No Solutions Found In Election-Style Health Care Politics
In some political circles, there is reluctance to talk about health care during elections. There never seems to be enough funding to meet the overall demand for care and there are growing numbers of patients who cannot access the services they need. Health care issues are complex and serious, and don’t lend themselves to simple election-style rhetoric like “The Budget Will Balance Itself” and “Buck-A-Beer”. But they do need to be discussed and debated despite former Prime Minister Kim Campbell’s reported line decades ago that, “An election is no time to discuss serious issues”.
The primary care crisis is too big and urgent a problem to be dismissed with political spin as was attempted in May of 2024 when the Ontario Ministry of Health stated there was “no concern” about diminished supply of doctors in the province. Now, with the provincial election called and the federal election looming, the Ontario government’s efforts to address primary care have taken shape with former Liberal federal health minister Dr. Jane Philpott as the Ford government’s Primary Care Action Team leader and $1.8 billion in funding.
As reported in iPolitics on Aug 30, 2024, before Dr. Philpott was given the position of Ontario’s Primary Care Action Team lead, she was considering a political comeback. It is refreshing to see a person so well-qualified be tapped to provide advice to the Ford government at such a pivotal time in health care; it was also a pivotal time in the campaign cycle when she could have been running for the Ontario Liberals in the Markham-Stouffville riding against Ontario Minister Paul Calandra who she defeated federally in 2015. Whatever the reason Premier Ford chose to pull Dr. Philpott into his circle of advisors, Ontario is lucky to have her in this new role. Qualified and experienced advisers are needed.
Dr. Philpott would not be the first physician to be pulled into the vortex of health care politics at strategic times including leading into an election. Recall that Dr. Bob Bell was president of the University Health Network for nine years and became Ontario’s Deputy Health Minister days before Ontario went to the polls in 2014. He had been instrumental in promoting innovation in the acute care system such as providing care for international patients that could support hospital budgets and contribute to more services for Ontarians.
In Healthy Debate from April 23, 2014, the program was explained as follows:
“The revenues from this work have funded improvements to the facilities at Princess Margaret Cancer Centre and will also allow us to invest in a new electronic patient record. These funds are critical to our ability to continue as Canada’s leading research hospital – something that is of great benefit to the citizens of this province and Canada as a whole.”
Unfortunately, some groups such as the RNAO were unsupportive even though improving hospital budgets would have retained nursing positions and doctors and created more capacity to care for Ontarians. RNAO’s Doris Grinspun wrote at the time:
“If patients from other countries can come and pay for services, there is nothing stopping Ontarians from asking for-or demanding-the same.”
Unfortunately, this program was halted, and Dr. Bell was absorbed into the government as Deputy Minister for Ontario’s Ministry of Health and Long-Term Care. He served as DM from June 2014 until June 2018 when the Ontario Liberal government was defeated after the scandal-ridden Wynne government attempted to balance its books by freezing hospital budgets and offering sub inflationary increases while waits for care grew and access worsened.
Dr. Bell continues to contribute to health care discussions in a variety of roles long after his time as Deputy Minister. His insights are valuable and credible.
Dr. Philpott and Dr. Bell are just two examples of the many capable and qualified people who have attempted to contribute to improving health care in Ontario, yet access problems only worsen. The hard truth is that health care in Ontario and across Canada has a structural problem where choice is denied to patients and integration between care in the community and acute care settings is sorely lagging.
As is frequently the case, individuals and groups from academic and health institutions are tapped to provide reports on how to address health care including primary care. This is done routinely rather than government looking to support the efforts of community-based physicians themselves who have the clearest lens on what could be done to improve access for patients and who understand the importance of the patient-physician relationship best.
Those physicians who have attempted to innovate within the confines of existing rules as they understood them, find themselves up against newly created barriers and more uncertainty in providing their services than ever before. Mark Holland’s letter to provinces and territories describing new federal policy on the Canada Health Act as pertaining to nurse practitioners, pharmacists, and midwives is an example of self-serving political gamesmanship that raises many questions about the limits, if any, of federal intrusion into provincial and territorial health care authority.
Physicians want to innovate but when they do, politicians and bureaucrats often fail to support their efforts, instead relying on the same institutions and organizations that have failed for decades to produce the solutions needed. Yet, the status quo is not tenable. Front-line providers can be the drivers of innovation themselves if they have the freedom to be productive and to foster the relationships needed in the community.
More innovation needs to occur to bring choice and integration to the overall health care system beyond acute care and academia. There are innovative thinkers who could help academic, and health institutions broaden their perspectives in health care beyond health care politics.
The DeGroote School of Business recently interviewed the President of St. Joseph’s Healthcare Hamilton, Mike Heenan. His experience within the health bureaucracy of the Ontario provincial government helps to provide context.
The trends he foresees in the future of healthcare include:
A demand for greater choice by patients and their family.
“We are going to be pressed for different models of care, access to different services and convenience.”
Integration along the continuum of care.
“There are hospitals, long-term care and home care services that are all part of the healthcare system, but they are disparate entities, and they need to come together.”
He makes the following statement in terms of the seriousness of health human resource shortages compared to the growing demand for care, particularly for the 75-90 year old age group:
“The thing that has struck me the most is that unique collision: this population is getting sicker as our health human resources are retiring. We were unable to predict that collision because of the pandemic, which is why it is disrupting the system. We did not have the time to pause and think about that part of the future.”
The Ontario Medical Association reports that despite renewed government commitments, the shortage of doctors has not improved over the past year. There are 2,600 vacant physician positions across the province, no change since last year. Ontario has 2.5 million people without a family doctor and expected to be 4.4 million by next year. But the shortage of nurses is also severe and there is a much smaller pool of nurse practitioners. There is a relative shortage of pharmacists as well.
Solutions including improved compensation are urgently needed to support existing family doctors, reduce their burden of administration, and attract new doctors to primary care. Universal team-based primary care is only viable if there are sufficient providers over the long-term, including family physicians, and sufficient funding to create sustainability and certainty for conditions of practice. The bottom line is that sufficient sources of funding are needed to pay for sufficient numbers of professionals if health care is to be truly universal.
Despite the demographic shift being evident for many years at both the general population and workforce level, the federal government has only just released “the first pan-Canadian study of its kind, confirming a significant gap in the health workforce that, if no action is taken, will worsen over ten years”. This should not be a surprise.
Caring for Canadians: Canada’s Future Health Workforce-The Canadian Health Workforce Education, Training and Distribution Study conducted by Dr. Genevieve Moineau, Chief Medical workforce Advisor at Health Canada, indicates a significant lag in workforce planning compared to Canada’s OECD nation peers. The numbers speak for themselves as to the severity of the problem in a Canadian Medical Association bulletin January 31, 2025, referring to the report:
“With the 2023 OECD average number of new graduates at 14.2 per 100,000 population, Canada is at the bottom of the pack, producing 7.5 new doctors per 100,000 people with only Japan, Korea and Israel lagging behind”
“There is currently a deficit of 22,823 between supply and demand for family physicians in Canada, and with only approximately 1300 new graduates per year. At this rate, Canada will never solve the existing physician shortage”
There are shortages of other providers as well, but which have not been fully quantified before. The projected deficits include 28,000 nurses; 2,700 nurse practitioners; and 1,700 pharmacists.
The data is a message for politicians that health care requires immediate attention and structural reconsideration beyond our current system that has led to the constriction of the health workforce over many years. The data is not an indication that family physicians can be replaced with nurse practitioners or nurses in primary care team settings. There are simply not enough of them either and shifting them to primary care will only leave a void in acute care settings or other community-based areas of work.
Despite the efforts of so many good and experienced people attempting to address the shortcomings of our health care system including in primary care, access is worsening in Ontario and across the country. The shortage of health human resources, especially family physicians, will not be solved by looking away and simply depending on an improved economy. It cannot be solved by making personnel announcements and splashing money about just before an election. Better understanding of innovation that is occurring in the community is needed and can inform improved choice and integration. There are three specific areas where government can find innovative solutions. More on this in my next column.
References
“No Concern about ‘diminished supply’ of doctors: health ministry”, Canadian Press, May 8, 2024
https://www.cbc.ca/news/canada/toronto/doctors-ontario-medical-association-fees-1.7197475
“An election is no time to discuss serious issues: Five comments that sank Canadian political campaigns”, National Post, August 12, 2015
“Jane Philpott considering political comeback”, iPolitics, August 30, 2024
https://www.ipolitics.ca/news/jane-philpott-considering-political-comeback
“Province Appoints Dr. Jane Philpott as Chair of New Primary Care Action Team”, Ontario Newsroom, News Release, October 21, 2024
“Toronto hospitals seek more medical tourists”, Toronto Star, April 2, 2014
“Caring for international patients improves care for Canadians”, Healthy Debate, April 23, 2014
“Medical tourism: the beginning of the end of Medicare”, RNAO CEO Dispatch With Doris Grinspun, May-June 2014
https://rnao.ca/sites/rnao-ca/files/CEODispatchMayJune2014.pdf
“UHN’s president named deputy minister of health”, Canadian Healthcare Technology, April 2, 2014
https://www.canhealth.com/2014/04/02/uhns-president-named-deputy-minister-of-health/
“Mark Holland’s new interpretation of the Canada Health Act: too little too late?”, Policy Options, January 31, 2025
https://policyoptions.irpp.org/magazines/january-2025/canada-health-act-interpretation/
“The future of healthcare: Mike Heenan on trends and disruptions”, DeGroote School of Business,
“In an election that puts Ontario first, your health shouldn’t be second”, Ontario Medical Association, January 29, 2025
“Ground-breaking new report reveals Canada can’t train enough doctors and other health professionals. Unless we dramatically change how we do things.”, CMA, January 31, 2025
“Caring for Canadians: Canada’s Future Health Workforce-The Canadian Health Workforce Education, Training and Distribution Study”, Health Canada, January 30, 2025
“Canadian health work force needs tens of thousands of additional providers, study finds”, Globe and Mail, February 2, 2025
Dr. Merrilee Fullerton’s book “A Physician in the Political Arena” can be read here.