The Canadian medical profession is facing major upheaval

[aaronjw]

http://www.theglobeandmail.com/life/health-and-fitness/health/the-canadian-medical-profession-is-facing-major-upheaval/article13941175/

 

 

The Canadian medical profession is facing major upheaval

By ANDRÉ PICARD

Patients are demanding more patient- and family-centred care and a lot less paternalism

 

"I don't think there's ever been a greater time for our profession to shine than right now," Louis Francescutti, the new president of the Canadian Medical Association, said at the outset of his inaugural address at the 146th annual meeting of the CMA.

 

But nor has there been a time when there was more angst in the profession of medicine, and that unease bubbled just under the surface throughout the deliberations of the self-proclaimed "Parliament of Medicine." There are 78,000 doctors in Canada; that is more than there ever has been, in raw numbers and per capita. Physician income has climbed steadily in recent years; in some parts of the profession, gross income is up 30 per cent over the past decade.

 

Yet there was little celebration at the physicians' gathering in Calgary this week. There were long discussions about a troubling new trend: Unemployed and underemployed doctors, and concerns – expressed explicitly and implicitly – about health professionals such as pharmacists and nurse-practitioners assuming roles that were once the exclusive purview of physicians.

 

There were many hallway chats about the tough labour environment: the numerous contract squabbles of the past year, the even more difficult talks that lie ahead as governments try to move away from fee-for-service payments and impose more restrictions on physicians and demand more accountability. But beyond physician supply and income – the hot button issues that always get the most attention – there is a much more fundamental upheaval taking place.

 

Medicine has long been synonymous with health care. Doctors were the masters of hospitals and they dominated primary care with private practices, all the while remaining fiercely independent. But all that is changing.

 

Health-care systems in Canada and elsewhere are moving away from the traditional medical model. Patients (and payers) are demanding more patient- and family-centred care and a lot less paternalism. Care is shifting out of hospitals, the traditional power base for specialist physicians, and into the community. The traditional family physician in solo practice is disappearing and being replaced by clinics staffed by multidisciplinary teams. (Where doctors will still play an essential role, let's not forget.)

 

Along with the recognition that the sands are shifting is a fair bit of grumbling, especially from older docs (there is a striking generation gap in the practice of medicine that is rarely talked about).

 

Dr. Francescutti told his colleagues to embrace rather than resist change, for the good of patients. He even urged them to consider some radical ideas.

 

"Wouldn't it be great if there were no patients?" the CMA president said. "We need to have that conversation."

 

By this, he means that physicians should not just sit back and treat disease; they have to put much more effort into prevention and, in particular, use their influence to get governments and the public to address the root causes of disease, the so-called socio-economic determinants of health. (His predecessor as CMA president, Anna Reid, also made this her rallying cry.) That means advocating for early childhood education, social housing, decent wages and the like, not just more health spending.

 

Dr. Francescutti referred, at length, to the "wake-up call to the profession" delivered last year by Governor-General David Johnston.

 

In a memorable speech to the Royal College of Physicians and Surgeons, Mr. Johnston reminded doctors that they are a party to a social contract, one that grants them status and privilege, but in return entails an obligation to serve the public good.

 

In 2013, the public good requires that Canadian physicians embrace a fundamental transformation of the health system and that they advocate passionately for the changes – patient-centred care, a shift to the community and tackling social inequities – even if they will, as a profession, pay a price for doing so.

 

That may be a bitter pill to swallow, but it's better than the alternative.

 

As Dr. Francescutti said: "Embrace new ideas or have them imposed." If Canada's doctors respect the social contract, the medical profession will indeed shine, and we will all be healthier for it.

[Slipstream]

Good read, thanks for posting.

 

I especially liked the part, "What if there were no patients?" Got me thinking a little bit. That would be amazing, although it probably won't happen. But if it did, after going through medical training, what would you guys do? I'd say I'd do research, but if there were no diseases at all, I guess I'd have to pick something totally different (my options other than med school were neuroscience research and physical rehabilitation).

 

I guess I'd go into some sort of governmental / policy work.

[seeking1]

Hey OP, isn't you copy-pasting large segments of an article like that onto the internet some kind of plagiarism? They put up a pay wall for a reason.

[Slipstream]

Hey OP, isn't you copy-pasting large segments of an article like that onto the internet some kind of plagiarism? They put up a pay wall for a reason.

 

There isn't a pay wall for this article. Plus, he basically referenced it by putting the link up there. Now, if he passed it off as HIS work, then it'd be plagiarism

[ralk]

Supporting the midlevel encroachment on medicine is also a stupid move. This "multidisciplinary team" garbage reduces the role of a physician from patient advocate and care leader to cog. Again, the patient loses their independent advocate. The pharmadrnurse says: " I'm sorry brooksbane(not prefaced by Dr.), but we cannot investigate using X test on Mr. Y because the 2013 Ontario/Pfizer consensus guidelines recommends test Z, since it is a cheaper alternative. If you think it is inappropriate and test X is warranted, fill out this "request for test clearance" and fax it to the head office. They'll determine whether the test is ordered or not. The head office is staffed by BAs from Bob's Community College."

 

Physicuans aren't the only ones who can be advocates for patients - so can nurses, pharmacists, etc. I agree that the role of administrators should be minimized, and that final decisions should be kept with physicians. However, other health care professionals have a roll to play in patient advocacy and are often better positioned to see impacts on patients - nurses especially. Giving other professions a stronger voice in patient care decisions means there are more patient advocates, not fewer.

[future_doc]

Hey OP, isn't you copy-pasting large segments of an article like that onto the internet some kind of plagiarism? They put up a pay wall for a reason.

 

No, it is not. He has given attribution. Certain websites prohibit copying and publishing, this one does not. The OP in giving the link/source has not violated copyright law.

[ralk]

I disagree. One can only be a true advocate if they have only the patient to answer to. Nurses and other ancillary staff answer to their paymasters, and will always do so unless awarded independent practice rights like physicians. This would never be allowed by legislators because it would be too costly;the reason for mid level encroachment is cost containment, not to mention their training is wholly unqualified for medical practice.

 

When physicians become employed team members, or need to answer to midlevel staff employed by bureaucrats, patient advocacy erodes.

 

All regulated health care professions have the exact same responsibility to their patients as physicians do. They have regulatory bodies which have the legal responsibility to ensure quality, which must have mechanisms for patient complaints, same as physicians. They can be sued for negligence or incompetence.

 

Yes, other health care professions also have a responsibility to their employers. However, it is very difficult to fire a practitioner unless they are being negligent or demonstrating incompetence. Physicians, at least in hospital settings, have much the same feedback mechanism; they can lose privileges in the hospital. Furthermore, in many specialties, what a physician can do is set by what's available in the hospital - which is still ultimately controlled by bureaucrats.

 

I'm not arguing for physicians to be salaried employees, I don't think that would be a beneficial move for the profession or for patients. But in terms of patient advocacy, despite needing to "answer to bureaucrats" (many of which are former health care practitioners themselves), other health care professionals are frequently the ones advocating for their patients' best interests.

[NLengr]

 

Francescutti is the guy who lambasted the new generation of unemployed doctors on WhiteCoat. I thought that was in poor taste given the wait-times for patients that require the care these specialists could provide if the appropriate infrastructure was in place.

 

 

After I heard that, I lost all faith that he would act in my best interest as a young physician. Typical baby boomer.

 

The sooner this guy finishes up his stint at the CMA the better. Someone who actively insults a huge part of the CMA membership and clearly demonstrates he has no interest in their well being should have no role in the CMA.

 

I have zero confidence in his ability to lead, and I think that feeling is widespread amoung young physicians.

[chicagoschool]

After I heard that, I lost all faith that he would act in my best interest as a young physician. Typical baby boomer.

 

The sooner this guy finishes up his stint at the CMA the better. Someone who actively insults a huge part of the CMA membership and clearly demonstrates he has no interest in their well being should have no role in the CMA.

 

I have zero confidence in his ability to lead, and I think that feeling is widespread amoung young physicians.

 

And yet he still is right about many things, regardless how it makes you feel. Particularly in his whitecoat interview he got to the heart of an important idea - that it's not an employment system. It's a healthcare system.

[A-Stark]

And yet he still is right about many things, regardless how it makes you feel. Particularly in his whitecoat interview he got to the heart of an important idea - that it's not an employment system. It's a healthcare system.

 

Which is just empty rhetoric that happens to sidestep the considerable problems in postgrad training spaces and available jobs. And, yes, it is a healthcare system, so that underemployed orthopaedic surgeons in a setting of record wait lists for orthopaedic surgery is absolutely unconscionable.

[NLengr]

And yet he still is right about many things, regardless how it makes you feel. Particularly in his whitecoat interview he got to the heart of an important idea - that it's not an employment system. It's a healthcare system.

 

He is the head of a physicians advocacy group. He leads a group whose main role is to advocate for its members. He takes OUR money as members. We PAY him to advocate for us. I expect him to do his job and advocate for members, not insult and dismiss a huge portion of the membership.

 

If he wants to ignore membership concerns and advocate only for what he thinks the system needs at the expense of physician members, he should quit the CMA leadership, stop taking our money and join a provincial govt as a health minister.

 

That's my problem with him. He'll take our money, but won't represent the interests of the whole membership.

[NLengr]

And yet he still is right about many things, regardless how it makes you feel. Particularly in his whitecoat interview he got to the heart of an important idea - that it's not an employment system. It's a healthcare system.

 

You understand that paying millions of dollars to train people for jobs that don't exist is a huge waste of healthcare dollars right?

 

Everyone agrees there needs to be realignment of post grad positions. People have a problem with the fact that he never talked at all about better human resources planning and how to fix post grad education. All he did was insult young physicians and tell them that it's their own fault and tough ****. Despite the fact that as an older academic physician he is part of the system that created our current problems.

[chicagoschool]

I am just so routinely amazed that a cohort of such intelligent people is shocked when a labour market *that is not really guided by the price system* ends up with supply/demand mismatches. And millions will be spent "studying" and "planning", as if conscious planning of a solution is possible.

[A-Stark]

Spare us the patronizing economics lesson.