No easy answers

January 12, 2024
Stethoscope sitting on a Canadian flag.
Sage asked health-care experts if they could wave a magic wand to fix Canada’s health-care system, where they would start. The short answer is there’s no magic wand.

In ancient Greek mythology, Asclepius was a prolific healer as a mortal. After death, he was resurrected as the god of medicine. He is usually depicted as carrying a serpent-entwined rod that is a symbol of medicine and health-care to this day. The connection of rods to medicine shows up in other ancient cultures as well, where they were often credited with healing properties. So it’s a short leap from healing rods to magic wands, which have long played a role in popular culture — from Homer to Harry Potter. When someone is in an impossibly tight spot, there’s nothing like waving a magic wand.

Canada’s health-care system could really, really use a magic wand today.
People without a family doctor. Long waiting lists for surgery. Closed emergency rooms. Inadequate mental health services. Medical staff are overworked and exhausted. If not dying, Canada’s health-care system is certainly sick. Even Prime Minister Justin Trudeau referred to it as a “broken system” earlier this year.  

What’s to be done?

As president of the Canadian Medical Association and a family physician in the B.C. communities of Coquitlam and New Westminster, Kathleen Ross, not surprisingly, would address the doctor shortage.

“As a community-based physician myself, I live, every day, the crisis that we face in primary care,” Ross says. “So increasing the number of primary-care providers, particularly family physicians working in…community-based care would be where I would wave my magic wand.”

She knows it won’t be easy. It means training more family doctors in what Ross calls the four Cs of primary care: first contact, comprehensive, continuous and collaborative. It means recruiting more internationally trained physicians and streamlining the credentialing process for the ones already here, while also keeping the family doctors currently practising from leaving the field by “looking at administrative burdens to try to ensure we’re spending more time caring for patients.”

That’s also an approach favoured by Jane Philpott, who spent almost 20 years as a family doctor in the Markham-Stouffville area near Toronto before serving as federal health minister from 2015 to 2017. She is now dean of the faculty of health sciences at Queen’s University in Kingston.

“I would wave a magic wand and make sure that every single person who lives in Canada had access to a primary-care team where they could go through the front door of the health-care system and get access to care,” Philpott says. “That is the one thing that would have a ripple effect through the entire system.”

She acknowledges we are “quite a ways” from that.

“The latest data is that approximately 80 per cent of Canadians are at least technically aligned with either a family doctor or a primary-care nurse practitioner,” Philpott says.

“Even within those, though, there is probably 30 per cent who are attached, but can’t actually get in to see their physician. So only half of Canadians can regularly count on a place to go for their care.”  

She says health-care should be no different than education as a basic right.

“Can you imagine the outrage if we said, ‘Yeah, 80 per cent of our kids can access a public school. The rest can figure it out for themselves,’” Philpott says. “But that’s actually what we’re saying when it comes to primary care.”   

That’s the same analogy used by Danyaal Raza, a fellow at the Broadbent Institute think-tank and a family physician with Unity Health in Toronto.

“No matter where you live, you have schools to send your son or daughter when you move to a new neighbourhood,” says Raza. “We can build a primary-care system that works in a similar way.”

He agrees there is a crisis within the health-care system.

“It’s no secret that more and more people across the country are having difficulty finding a family doctor and that problem is likely to get worse before it gets better,” Raza says. “There are also issues around the corporatization of primary care. We’re seeing large, publicly traded companies look to family medicine and family doctors as a revenue stream, but it doesn’t have to be this way.”

Raza doesn’t buy the argument that public funding for health-care is out of control in Canada.

“You look at every dollar of health-care spending in Canada, 70 per cent is public, but that’s actually less than many of our peer countries, countries such as the U.K., Germany, France, Sweden,” Raza says. “They all spend 80 per cent or more and I think this surprises a lot of Canadians.”   

He points out there are only two areas of health-care where Canada currently offers universal access: doctors and hospitals.

“But we have huge access issues in prescription drugs, mental health, especially mental health that is offered by psychologists and social workers, home care, long-term care,” says Raza.

Douglas Angus is professor emeritus at the Telfer School of Management at the University of Ottawa, where he has spent much of his career looking at health economics. He is not surprised Canada’s health-care system is in crisis.

“There was no question it was going to happen, based on demographics,” Angus says.

An aging population has put demands on a system designed for a younger population. The need for chronic care, for example, has skyrocketed.

His magic wand solution?

“This has been recommended I don’t know how many times — beef up the home-care sector.”   

Angus would like to see an emphasis on keeping people in their homes or getting them back there as soon as possible after a hospital stay. That means providing everything from nurse visits to meals delivered. One of the first steps would be making home care a more attractive profession in terms of wages and working conditions.

Angus says this would actually be less expensive overall for the system and have the added benefit of keeping people healthier.

But he’s not optimistic Canada will see changes any time soon, partly because of our federal system where each province has its own health-care system.

“We do not have a Canadian health-care system,” says Angus. “We have 13 different systems with significant differences.”

So he isn’t holding his breath waiting for needed changes.

“There is no quick fix, that’s the sad thing about it,” he says, lamenting the lack of long-term planning. “It is so engrained in the political system that politicians don’t look beyond the next election.”

Louis P. Perrault, a cardiovascular surgeon in Montreal and president of the Association of Cardiovascular and Thoracic Surgeons of Quebec, has been outspoken about the need for more funding in the system, after watching some colleagues burn out during the pandemic while others moved to the United States and elsewhere.  

But the answer isn’t just throwing money at the system. He would wave his magic wand to get everyone working together on improving the health-care system: governments, hospital administrators and clinicians.

“I would transform the health-care system into a timely, well-funded, caring, patient-centred, humane, personalized system that [is respectful of diversity and individuals] and provides an attractive, stimulating, gratifying, decently compensated and individually conscious environment for all health-care providers to work as a collaborative multidisciplinary team,” says Perrault, adding that the emphasis would be on prevention and treatment for

“all Canadians and their families, irrespective of their capacity to pay or their connections.”

Michael Gardam agrees the health-care system is in need of repair.

“I think it was broken before the pandemic, but the pandemic made it glaringly obvious that it was broken,” says Gardam, the CEO of Health Prince Edward Island and chairman of HealthCareCAN, which calls itself the national voice of hospitals and health-care organizations.   
If he could wave a magic wand, he’d give Canada’s health-care system a complete makeover.

“I think we’ve had many decades of expansions and Band-Aid solutions, using duct tape to keep it together,” Gardam says. “This health-care system that medicare was brought into in the 1960s is nothing like our health-care system today, but we have kind of refused to go back and look at those initial ideas because we’re just not allowed to do that in Canada. Health-care is kind of considered to be an absolutely sacred thing.”

Trying new approaches can be useful, he says, even if they don’t work. He points to the example of Quebec, which experimented with private surgical clinics.

“They found out they were more expensive,” Gardam says. “They’ve studied it and it’s not saving us money. That’s not a failure. We’ve learned something and can move on.”

Too often, he says, politics get in the way of necessary reforms.

“Politicians get worried, the local populace gets worried. Don’t take away my local whatever. We need to talk about whether we can afford the local whatever.”

Gardam believes we need to have the “difficult conversation’ about what services should be covered and where they should be provided. Even in his small province of P.E.I., he says, where most people live within an hour of Charlottetown, there is a debate over whether people should be able to receive services closer to their communities.

Shawn Whatley is another one who believes we have to rethink the entire Canadian health-care system and address some sacred cows. In 2020, the Toronto-area physician and past-president of the Ontario Medical Association, published a book, When Politics Comes Before Patients: Why and How Canadian Medicare is Failing.

As that title suggests, Whatley thinks one of the big problems with the system is that politicians keep tinkering with it for political reasons. They’ve lost sight of what medicare is supposed to do, he says, focusing on the “fair” distribution of care rather than providing the necessary care.

Whatley believes the first step to fixing the system is finding out from Canadians what they want.

“Most people I talk to — and I mostly talk to patients — would say ‘We need medicare so I can get care without having to pay for it when I’m sick’.”

Whatley says there will have to be tough discussions about what level of care is appropriate.

“Are they thinking about a third opinion for their anterior knee pain? Anterior knee pain is the bane of an orthopedic surgeon’s existence. There’s nothing we can do for it, we shouldn’t be doing MRIs for it, yet patients will come in over and over and ask for this, that and the next thing. You look and say, there’s nothing we can do for them, but health-care’s free so we’ll order tests.”

One thing that gives Whatley optimism is the fact that Canadians — even politicians — are now recognizing the system needs a major overhaul. Changes are going to take a lot of hard work and soul-searching.

“One of the magic solutions is to stop asking for magic solutions,” he says.

This article appeared in the winter2023 issue of our in-house magazine, Sage. While you’re here, why not download the full issue and peruse our back issues too?