My prediction: more ERs will close and more doctors will burn out

Without a viable national strategy, Canada’s healthcare system will continue to collapse.

Alika Lafontaine is the president of the Canadian Medical Association.

mMost Canadians have only just become aware of the country’s severe shortage of health care workers over the past two years. The headlines are alarming: emergency rooms are shutting down and patients wait months for specialists. Some have even tried to recruit doctors by placing advertisements in local newspapers. This crisis, which has been going on for decades, is far from resolved. It could reach a breaking point in 2023.

Doctors are extremely burnt out, and it’s no wonder why: A study from the University of Chicago found that if U.S. primary care physicians followed national guidelines for preventive, chronic illness, and acute care, it would take them more hours than they would in a day ( 26.7) to see an average number of patients. You might as well apply those findings to Canadian doctors, who follow similar care guidelines. Our 2021 National Physician Health Survey found that physicians are considering working fewer hours. Many of our nurse colleagues do the same. It is likely that staff shortages and access to medical care will only worsen in 2023, and patients and their families will feel the greatest burden.

Hospitals could increase physician retention rates by improving working conditions. They could train and integrate medical writers and physician assistants to free up bandwidth for direct patient care. They could develop team-based models of care where several people share the burden. For example, some hospital rehabilitation programs form transdisciplinary teams—of physicians, nurses, social workers, and physical and occupational therapists—ensuring better communication and better patient care.

Canada has also never had a nationwide personnel system dedicated to the healthcare workforce. We have 13 health jurisdictions, each with their own localized plan. Many of those jurisdictions already prioritize mental health and increasing system capacity, but they still operate separately. Providers are weighed down by red tape. I know a general surgeon who practices in Atlantic Canada and sees patients in four provinces because those are the only areas that cover certain types of care. So that doctor has to work under four county jurisdictions each year, losing hours of administrative work that could otherwise be spent on patients — or on their own personal lives.

Pan-Canadian licensure would remove barriers in virtual mediamovie. If we had pan-national licenses, doctors would be vircare in places where they couldn’t work before and relieve the pressure on local doctors. Imagine a scenario where a patient in Yellowknife needs virtual care and can’t get an appointment with a healthcare provider near him because the doctors are overbooked. Under a pan-Canadian system, they could go online and see a Calgary licensed physician.

Last March, the federal government identified its top five awardsfor new healthcare spending: cutting back care arrears, better long-term and home care services, more resources for mental health and substance abuse, strengthened virtual care resources, and stabilization of primary care – the most pressing priority in my opinion. There are reasons to hope that a refurbishment could come in 2023. At the Federation Council meeting in Victoria last July, the Prime Ministers focused heavily on strengthening health care partnerships between the provincial and federal governments, as well as improving patient care. There is certainly a need for better coordination between our compartmentalised health systems.

But talking about it is not enough. People, especially doctors, want to see action. For years, providers like myself have sacrificed significant parts of our lives in the service of a system that no longer works. What is different now is that we have nothing more to sacrifice. There is no capacity; we maximized our time. Unless we see major structural changes, I’m not very confident that things will get better next year. COVID revealed how close Canada’s healthcare system is to collapse, but it also showed that strong collaboration can go a long way. Faced with the pandemic, leaders across the country worked together to contain the damage from the virus in a short period of time. I hope we can work together again to resolve the current crisis before we reach the point of no return. We’re getting close.

– As told to Alex Cyr

This story is part of our annual “Year Ahead” package. Read the rest of our predictions for 2023 here.

This article will appear in print in the December 2022 issue from Maclean magazine. Buy the issue for $9.99 or better yet, subscribe to the monthly print magazine for only $39.99.

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