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Are Democracy and Health Care Mutually Exclusive in Ontario?

09/22/2015 08:03 EDT | Updated 09/22/2016 05:12 EDT
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Portrait of confident female surgeon with colleagues working in operating room

I am not a blogger. I am not typically much of a writer. I don't even usually get caught up in politics. But I've taken an oath to be an advocate for my patients. In light of the ongoing struggles with the Ministry of Health and the looming third set of cuts from health-care spending this year, I feel the need to relay some information to the public.

Kathleen Wynne's government has not been transparent, nor has it been providing accurate information to the patients of Ontario. In fact, it has been providing little to no information. I've penned the below letter that I hope they take the time to read. I wanted to share it with as broad an audience as I could:

"Dear Premier Wynne and Health Minister Hoskins:

I am writing to you with grave concerns for the well-being of health care in our beautiful province of Ontario. I am an orthopedic surgeon, three years out of training, who has been working in the U.S. due to lack of job availability in Ontario, and Canada in general. I am in the process of relocating back to Ontario as a job came up in my home community. News of further cuts, caps and clawbacks are distressing to me, not only from a personal income perspective, but in the greater sense.

I am leaving the U.S. for a few reasons. One is that I do not share some of my current employer's attitudes about care delivery. I have been forced to relegate aspects of my decision making to bean-counting administrators and insurance companies who have no clinical training or experience. This is not good medicine. The other reason for my move is that I have been given the opportunity to practice the profession to which I've dedicated the last 13 years of my life in my home town. Finances were not part of my decision-making. Taking my passion home was.

Here in the U.S., I am limited in who I can serve based on their insurance. In Canada, people are extremely fortunate to have equal access to care, regardless of socioeconomic factors. It is upsetting that the proposed funding cuts have and will continue to restrict timely and appropriate access to not just a subset but ALL patients who need these services. Physicians in Ontario have been providing unremunerated services for a long time because of fiscal constraints. Your government is exploiting that fact. You know we put our patients first and will continue to provide necessary services regardless of subsequent cash flow back to our practices. You are taking for granted that we will continue to do so, and this may be a detrimental assumption on your part.

Our practices are small businesses. We pay rent to building owners, utilities to regional suppliers, we employ support staff and we write prescriptions for drugs, medical devices and rehabilitation services, which are provided by other small business. If our patient load continues to increase (and it most definitely will, based on the aging demographics and epidemics of chronic diseases in our society) and our revenue continues to diminish, we will be less able to pay salaries to employees and other overhead expenses. As our businesses dwindle, our return to the economy via these employees and ancillary services will also continue to dwindle creating a significant downstream economic impact.

There will come a point, financially, that we will be forced to limit our workloads. This will ruin any progress that has been made in recent years in reducing wait times for things like joint replacement surgery. These patients will become more debilitated, for longer periods, resulting in worsened quality of life, less contribution to society, with concomitant increased utilization of support services and disability insurance.

This may catch your attention -- if doctors can't afford to pay staff, and patients are too disabled to return to work because they cannot get surgery in a timely fashion, your government will lose significant tax dollar revenue whilst having to support more unemployed or underemployed citizens. Does this hit home to you? Doctors number in the thousands but the implications of these cuts, caps and clawbacks extend to millions.

Here's an analogy: The Ontario government offered a pie to the doctors of Ontario to serve to our "guests," the patients of Ontario. Suddenly that pie got smaller but the guests kept arriving in increasing numbers. The doctors have two options. 1) Cut the pie into increasingly smaller slices as more people show up, which has finite limitations. 2) Cut the pie into average sized slices but turn people away when the pie is gone. Neither of these scenarios is good, appropriate or even safe when the pie pieces are health-care services.

Moving on from the broad financial implications of your proposed "strategy," I would also like to touch on the ethical implications. Your "strategy" has been unilaterally imposed. Those that know the needs of the patients the best have been excluded from the decision-making. We doctors have lost our voice and ability to negotiate for our own and our patients' needs. We are your front-line eyes and ears. We individually have many years of education, knowledge and experience in delivering health care.

Cumulatively as a group, you have shut out the most valuable resource you have in devising a long-term action plan to positively influence change in the system. We want our services to be as efficiently rendered as you do. We want as many Ontarians as possible to have timely, safe and appropriate access to care, not just emergency care but preventative care. We want to reduce the burden of disease on our society. We want to be doctors to the people of Ontario. We want to negotiate with you as to how best to do this. No labour union in its right mind would relinquish its rights to negotiation. We cannot strike. You know this. But please allow us our rights as citizens of a democracy and let us speak.

With sincerest regards,

Adrienne M. Kelly, MD, FRCSC"

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