A commentary by a former deputy health minister in British Columbia and Saskatchewan who also served on two royal commissions on health care. He is a former CEO of the Greater Victoria Hospital Society and the Capital Health Region.
Like many Canadians I watched the meeting of our political leaders wrestling with the “epic” subject of “money” for health. I reflected on the many episodes of so-called Medicare crisis, I have witnessed since I began my career as a pharmacist on July 1, 1962, the day Medicare was introduced to Canada.
Over the years, Canada has had at least nine health commissions to recommend improvements to Medicare. Most of these commissions recommended primary health reform, and showed the lack of money was the least of the problem.
Yet here we were on Feb. 7, 2023, holding our collective breaths when the prime minister announced a financial package and the premiers reluctantly agreed to bilateral talks for more.
Our political leaders reacted as though the higher the dollars, the healthier we will be.
Reforming primary health is essential; however, it is only one contributor to a healthy society.
Other contributors include housing, climate, industrial competitiveness, and jobs. Reforming primary health addresses the root causes of our Medicare crisis and makes our health services more sustainable.
The commissions emphasized that primary health is the foundation of our public health services, and the real shortcoming is not the lack of money, nor is it the lack of professionals.
The real shortcoming is the division of labour and restrictive ‘scope of practice’ for most professionals. Nurses, pharmacists, and others have the education to fully practice their profession; however, they are prevented from using many of their skills.
Family doctors do what nurse practitioners ought to do, and nurses do what therapists ought to do and on and on.
My experience as a pharmacist was that the practice was extremely limited relative to my education and soon moved to a more satisfying career.
To change primary health, we must have a mature discussion about the roles of professionals.
We will not meet the needs of our citizens, nor will we have sustainable services if we cling to outmoded “turf protection” rather than health results and provider satisfaction. We need to reward good results, abandon obsolete practice, pursue innovation, and realign the division of labour referred to as “scope of practice.”
Family physicians need more than a higher fee schedule. They need reimbursement systems that support them to spend the time required so patients do not seek everyday care in hospital emergency departments.
Nurses need to practise at a higher level and assume responsibilities currently the purview of the physician.
Pharmacists need to be responsible for medication therapy consistent with their six or more years of education. Similar changes are needed in the scope of practice of most other health professions as well.
There are inefficiencies in our health services, and the gross under-utilization of our dedicated professionals is the greatest travesty of waste, frustration, burn-out, and professionals leaving.
While I left pharmacy many years ago, the problem today has greater implications for our country.
Maintaining obsolete divisions of labour, that are eroding our health services, contributing to staff shortages, and overwhelming emergency services, while pursuing answers through more money, client-pay clinics, increased training programs, and adding new health specialities will only result in more wasted public resources, public anger, and more crises.
Before we spend billions of dollars buying more of the same, whether it is higher incomes, more training programs or more health professionals, let us have the courage and leadership to achieve a division of labour that is contemporary, rewarding, satisfying, and one that meets the real needs of our citizens.
With a progressive vision for the future already available, our political leaders have an historic opportunity to use the proposed bilateral talks to ensure our resources are used in the best way to improve our health and ensure health services are sustainable.
They can seize this moment to reform primary health services and end the recurring episodes of Medicare crisis that have plagued our country for 60 years.
While history tempers my optimism, I am still hopeful.
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