Bill 41, the Patients First Act, became law on Dec. 7, 2016 -- an announcement met with disappointment and even outright anger by front-line doctors across Ontario.
So much anger that, with the support of the Ontario Medical Association, doctor after doctor after doctor, from all corners of Ontario, are resigning from committees tasked with turning the Patients First Act into reality.
They will still care for their patients and serve their communities.
But doctors will no longer help the government play this ridiculously expensive game of musical chairs. They will not waste time expediting the government's sketchy schemes. The Liberals are on their own -- even the PCs and NDP voted against the Patients First Act.
On the surface, doctors disengaging may not sound like much. But doctors on LHIN committees help translate thought into meaningful action, law into practical reality. So doctors disengaging will throw a wrench into the works.
Doctors disengaging will throw a wrench into the works.
Administrative bodies like the Ministry of Health, LHINs and CCAC know how to divvy up funding among various health service providers. They do it poorly -- as the auditor general revealed in last year's and this year's reports -- but it's familiar territory. However, these mainly bureaucratic bodies have no clue what makes doctors, nurses and allied health providers tick. Many do not know what patients need and even if they did, would not know how to meet that need. Many do not understand the inner workings of the system they now control.
Doctors, on the other hand, are embedded in the health-care system. From hospitals to home care to hospices, from clinics to house-calls, from retirement homes to nursing homes, from WSIB to public health, from imaging to treating to operating -- we coordinate and provide patient care.
Our knowledge and skill in direct patient service and health system policy simply cannot be replaced.
We share the playground and work happily within team environments. Midwives help deliver babies, but they are not trained in C-sections or advanced neonatal resuscitation. Nurse practitioners excel at patient education and managing common illnesses, but their scope of practice is not at all the same as that of a family doctor. Mental health workers counsel well, but they cannot replace a psychiatrist or a psychologist. Allied health workers and doctors complement one another's abilities. They do not replace one another. Doctors offer unique insight and expertise.
So, the LHINs need doctors to pull off the Liberal transformation agenda -- within the government's tight deadlines. If they don't, they themselves will be replaced by government-appointed supervisors. The threat is implicit in the Patients First Act, an iron fist wrapped in a velvet glove.
Hundreds of my colleagues volunteered thousands of hours at meetings, offering ideas for visionary health-care reform. Yet none of it made it into the Patients First Act. So although this government says it seeks the opinion and advice of industry experts, it ignores all that is offered. In fact, perusing the Standing Committee minutes, this government ignores the advice of doctors, nurses, patient advocates, caregivers and hospitals. Frankly, I'm tired of the Liberals talking out of both sides of their mouths.
This goes beyond issues of physician contracts and funding. Industry experts are coming out against the Patients First Act. Valuing -- and funding -- bureaucracy over patient services will put patients dead last.
The Liberals have stated, there is no extra funding for health care in Ontario. If the health-care budget was a pie, a bigger slice for bureaucracy and flawed health care transformations means less left over for services people actually use: doctors, nurses, personal support workers, physiotherapists, occupational therapists, nursing home beds and hospital beds.
We are turning our backs on those who willfully ignore our warnings and our advice.
So my elderly patient loses out, the one whom I just accepted as a favour though my practice is full; the one with dementia and end-stage liver disease; the one who was discharged from hospital even though he requires 24/7 supervision; the one who, like hundreds of others, is on a wait list for a nursing home bed -- beds that are becoming as unlikely as a unicorn sighting.
My other patients lose out, the ones waiting for surgery be it, cataracts or knee replacements; the ones waiting for specialist consults, be it psychiatry or neurology; the ones waiting for imaging or investigations, be it for ankle pain or a cancer diagnosis.
Again, I am not alone in this concern. I hear it from my colleagues: the palliative patient who may very well die before he gets adequate home care. Or the developmentally delayed elderly woman who herself is a caregiver for her elderly husband. Or the pregnant Toronto women who cannot access obstetric care because of an irrational funding cap. Or the patients whose surgeries have been delayed again because hospital funding ran out.
This health-care system is so overburdened, underfunded and mismanaged that it no longer provides patients with reliable, timely or even universal access to care.
Ontario needs genuine health system reform. Instead we get the Patients First Act.
Doctors are hopping mad. So we are turning our backs on those who willfully ignore our warnings and our advice. They will now stand alone as their committees and sub-committees waste more time and more taxpayer money on a sketchy health care "transformation." Responsibility for the ensuing mess will rest squarely on this government's shoulders.
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