. Here are a few examples of things we should and shouldn't be worried about:

• Any "privatization" of the system is bad. For starters, most doctors specifically family physicians are private contractors who run their offices/clinics like a small business. They bill OHIP for insured services and bill the patient for any non-insured services they provide. In my view, there is no issue with this. An even better example is the private ultrasound and x-ray clinic my family doctor uses. The owner(s) have purchased the equipment and hired the technicians and personnel required to staff the clinic. When I show up for an ultrasound or x-ray, I only need to show my OHIP card - the clinic bills OHIP for the services rendered at no cost to me. In my view, this works perfectly. By the way, I can walk in for an x-ray with no appointment and get a same-day appointment for an ultrasound. There is no way having this clinic owned and operated by the government would improve this service (it would likely ruin it).

• Paying a private clinic for insured healthcare services is the beginning of a two-tiered healthcare system and likely the end of our public system. In my view, this must be avoided at all costs. Once we let our public healthcare system go, there will be no way to get it back. This includes paying a private clinic for an insured service (one that can billed to OHIP), charging for a component of an insured service (including a block fee for a service) or paying a fee to expedite a service.

Our healthcare system must be protected, but medical professionals and politicians need to be accurate, specific and honest about the issues and solutions by not understating the problem or creating scare tactics.

Mental Health care is significantly underserved as our healthcare system is largely set up to handle physical health issues. When my mother was alive she suffered from several mental health issues. These issues inhibited her from living independently. I would take her to the hospital emergency and explain her problems to the doctors. They would refuse to admit her saying there was "nothing (physically)" wrong with her. Fortunately, I was able to get her into a private residence that supported her needs, but this removed any possibility that she would live independently again. I don't know whether mental health treatment would have allowed her to live on her own successfully but unfortunately, our system in Ontario does not support this requirement so we will never find out.

I think it is worthwhile to describe my two most significant interactions with the Ontario Healthcare system and what I conclude from the experience.

• Hip Surgery - Teresa and I started working out with a personal trainer in January 2024. Over the next few months, it became obvious that I had significant weakness and a lack of mobility in my left hip. During my annual physical, I was able to discuss this issue with my family doctor. In my mind, this is the first critical point to ensure a successful outcome. If you don't have a family doctor, you are forced to use a walk-in clinic or the ER at a hospital. Neither of these options is likely to have the same quality of timeliness or follow-through. After examining my hip, my doctor concluded I had significantly less mobility on my left side and sent me for x-rays and an ultra-sound. The results came back showing the lining on my hip joint was largely gone and I had significant arthritis in my left hip (ugh!).

  My family doctor referred me to my local hospital (Oshawa-Lakeridge) for a hip replacement assessment. This assessment process was previously handled by the orthopedic surgeon, taking up his/her valuable time that would be better used performing surgeries in a timely way. Now a physiotherapist assesses whether you are a candidate for surgery and whether your case is considered urgent or non-urgent. This change assigns the assessment to a qualified professional, saves the healthcare system money and as mentioned above, frees up the surgeon's time. My assessment was scheduled in May less than four weeks after my doctor's referral. I met with the surgeon in June for a short appointment where she confirmed I was a candidate for a hip replacement. At that time, they were scheduling operations for September - I was thinking I would be waiting for at least 18 months, not 2! I told her we were planning to travel in September, but no problem she would complete the operation when we returned. I was promptly scheduled for November 22. After returning home, I had my pre-op appointment at Oshawa-Lakeridge with a physiotherapist where I was given a complete booklet on everything I needed to know about the surgery, and what I needed to do before and after the surgery. The communication within this booklet, with the hospital, the surgeon and her office was complete and thorough. I arrived at 6:15 am for my 7:30 operation (day surgery). I woke up around 11:00 am in recovery where the nurses were professional, attentive and helpful. I messaged Teresa to let her know everything was good and she had already received a call from the surgeon letting her know everything went well (this was a very nice touch). Before leaving the hospital, an occupational and a physical therapist showed me how to get dressed, use the walker, get up and down stairs as well as exercises to do while recovering at home. Because I read the booklet, I had already rented the necessary equipment. Before I left the hospital, my follow-up appointment with my surgeon was scheduled (less than two weeks after the surgery), as was my first session with a physiotherapist (also two weeks after surgery). I was also required to download the SeamlessMD app which provides daily remote medical monitoring. Each day for two weeks I completed a series of questions about my health relating to the surgery. You can highlight things you are concerned about and attach photographs if required. I did this twice during the two weeks and both times I received a call from a nurse within 10 minutes of submitting my data. This was efficient, much better than having to go to an appointment and a lower cost for the healthcare system. At my first appointment, the physiotherapist had access to all the information about my surgery. I really can't think of how my experience could have been better. The whole process from beginning to end had been timely, responsive and empathetic. I am approaching six weeks post-surgery and will have further physio sessions to strengthen my hip. I see my surgeon next week to ensure everything has healed properly and get her final "clearance". As a bonus, I have not had any pain (zero!) and more mobility than I expected. This is an example of how the system should work.

• My second example is from just over 20 years ago. I was diagnosed with prostate cancer. Fortunately, my family doctor had me complete the PSA test when I turned 40. At 45 the results of the test were still in the normal range but significantly higher than the four previous tests. Although at this point I was hoping this was nothing serious, after completing both an ultrasound and a biopsy, the biopsy showed I had prostate cancer. Again, my family doctor was key to this early detection. He had suggested taking the PSA test at age 40 (much earlier than most men take it) and he quickly referred me to a urologist for testing. Based on the recommendation of the urologist and family members who were MDs, I decided to have my prostate removed. I remember standing with the urologist's receptionist to book my surgery date (again at Oshawa-Lakeridge). It was a Wednesday and she told me I would be scheduled for Tuesday. "This Tuesday?" I asked. "Is there no wait time for this surgery?" She nicely (kind of) asked whether I wanted the time or not. When Teresa and I arrived home after my operation, there was a huge box at our front door. These were all the medical supplies the visiting nurse would need to ensure my recovery was successful. Although I would say the urologist's bedside manner could have been better, that was a very minor issue in the whole process. Again, the system was timely and coordinated. Although prostate removal was a very invasive procedure 20+ years ago (I was in the hospital for over a week and off work for 3 months) I was very fortunate to catch the cancer early, have successful surgery and remain cancer-free for over twenty years. My family doctor played a critical role in ensuring I successfully navigated the system.

So what can we conclude from all of this and what if anything can be done to "fix" the Ontario Healthcare system? I am going to acknowledge upfront that "fixing" this complex system is something I don't know how to do. However, I think some steps can be taken that will help.

• Family doctors are critical to successful outcomes in the healthcare system - Without a family doctor, you are unlikely to get the attention, responsiveness or follow-through you need. If family physicians are key to successful outcomes and 1 in 4 Ontarians will be without a family doctor by 2026, then action needs to be taken now

  • Family physicians need to be paid more. This can be accomplished by either increasing the service fee doctors bill or increasing the annual amount doctors get paid per patient (the two systems currently being used in Ontario). Family physicians need to be paid competitively with other disciplines to ensure that graduating students see family medicine as a desirable career.

  • Along with increasing the fees to family physicians we also need to reduce the number of patients family physicians are expected to see. Currently, this is approximately 80 patients during an 8-hour shift. This does not allow for the time and thoughtfulness that is required for quality care. Getting input from family doctors is a way to solve this problem.

  • The CMA and provincial governments have colluded to restrict the number of students that can enter medical school. Without lowering standards this practice needs to stop so we get more doctors into the system, ensuring that the family physician issues are solved and underserved areas have access to health care.

  • Family physicians should be encouraged and incentivized to have patients take preventative actions to improve their health. This could include ensuring complete and timely vaccinations, diet and weight management, etc. Again, I think family physicians would have the insight on how to implement this successfully.

• Explore creative ways to free up specialists'/surgeons' time - The process in place for my hip replacement surgery works. The use of physiotherapists ensures a qualified person is completing the assessment while freeing up the surgeon's time and hopefully shortening wait times. This process could surely be expanded to other specialties and surgeries. There have been several cases written where surgeons have come up with ideas to speed up surgeries. One idea was to utilize operating rooms during "off hours". In this case, an orthopedic surgeon was able to assemble the required team (nurses, anesthetist, post-operative care, etc) that was willing to work in the middle of the night (midnight to 6:00 am) or on weekends. This allowed the surgeon to specialize in a particular operation (hip replacement for example) and perform a number of these operations that otherwise would have taken longer to schedule during regular hospital hours.

• Continue to expand the use of private services to provide OHIP-covered healthcare - As a reminder, both my family doctor and orthopedic surgeon are independent businesses. They are responsible for their expenses (rent, staff, insurance, etc). They are not government employees, they do not receive a salary from the government. They provide services that in most cases they bill OHIP for. From this OHIP revenue, they pay their expenses etc. (in rare cases they may bill the patient directly for services not covered by OHIP). Likewise, my x-ray and ultrasound clinic are also independent businesses that provide services and bill OHIP. Blood work labs operate the same way and seem to be very efficient. One area where it seems to me this could be expanded is for MRIs. The wait times for MRIs in Ontario are horrendous and in many cases by the time the patient can schedule an appointment the usefulness of the procedure is gone. Why not encourage private clinics to provide OHIP-covered MRIs to shorten the unacceptable backlog? This could take the form of low/no interest loans to purchase the equipment or grants to subsidize the cost. In return, the clinic would be expected to efficiently provide the service for only OHIP-covered procedures (no private billing).

• Expanding Mental Health Care - I don't have a specific idea on how to implement this but certainly, the need is there. The stress and negative impacts on both children's and adults' mental health are increasing exponentially. Again, I think input from doctors, and community leaders would likely bring forward the best solutions.

I completely understand that my list of recommendations will not correct all the issues with the Ontario Healthcare system. However, during my business career, when facing large complex problems I usually led to a two-pronged strategy. Even in the most complex of problems, there are always opportunities to implement smaller, quicker solutions that will be consistent with your longer-term strategy. These "quick fixes" not only resolve real issues but they provide momentum to help you while you resolve the longer term more complex issues.

One solution that I am very wary of is the outsourcing of healthcare services to pharmacies. While I agree that some medical services would be better provided by lower-cost professionals other than doctors the use of large corporate cabals like the Weston family does not seem like a good direction to me. These companies have already proven their level of sleaze with price fixing, poor employment practices and price gouging. There are already reports surfacing of overbilling for shoddy drug "reviews" that take advantage of the elderly and most vulnerable. I am sure there are better alternatives than entrusting healthcare services to Shoppers Drugmart and the elitist Weston family.

So what am I hoping you get from all of this?

1. Family physicians are of utmost importance in ensuring that the healthcare system, even in its current imperfect form, provides an adequate level of care to patients. Do whatever you can to support family physicians and force our politicians to recognize this key resource.

2. The system can work. My two experiences prove that and I know there are lots of others who have had a positive experience with the healthcare system. Let's not trash the system, let's work to make it better.

3. Do not let politicians erode our public healthcare system. Once it is gone we will never get it back

4. Speak specifically and in detail about issues and solutions. Don't fall for political taglines like "outsourcing" or "privatization". Doctors' clinics, x-ray/ultrasound labs, and blood work labs are all good examples of "private" businesses that can provide high-quality healthcare funded through the public system.

Let me know your thoughts, ideas, and experiences at thethirdperiod.ca@gmail.com