Transcript: Health Care Crisis? | Feb 07, 2001

The title “More to health” appears inside the shape of a house.

The opening sequence shows a wooden table with a small lit candle as several words fly by: Nutrition, medicine, prevention, treatment and health.
Fast clips show different sets of hands performing activities on the table such as drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.
In animation, the title appears inside the shape of a house: “More to life.”

Maureen Taylor sits in a studio with yellow walls and a carved board that reads “More to life” in the background.

Maureen is in her late thirties, with wavy red hair in a bob. She wears a floral blouse and a dark brown blazer.

Maureen says GOOD AFTERNOON,
YOU'RE WATCHING “MORE TO
LIFE” AND I'M MAUREEN
TAYLOR.
EVEN IF YOU HAVEN'T LIVED A
HEALTHCARE NIGHTMARE, YOU'VE
CERTAINLY HEARD ABOUT THEM.
AN 18 MONTH WAITING LIST TO
SEE A SPECIALIST.
HAVING TO GO OUT OF THE
COUNTRY TO RECEIVE TREATMENT,
OR SPENDING COUNTLESS HOURS
ON A GURNEY IN THE HALLWAY
OF A HOSPITAL EMERGENCY
WARD.
BUT IS THAT THE WHOLE STORY?
AND ARE THINGS ANY WORSE NOW
THAN THEY WERE SAY 15 OR 20
YEARS AGO?
NO, ACCORDING TO ONE OF MY
GUEST, DOCTOR MICHAEL RACHLIS
IS A HEALTH POLICY ANALYST
AND THE CO-AUTHOR OF A
REPORT SPONSORED BY THE
TOMMY DOUGLAS INSTITUTE.
IT CONCLUDES THE CRISIS IN
MEDICARE IS EXAGGERATED.
DOCTOR WALTER ROSSER IS THE
CHAIR OF THE DEPARTMENT OF
COMMUNITY AND FAMILY
MEDICINE AT THE UNIVERSITY
OF TORONTO AND PAST
PRESIDENT OF THE COLLEGE,
ONTARIO COLLEGE OF FAMILY
PHYSICIANS.
IS THERE A HEALTH CRISIS IN
CANADA?
IS THE SOLUTION A MOVE
TOWARD MORE PRIVATIZED
MEDICARE?
GIVE US A CALL AND TELL US
ABOUT YOUR HEALTHCARE
EXPERIENCES AND WHAT YOU
THINK SHOULD BE DONE
IN TORONTO DIAL 416 484-2727
WE’VE GOT A TOLL FREE LINE IF
YOU’RE LONG DISTANCE
1-888-411-1234
AND YOU CAN E-MAIL YOUR COMMENTS
TO MORETOLIGE@TVO.COM
GENTLEMEN,
WELCOME.
I'LL BEGIN WITH YOU,
DOCTOR RACHLIS, SAY IN THE
REPORT THE ENEMIES OF
MEDICARE ARE ALARMISTS AND
CREATING A FALSE SENSE OF
PANIC IN THE SYSTEM.
WHO ARE THESE ENEMIES AND
WHAT ARE THEIR MOTIVES?

A caption reads “Doctor Michael Rachlis. Revitalizing Medicare.”

Michael is in his early fifties, clean-shaven and balding. He wears thick glasses, a blue suit, white shirt and patterned burgundy tie.

He says WELL, IF I COULD JUST
BACKTRACK JUST A LITTLE BIT
HERE TO EXPLAIN SOME OF THE
THINGS YOU WERE JUST
MENTIONING ABOUT THE REPORT,
AND GET YOUR QUESTION, WE
SAID IN THE REPORT, OF
COURSE, THERE ARE SERIOUS
PROBLEMS WITH THE SYSTEM, WE
DEFINITELY BELIEVE THERE ARE
SERIOUS PROBLEMS.
WE TRY TO AVOID THE WORD
CRISIS BECAUSE THAT SUGGESTS
THAT OUR PROBLEMS CANNOT BE
SOLVED AND PUSHES PEOPLE TO
THINK OF PRIVATE SOLUTIONS
TO OUR PROBLEMS.
AND SO THAT, THAT WE THINK
THAT, FOR EXAMPLE, THAT SOME,
SOME PARTS OF THE MEDIA, ONE
LARGE PART OF THE MEDIA,
CONRAD BLACK, CERTAINLY HAS
MADE NO SECRET OF HIS
ANTAGONISM TO PUBLIC FINANCE
MEDICARE, AND HE'S ALSO MADE
NO BONES ABOUT THE FACT THAT
HE EXPECTS HIS JOURNALISTS
TO TOW THE LINE SO THAT
THERE ARE SOME WEALTHY
CANADIANS WHO HAVE ALWAYS
OPPOSED MEDICARE, AND THIS
IS BECAUSE THAT PEOPLE WITH
HIGH INCOME, PARTICULARLY
LIKE CONRAD BLACK, WOULD PAY
LESS OUT OF THEIR OWN
POCKETS FOR PRIVATE
HEALTHCARE THAN THEY'RE
CURRENTLY SPENDING IN TACKS
TO SUPPORT A PUBLIC SYSTEM.
WE HIGHLIGHT AS WELL
MEDICARE'S ALWAYS BEEN
OPPOSED BY PEOPLE WHO REGARD
HEALTHCARE AS A TRADABLE
GOOD AND SERVICE.
PEOPLE WHO WANT TO MAKE A
BUSINESS OUT OF HEALTHCARE
AND THOSE PEOPLE, OF COURSE,
ARE FRUSTRATED OFTEN IN
CANADA'S PUBLICLY FINANCE
SYSTEM MAINLY RELIED UPON
NOT-FOR-PROFIT DELIVERY.
BUT WHAT WE'RE SAYING IS
DESPITE ALL THE PROBLEMS
MEDICARE HAS THE MAIN PART
OF OUR REPORT DEALS WITH
CREATIVE SOLUTIONS WE SEE
DEVELOPING ACROSS THE
COUNTRY, SOME OF THEM FROM
ONTARIO AND WE FEEL IF WE
COULD TAKE THESE INNOVATIVE
PROGRAMMES AND SWIFTLY MOVE
THEM ACROSS THE COUNTRY THAT
THE SENSE OF PANIC WOULD
TEND TO DEFLATE AND THAT
PEOPLE COULD GO ON TO MAKE
OUR PUBLIC HEALTHCARE SYSTEM
A BETTER PLACE.

Maureen says WE WILL GET YOU
TO DESCRIBE SOME OF THE
THINGS YOU TALK ABOUT IN THE
REPORT THAT ARE WORKING BUT
I WANT TO ASK DOCTOR ROSSER, DO
YOU THINK THAT THOSE WHO
ADVOCATE ANY SORT OF
PARALLEL PRIVATE SYSTEM ARE
REALLY OUT TO DESTROY
UNIVERSAL HEALTHCARE?
AND THAT'S THEIR MOTIVE?
The caption changes to “Doctor Walter Rosser. University of Toronto.”

Walter is in his early fifties, clean-shaven and with short wavy gray hair. He wears a black suit, gray shirt and patterned tie.

He says I THINK THERE'S BEEN A
FAIR AMOUNT OF THINKING THAT
WAY FOR THE LAST FIVE OR
SEVEN YEARS, THAT THE ONLY
SOLUTION TO OUR HEALTHCARE
IS THAT WE HAVE TO MOVE INTO
A PRIVATE SYSTEM.
AND THAT THE CURRENT SYSTEM
ISN'T SUSTAINABLE.
AND THEREFORE I'M INCLINED
TO AGREE WITH DOCTOR RACHLIS
THAT PEOPLE THAT BELIEVE
THAT, THE BEST THING TO DO
IS SAY THINGS ARE FALLING
APART THERE IS A CRISIS AND
THERE ARE NO SOLUTIONS.
SO I'M INCLINED TO AGREE
WITH DOCTOR RACHLIS THAT I
THINK THERE HAS BEEN
HYSTERIA ON THE ONE SIDE.
ON THE OTHER SIDE, I DON'T
THINK WE CAN IN ANY WAY
IGNORE THE -- THERE ARE SOME
FUNDAMENTAL PROBLEMS IN THE
SYSTEM RIGHT NOW THAT HAVE
BEEN GENERATED OVER THE LAST
15 OR 20 YEARS.
I BELIEVE THEY CAN BE FIXED,
BUT WE NEED TO MOVE FAIRLY
QUICKLY, AND WE NEED TO --
THERE ARE SOME THINGS THAT
WILL TAKE QUITE A WHILE TO
FIX.
I THINK ONE OF THE BIGGEST
ISSUES THAT I WOULD TAKE
WITH THE REPORT IS THE
ARGUMENT THAT IN FACT
THERE'S AN ADEQUATE SUPPLY
OF PHYSICIANS.

Maureen says YES.
LET'S GO TO THAT ONE.
YOU SAY -- AND YOU'VE SAID
BEFORE ON THIS PROGRAMME
DOCTOR RACHLIS THAT WE DON'T
HAVE A SHORTAGE OF
PHYSICIANS OVERALL IN
CANADA.
EXPLAIN YOUR REASONING AGAIN
BEHIND THAT.

Doctor Rachlis says OKAY, AGAIN, THERE ARE
SOME, THERE ARE SOME
EXCEPTIONS TO THIS, BY THE
WAY.
ONTARIO'S A BIT OF AN
EXCEPTION.
OF COURSE THIS IS AN
ONTARIO-BASED PROGRAMME, SO
THAT WE NEED TO ACKNOWLEDGE
THAT.
BUT ACROSS THE COUNTRY, WE
WENT FROM ONE PHYSICIAN FOR
EVERY THOUSAND CANADIANS
WHEN WE BROUGHT IN MEDICARE
AROUND 1970 TO ABOUT ONE
PHYSICIAN FOR EVERY 550
CANADIANS BY ABOUT 1990.
THAT'S WHEN GOVERNMENT
STARTED TO PUT THE BRAKES ON
MEDICAL SCHOOL ENROLMENT,
POST GRADUATE ENROLMENT AND
SO THE NUMBER OF DOCTORS PER
CAPITA DIPPED BUT IT'S BEEN
COMING UP AGAIN.
BETWEEN '97 AND '99, THE
LAST TWO YEARS WE HAVE DATA
FOR THE PHYSICIAN POPULATION
GREW ALMOST TWICE AS GREAT
AS THAT OF THE GENERAL
POPULATION.
SO IN OTHER WORDS, NUMBERS
DON'T EXPLAIN THE WHOLE
STORY.
THAT IT'S REALLY --

Maureen says NO.

Doctor Rachlis says OUR REPORT IS SAYING, AND
CERTAINLY THERE ARE PARTS OF
THIS PROVINCE, A
FAST-GROWING PROVINCE
COMPARED TO OTHER PROVINCES
WHERE THE POPULATION IS
STAGNANT, AREAS LIKE WINDSOR
AND SOME AREAS AROUND THE
GOLDEN HORSESHOE WHICH ARE
VERY FAST-GROWING AND WHERE
THERE JUST AREN'T ENOUGH
DOCTORS, PERHAPS.
BUT ON THE OTHER HAND I
WOULD SAY THAT IF WE USED
THE PHYSICIANS THAT WE HAVE
DIFFERENTLY, THERE ARE SOME
MODELS IN ONTARIO, THEN WE'D
FIND THAT ONE IN 550 MIGHT
BE MORE THAN ENOUGH.
THERE ARE EXAMPLES OF GREAT
HEALTH PROGRAMMES IN ONTARIO,
OTHER PARTS OF CANADA, THE
UNITED STATES, WHERE ONE
PHYSICIAN FOR EVERY 800 TO
1,000 PEOPLE SEEMS TO
DELIVER WONDERFUL HEALTHCARE
WHEN TEAMED UP WITH NURSE
PRACTITIONERS AND SOCIAL
WORKER, THEY'RE WORKING IN A
DIFFERENTLY FUNDED SYSTEM.
SO WE'RE DEFINITELY NOT
DENYING THE FACT THAT SOME
PEOPLE ARE HAVING DIFFICULTY
ACCESSING FAMILY DOCTORS OR
SPECIALISTS, BUT WE WOULD
SAY THAT THERE ARE ALL SORTS
OF WAYS THAT WE COULD GO
ABOUT SOLVING THE PROBLEM
THAT WOULD BE MORE
PRODUCTIVE THAN SIMPLY INCREASING
THE NUMBER OF DOCTORS.

Maureen says WHAT DO YOU
THINK, DOCTOR ROSSER?
WOULD DOCTORS BE HAPPIER
WORKING IN SORTS OF THESE
INTEGRATED COMMUNITY HEALTH
CENTRES?

Doctor Rosser says WE BELIEVE THEY ARE --
THE ONTARIO COLLEGE OF
FAMILY PHYSICIANS HAS DONE A
LOT OF WORK ON THIS SUBJECT
OVER THE LAST FIVE YEARS.
WE'VE PRODUCED A MODEL THAT
INCLUDES NURSE PRACTITIONERS,
THAT INCLUDES THE DOCTORS
WORKING TOGETHER IN GROUPS,
SO THEY CAN PROVIDE A VERY
COMPREHENSIVE SET OF
SERVICES, SO THAT ONE
INDIVIDUAL DOCTOR DOESN'T
HAVE TO PROVIDE EVERYTHING,
BUT GROUPS OF FIVE OR SEVEN
OR EIGHT DOCTORS WOULD BE
ABLE TO DO THAT.

Maureen says WELL WHY AREN'T
WE DOING THIS THEN?

Walters says WELL THAT'S ONE OF THE
FRUSTRATIONS.
I THINK THESE THINGS HAVE
BEEN TALKED ABOUT FOR YEARS.
THERE ARE MANY GOOD MODELS.
THERE ARE MODELS AROUND
ONTARIO, AS DOCTOR RACHLIS HAS
SAID, AND YET THERE'S BEEN A
TREMENDOUS AMOUNT OF DEBATE
AND DISCUSSION AND --

Maureen says TASK FORCES AND
MORE REPORTS.

Doctor Rosser says YES, LOTS OF
INVESTIGATIONS AND LOTS OF
REPORTS, MANY OF THEM
GATHERING DUST.
AND IN FACT AS YET -- AND IN
FACT THE GOVERNMENT ACTUALLY
COMMITTED TO IMPLEMENT WHAT
THEY CALL PRIMARY CARE
REFORM.
I PREFER TO CALL IT PRIMARY
CARE ENHANCEMENT.
AGAIN, A SORT OF SUBTLETY IN
TERMS OF -- WE ALREADY HAVE,
WE THINK, QUITE A GOOD
SYSTEM, BUT WE CAN MAKE IT
BETTER RATHER THAN HAVING TO
COMPLETELY TEAR IT APART AND
REBUILD IT, WHICH IS KIND OF
IMPLIED WITH REFORM.

Maureen says I THINK WE HAVE
SOMEBODY ON THE LINE
ACTUALLY EXPERIENCING A
DOCTOR SHORT ANNE SO WE'RE
GOING TO GO TO LYNN IN A
SECOND.
I'LL GIVE OUT THE NUMBERS
AGAIN.
WE'RE ASKING YOU WHAT YOUR
OBSERVATIONS ARE ABOUT THE
HEALTHCARE SYSTEM.
DO YOU BELIEVE THAT THERE IS
A CRISIS?
DO YOU BELIEVE THAT PART OF
THE SOLUTION IS SOME FORM OF
PRIVATIZED MEDICINE?
TELL US WHAT YOU THINK.
IN TORONTO DIAL 416 484-2727
WE’VE GOT A TOLL FREE LINE IF
YOU’RE LONG DISTANCE
1-888-411-1234
AND YOU CAN E-MAIL YOUR COMMENTS
TO MORETOLIGE@TVO.COM
AND LYNN IS IN
PORT ROBINSON.
HI LYNN.

Lynn says HI.

Maureen says HI.

Lynn says WE HAVE A REAL
DOCTOR SHORTAGE IN THIS
AREA.
IF YOU'RE IN SAINT CATHARINE’S
OR NIAGARA FALLS, THE ONLY
HOPE OF GETTING A DOCTOR IS
A WALK-IN CLINIC.
RECENTLY A DOCTOR LEFT HIS
PRACTICE IN WELLAND AND
PEOPLE HAVE BEEN FORCED TO
HAND NOTES UNDER A LOCKED
DOOR IN ORDER TO GET THEIR
MEDICAL RECORDS, AND THEY'RE
TOLD THAT THEY'LL JUST HAVE
TO USE THEIR OWN RESOURCES
TO FIND A DOCTOR.
IT'S REALLY DESPERATE AROUND
HERE, AND AS FORGETTING A
SPECIALIST, WE'RE MONTHS AND
MONTHS AWAY, FROM EVEN TO
GET INTO A SPECIALIST.

Maureen says I'VE HEARD THIS
STORY A LOT, DOCTOR ROSSER.

Doctor Rosser says WELL, WE HAVE AS WELL.
AND IN FACT THE PROVINCE HAS
DESIGNATED OVER 100
COMMUNITIES AS UNDER-SERVED.
AND I CAN TELL YOU THAT THE
PROVINCE DOESN'T DESIGNATE A
COMMUNITY UNDER-SERVED
UNLESS IT REALLY IS THE WAY
THEY CALCULATE THINGS,
THEY'RE QUITE CONSERVATIVE
ABOUT DOING THAT.

Maureen says DO YOU AGREE,
DOCTOR RACHLIS?

Doctor Rachlis says WELL, IT'S LIKE SAYING --
WE'VE GOT IT LOOK AT WHETHER
IT'S A SITUATION OF WHERE
WE'RE COMPLETELY LACKING IN
RESOURCES.
SOME COMMUNITIES, THERE JUST
ARE NO DOCTORS.
BUT IN MANY COMMUNITIES
THERE ARE PHYSICIANS, BUT
IT'S JUST WE'RE NOT
MAXIMIZING THEIR EFFICIENCY.
I'M SORRY TO SAY THIS --

Maureen says WHAT DO YOU MEAN
BY THAT?

Doctor Rachlis says LET ME GIVE YOU A
CONCRETE EXAMPLE.
THERE ARE SOME COMMUNITIES
IN SOUTHWESTERN SASKATCHEWAN,
WHERE THERE WERE TWO
PHYSICIANS IN THE EARLY '90s,
ONE OF THEM LEFT, 4,000
PATIENTS NEEDED TO BE SERVED,
THE DOCTOR THERE WAS
CONCERNED ABOUT THE HEALTH
REFORM THE GOVERNMENT WAS
GOING TO ENGAGE IN, DECIDED
TO PLAY ALONG, THEY BROUGHT
IN A NURSE PRACTITIONER IN
'95, TWO MORE IN '99, NOW
THEY HAVE ONE PHYSICIAN
WORKING WITH THREE NURSE
PRACTITIONERS, ALONG WITH
THE HOMECARE AND MENTAL
HEALTH STAFF THERE FROM THE
DISTRICT, THEY ARE PROVIDING
CRACKERJACK PRIMARY
HEALTHCARE TO AROUND 4,000
PATIENTS.
NOW I'M NOT SAYING THAT
THAT'S NECESSARILY IDEAL AND
WE'VE GOT TO LOOK AT THE
FACT THAT THESE NURSE
PRACTITIONERS IN FACT HAVE
MORE TRAINING THAN MOST
URBAN GENERAL PRACTITIONERS
HAVE.
THEY CAN INTUBATE, PUT IN
CHEST TUBE, MOST URBAN
FAMILY DOCTORS CAN'T, AFTER
THEY'VE BEEN IN PRACTICE FOR
A WHILE, EVEN IF THEY WERE
TAUGHT THAT IN TRAINING.
THERE'S A MODEL WHERE WE
HAVE ONE PHYSICIAN PROVIDING
PRIMARY HEALTHCARE TO 4,000
PATIENTS WORKING IN A TEAM.
EVEN IF YOU HAD TWO FAMILY
PHYSICIANS THERE, ONE PER
2,000, THAT'S A MUCH SMALLER
RATIO THAN WE TEND TO HAVE
IN MOST PARTS OF ONTARIO.
THERE ARE IN FACT OVER 200
UNEMPLOYED NURSE
PRACTITIONERS IN ONTARIO
RIGHT NOW OR UNDER EMPLOYED
NURSE PRACTITIONERS.
THEY MAY BE WORKING AS
REGISTERED NURSES WHEN IN
FACT THEY HAVE ADDITIONAL
SKILLS AND THEY'RE NOT ABLE
TO WORK.
WE'VE TALKED ABOUT THE
COMMUNITY HEALTH CENTRE
MODEL FOR MANY YEARS, WHERE
PHYSICIANS WORK ON A
NON-FEE-FOR-SERVICE PAYMENT
WITH NURSE PRACTITIONERS AND
OTHERS AND THERE ARE DOZENS
OF COMMUNITIES IN THE
PROVINCE THAT WANT TO GET
COMMUNITY HEALTH CENTRES AND
THE PROVINCE IS NOT
RESPONDING TO ANY OF THOSE.

Maureen says SO IT'S AT THE
GOVERNMENT LEVEL.
HOW DO FAMILY PHYSICIANS
FEEL ABOUT NURSE
PRACTITIONERS COMING IN IT
HELP THEM OUT IN THE
PRACTICE?

Doctor Rosser says GENERALLY I THINK THE
IDEA IS VERY WELL-RECEIVED
BY FAMILY DOCTORS.
WE'VE BEEN SURVEYING THE
MEMBERSHIP OF THE ONTARIO
COLLEGE FOR THE LAST THREE
OR FOUR YEARS.
INITIALLY THERE WAS
RELUCTANCE, A LOT OF
NEGATIVISM, PORTRAYED MOSTLY
IN THE MEDIA THAT DOCTORS
AND NURSES WERE AT LOGGER
HEADS, ET CETERA, ET CETERA.
THE REALITY IS THAT MOST
FAMILY DOCTORS WOULD WELCOME
WORKING WITH A NURSE
PRACTITIONER AND SEE IT AS A
HUGE ADVANTAGE IN BEING ABLE
TO PROVIDE MORE SERVICES,
PROVIDE BETTER SERVICE.
I THINK THAT THE MAIN
ARGUMENT THAT MOST FAMILY
DOCTORS HAVE IS THEY CAN
PROVIDE BETTER SERVICE,
ESPECIALLY TO THE
CHRONICALLY ILL, THE ELDERLY,
THAT IN FACT IF THEY HAD
SOMEONE LIKE A NURSE
PRACTITIONER WITH THE
TRAINING AND SKILLS TO WORK
WITH THEM FOLLOWING A GROUP
OF DIABETICS, AS AN EXAMPLE,
THEY COULD DO A MUCH BETTER
JOB THAN THEY CAN ON THEIR
OWN, WORKING IN AN OFFICE ON
THEIR OWN.
SO I THINK THAT OVERALL,
THERE'S A VERY GOOD
ACCEPTANCE.
THE PROBLEM IS THERE'S
CURRENTLY NO WAY IT PAY A
NURSE PRACTITIONER.
THE ONLY WAY THAT YOU CAN
PAY FOR THESE NURSE
PRACTITIONERS WOULD BE TO
SAY OKAY, I'LL PAY THEM OUT
OF MY INCOME --

Maureen says PUT YOU ON MY
STAFF.
YEAH.

Doctor Rosser says AND THE OTHER PROBLEM IN
A FEE-FOR-SERVICE SYSTEM IS
THAT THE DOCTOR ALWAYS HAS
TO SEE THE PATIENT.

Doctor Rachlis says OR THEY CAN'T BILL.

Maureen says THEY CAN'T BILL.

Doctor Rosser says SO IF YOU HIRED A NURSE
PRACTITIONER, YOU'D STILL
HAVE TO SEE ALL THE
PATIENTS.
NOW IF YOU CAN MOVE INTO
WHAT WE CALL AN ALTERNATE
FUNDING PLAN OR AN
ALTERED -- THEN THE NURSE
PRACTITIONER COULD SEE AND
TREAT PATIENTS ALONG WITH
THE DOCTOR IN COLLABORATION
AND THAT MODEL, I THINK,
WOULD BE VERY ACCEPTABLE.
SO THAT'S BASICALLY WHAT THE
ONTARIO COLLEGE OF FAMILY
PHYSICIANS HAS PROPOSED.
OUR MEMBERSHIP SUPPORTS IT
WIDELY --

Maureen says DOCTORS HAVE A
REPUTATION FOR SAYING NO TO
NEW IDEAS AND LETTING --
MID-WIVES WERE NOT POPULAR
AT FIRST WITH OBSTETRICIANS,
YOU KNOW?

Doctor Rachlis says THERE ARE MANY DIFFERENT
VOICES WITHIN THE MEDICAL
PROFESSION, AND I THINK ONE
VOICE THAT'S MISSING HERE
THEY CAN'T DEFEND THEMSELVES
UNLESS THEY PHONE IN IS THE
ONTARIO MEDICAL ASSOCIATION.
I THINK A LOT OF LAYPEOPLE
DON'T UNDERSTAND ALL THE
DIFFERENCE BETWEEN THESE
ORGANIZATIONS.
S THERE THE COLLEGE OF
PHYSICIANS AND SURGEONS, THE
ONTARIO MEDICAL ASSOCIATION.
THE ONTARIO MEDICAL
ASSOCIATION'S A PROFESSIONAL
ASSOCIATION BUT ALSO THE
UNION, IF YOU, FOR DOCTORS
AND THEY'RE THE ONES THAT
NEGOTIATE.
AND IN THIS PROVINCE THE
O.M.A. HAS MADE IT MUCH
HARDER THAN IN OTHER
PROVINCES IT TAKE MONEY OUT
OF THE FEE-FOR-SERVICE POT
OF FUNDS SO THAT EVEN IF
YOU -- LET'S SAY YOU BILLED
IS 150,000 DOLLARS-- I THINK THE
AVERAGE GENERAL PRACTITIONER
IS BILLING AROUND 170 DOLLARS,
180,000 NEED DAYS, IF THAT
FAMILY DOCTOR WANTED TO BE
PAID DIFFERENTLY AND THEY
CAN'T GO IT A GOVERNMENT AND
SAY THE 180,000 DOLLARS YOU PAID
FOR ME LAST YEAR WAS MYSELF
AND THE OFFICE, NOW WE WANT
SOME NURSE PRACTITIONERS,
AND ET CETERA, LET'S SPEND
THE MONEY DIFFERENTLY, THEY
CAN'T DO THAT IN ONTARIO
BECAUSE THE O.M.A. HAS A
LOCK ON THAT POOL OF FUNDS.
AND IN OTHER PROVINCES, IT'S
SOMEWHAT EASIER, ALTHOUGH
NOT ALWAYS REALLY EASY TO
MOVE THE MONEY OUT.
FOR EXAMPLE IN MANITOBA NOW,
EVERY TIME A DOCTOR LEAVES A
RURAL AREA, THE PROVINCIAL
GOVERNMENT IS TRYING TO TAKE
THE FEE-FOR-SERVICE BILLINGS
AND CONVERT THEM IN A
CONTRACT WHERE A DOCTOR
ISN'T STRICTLY ON SALARY,
THEY'RE ON CONTRACT BUT
DON'T HAVE TO BILL
FEE-FOR-SERVICE.

Maureen says WE CAN COME BACK
TO THIS.
LET'S GET TO SHANNON'S CALL.

Shannon says HELLO.
YOU KNOW, YOU TALK ABOUT
DOCTORS AND THE NURSING
PRACTITIONERS BUT WHAT ABOUT
THE ACTUAL PROBLEMS WITHIN
THE HOSPITALS THEMSELVES
THAT MORE DIRECTLY INVOLVE
THE R.N.s AND R.P.N.s WHO
ARE DOING THE CARE AND OVER
WORKED AND UNDER STAFF,
WORKING WITH HALF THE
HOSPITAL FLOOR CLOSED.
I CAME OUT OF NURSING
SCHOOL.
I DID MY NURSING THROUGH
HUMBER AND CAME OUT OF
SCHOOL BEING TOLD THAT I
WOULD HAVE ONE OR TWO
PATIENTS WHEN I FIRST
STARTED AS A STUDENT NURSE
AND THEN I WOULD END UP WITH
FOUR OR FIVE WHEN I WAS
ACTUALLY GRADUATED.
I ENDED UP WITH EIGHT ON MY
FIRST DAY!

Maureen says YIKES!

Shannon says HOW CAN YOU SAY I AM
QUALIFIED TO CARE FOR EIGHT
WHEN I DIDN'T HAVE ANY
EXPOSURE TO IT.
I COULDN'T COPE!
AND I WAS SUPPOSED TO SAY,
“I'M SORRY, I CAN'T COPE
WITH THAT IT'S BEYOND MY
LEGAL CAPABILITIES.”
I HAVE TO COVER MYSELF, AND
YET I WOULDN'T GET WORK IN A
HOSPITAL IF I SAID THAT!

Maureen says ARE YOU STILL
NURSING?

Shannon says I HAD TO GIVE IT
UP.
I COULDN'T KEEP UP WITH THE
WORKLOAD.
THE PATIENTS WERE JUST
MISERABLY TREATED!
IT'S NOT THE DOCTORS, IT'S
THE WORKLOAD OF THE NURSE,
IT'S THE PROBLEMS WITH
LEAVING THE PEOPLE IN THE
HALLWAYS BECAUSE NOBODY'S
HOPING OPENS FLOORS UP STAIR,
IT WOULD BE REALLY HARD FOR
ME TO GO BACK WITHOUT SOME
REAL CONCRETE CHANGES MADE.

Maureen says THE REPORT
ADDRESSES THAT, TOO, BUT LET
ME GO TO DOCTOR ROSSER FIRST.

Doctor Rosser says I THINK THE SYSTEM IS
GOING THROUGH ENORMOUS
CHANGE.
AND IT SORT OF FROM
THE TIME OF MEDICARE COMING
IN, WHICH WAS 1969 OR 1970,
THINGS KIND OF WENT ALONG
AND THERE REALLY WASN'T A
LOT OF CHANGE UNTIL ABOUT
THE LAST FIVE YEARS.
AND ALL OF THE TIME THERE'S
BEEN A CONTINUOUS EVOLUTION
IN TECHNOLOGY.
SO THAT THE ABILITY, THE
NEED FOR PEOPLE STAY IN
HOSPITAL HAS BEEN GREATLY
REDUCED.
AND SO WOMEN NOW STAY IN
HOSPITAL FOR 24 HOURS AFTER
THEY'VE HAD A BABE BOAT.
WHEN I FIRST STARTED IN
PRACTICE SEVEN DAYS WAS THE
AVERAGE AND THEN IT MOVED
DOWN IT FIVE.
THAT WAS FOR HAVING A BABY.
ANY KIND OF SURGERY, LIKE A
GALLBLADDER SURGERY,
PEOPLE STAYED IN HOSPITAL
FIVE, SEVEN, TEN DAYS.
THAT'S ALL BEEN REDUCED
GREATLY.
SO WE'VE CUT DOWN THE NUMBER
OF BEDS THAT WE ACTUALLY
NEED, AND GONE THROUGH THIS
RESTRUCTURING OF HOSPITALS
TO TRY AND ACCOMMODATE ALL
OF THESE CHANGES, AND IT'S
BEEN EXTREMELY PAINFUL AND
DIFFICULT TO DO.

Maureen says WELL WHEN WE
TALK ABOUT SHUTTING DOWN
BEDS, AND I THINK YOU TWO
AGREE THAT SOME OF THAT
NEEDED TO BE DONE.
WE HAD TOO MANY BEDS.
BUT CUTTING DOWN BEDS MEANS
LAYING OFF NURSES.
IT'S JUST ANOTHER WAY OF
SAYING “LAYOFF NURSES.”
WELL WE'VE GONE WAY
OVERBOARD THERE, WOULD YOU
NOT ADMIT DOCTOR RACHLIS?

Doctor Rachlis says THERE'S TWO BIG PROBLEMS
NURSES ARE FACING RIGHT NOW.
ONE OF THEM IS STARTING
ABOUT 20 YEARS AGO IN THE
U.S., MAYBE TEN YEARS AGO OR
A LITTLE MORE IN CANADA,
WE'VE GONE TO SORT OF THE
TAILORIZATION OF NURSING AND
BY THAT I MEAN, THE
EFFICIENCY EXPERT WHO
DESIGNED THE ASSEMBLY LINING
80 YEARS AGO, DOING
SO-CALLED TIME-MOTION
STUDIES ON THE ASSEMBLY LINE,
HE CALCULATED HOW BEST
SOMEONE SHOULD TIGHTEN A NUT
OR BOLT OR WHATEVER AND
WE'VE TAKEN THAT SAME
PROCESS AND USED IT ON
NURSING IN THE HOSPITAL.
AND THE BIG PROBLEM WITH
THAT IS THAT WHAT GOT LEFT
OUT OF THIS ANALYSIS WAS THE
SPIRITUAL AND MENTAL CARE OF
PATIENTS AND THE TEACHING.
AND SO THAT WE'VE ONLY
FOCUSED ON STRICT PHYSICAL
CARE.
HOW LONG DOES IT TAKE TO DO
A BED BATH.
BUT THEY HAVEN'T SAID HOW
LONG DOES IT TAKE TO DO A
BED BATH FOR SOMEBODY WHO'S
DYING AND WORRYING ABOUT
THEIR SKIT FRIEND NICHOLSON
WHO THEY'VE BEEN TAKEN CARE
OF THE LAST 20 YEARS.
SO I THINK THAT, I CAN
THAT'S A BIG PROBLEM THAT
NURSES HAVE FACED, WHERE
THEIR TASKS HAVE BEEN BROKEN
DOWN TO PHYSICAL CARE IN
LITTLE, IN LITTLE BITS.
THE SECOND PROBLEM THAT
WE'RE FACING WITH NURSING IN
THIS PROVINCE THAT I THINK
I'VE HEARD DORIS GREENSPOON,
THE EXECUTIVE DIRECTOR OF
REGISTERED NURSES
ASSOCIATION SAY MANY TIME,
WE'VE ONLY GOT 50 percent OF THE
NURSING POSITIONS IN
HOSPITAL RIGHT NOW THAT ARE
FULL-TIME.
MANY NURSES DO WANT TO WORK
CASUAL AND PART TIME THAT IS
THEIR PREFERENCE BUT SAYS
MOST NURSES WOULD LIKE TO
WORK FULL-TIME AND IF WE HAD
AT LEAST 70 percent AND UP TO 80 percent
OF THE JOBS FULL-TIME, THEN
WE'D DO SOMETHING ABOUT THE
NURSING SHORTAGE.
PRACTICALLY SPEAKING, THE
OTHER THING IS THAT IF THE
PROVINCE IS WILLING TO PAY,
IF WE'RE GOING INTO A
RECESSION, A LOT OF NURSES
THAT HAVE SPENT THE LAST TEN
YEARS WORKING AT ALL THE TOW
PARTS PLANTS AND OTHER
PLACES BECAUSE THEY COULD
MAKE MORE MONEY WITH LESS
HASSLE AND UNFORTUNATELY
SOME OF THEM ARE GOING TO
LOSE THEIR JOBS AND THEN I
THINK WORKING IN HOSPITAL
WILL SEYMOUR ATTRACTIVE IF
WE CAN PROVIDE THE FULL-TIME
JOBS --

Maureen says SHANNON
OBVIOUSLY NEEDS TO SEE BIG
CHANGES IN THE HOSPITAL
BEFORE SHE'D GO BACK.

Doctor Rosser says THE OTHER PROBLEM IS THAT
IN THIS DOWNSIZING, OF
COURSE, SOME OF THE CARE
SHIFTED TO THE COMMUNITY.
PEOPLE WERE DISCHARGED FROM
HOSPITAL MORE ILL THAN THEY
HAD BEEN BEFORE.

Maureen says EXACTLY.

Doctor Rosser says AND YET THE PROMISE OF
THE GOVERNMENT WAS THEY
WOULD SHIFT SOME OF THE
RESOURCES, HIRE SOME OF THE
NURSES INTO THE HOME AND
THAT JUST DIDN'T HAPPEN.
IN FACT HOMECARE IN THE LAST
TWO OR THREE YEARS HAS BEEN
CUT, EVEN IN SPITE OF THE
INCREASED DEMANDS.

Maureen says YEAH, IT'S NOT
GOOD.
NOT A GOOD SITUATION.
SHANNON, THANKS FOR YOUR
CALL.
GARY IS IN BROCKVILLE.
HI GARY.

Gary says HELLO.
I'D JUST LIKE IT MAKE A
COMMENT ON THE CURRENT
HEALTHCARE SYSTEM?

Maureen says YEAH.

Gary says I WAS INJURED
BACK AUGUST 18th AS A POLICE
OFFICER IN BROCKVILLE.
ENDED UP I BROKE A PIECE OFF
MY VERTEBRAE BUT IT TOOK
THEM TWO AND A HALF MONTHS
TO GET ME IN FOR A CAT-SCAN
READING.
AND THEY FOUND AFTER THAT
THAT I NEEDED SURGERY, BUT
AGAIN IT TOOK ME UNTIL
NOVEMBER 3rd TO EVEN GET IN
FOR SURGERY.
THEY DID THE SURGERY.
I HAD CRUSHED THE VERTEBRAE,
THE PIECES WENT UP, RUPTURED
THE DISC, CRUSHED MY
VERTEBRAE, VERTEBRAE CAME
DOWN AND PINCHED MY NERVE
ENDINGS, SO I ENDED UP
NEEDING SURGERY TO CLEAR
THAT UP.
THAT EVENING I ENDED UP
HAVING AN ALLERGIC REACTION
OR WHATEVER TO THE MORPHINE
AND BECAUSE OF THE SHORTAGE
OF THE NURSES IN THE
HEALTHCARE SYSTEM, I WAS
ENABLE TO HAVE ONE COME TO
ME IMMEDIATELY SO, IT TOOK
THEM ALMOST AN HOUR TO BE
ABLE TO DEAL WITH MY CASE.
NEXT MORNING I FOUND OUT
THAT I HAD RUPTURED
EVERYTHING AGAIN AND HAD TO
GO IN FOR A SECOND SURGERY,
BUT THIS ALL COULD HAVE BEEN
CHANGED OR STOPPED IF I'D
HAD THE CAT-SCAN IN BROCKVILLE
BUT WE JUST DON'T HAVE THE
FUNDING EVEN TO DEAL WITH
IT.

Maureen says TWO ISSUE, COST
OF TECHNOLOGY AND THE
WAITING LIST ISSUE.
DOCTOR RACHLIS, WAITING LISTS
ARE SOMETHING THAT YOU SAY
ARE EXAGGERATED TODAY IN
CANADA.

Doctor Rachlis says WELL, THERE ARE
DEFINITELY PROBLEMS WITH
PEOPLE WAITING TOO LONG.
AND THIS CALLER, I DON'T
THINK THAT THAT --
FORTUNATELY HE DID GET SOME
CARE, BUT IT TOOK TOO LONG.
AND I'M CONCERNED A LITTLE
BIT ABOUT THE OTHER PROBLEMS
THAT HE MAY HAVE HAD WHILE
HE WAS IN HOSPITAL.
WHAT ARE THE SOLUTIONS?
WELL, SOMETIMES THE SOLUTION
IS MORE RESOURCES.
SOMETIMES IT SIMPLY IS
SHORTAGE OF RESOURCES.
FOR EXAMPLE WE'VE BEEN
HEARING ABOUT A LACK OF M.R.I.
SCANNERS IN THE
PROVINCE.
BUT ON THE OTHER HAND, EVEN
THERE THE ISSUE ISN'T SO
SIMPLE BECAUSE FOR EXAMPLE
IN OTTAWA, WHERE THERE'S
QUITE A BIT OF CONTROVERSY
THESE DAYS, IN FACT THERE
WAS A LETTER TO THE EDITOR
IN YESTERDAY'S “OTTAWA
CITIZEN” WHERE SOMEBODY
POINTED OUT THAT AT A TIME
WHEN OTTAWA'S FORECAST IT
WAS GOING TO HAVE AN M.R.I.
CRISIS THEY TOOK THEIR
EXISTING SCANNER OUT OF
SERVICE AS THEY WERE PUTTING
THE NEW ONE IN, AND THE NEW
ONE, AS FORECAST BY SOMEONE
PUBLICLY, DEVELOPED PROBLEMS
WITH ITS MAGNET AND THEY HAD
TO WITHDRAW IT.
THEY HAD ANOTHER M.R.I.
SCANNER THAT WAS ONLY BEING
RUN EIGHT HOURS A DAY.
THE HOSPITALS CLAIM THEY
ONLY GET A CERTAIN AMOUNT OF
FUNDING FROM THE MINISTRY,
THAT'S ONLY HOW LONG THEY
CAN RUN IT.
THE MINISTRY SAYS WAIT A
SECOND.
YOU HAVE A GLOBAL BUDGET.
WE DON'T GIVE YOU LINE
BY LINE, BUT WE EXPECT YOU TO
DO THINGS LIKE M.R.I.s 16 OR
24 HOURS A DAY SO THAT AS
YOU -- EVEN IN OTTAWA WITH
THE CRISIS THEY'VE HAD THERE
I WOULD SAY WITH M.R.I.
SCANS OVER THE LAST-YEAR
WHEN YOU LOOK INTO IT MORE
CLOSELY IT LOOKS LIKE
THERE'S A WHOLE BUNCH OF
MANAGEMENT ISSUES INVOLVED
AND FOR OTHER WAITING LIST
SITUATIONS, MANY SPECIALISTS,
FOR EXAMPLE, WE KNOW
UNFORTUNATELY TOO MANY
SPECIALISTS ARE SPENDING
THEIR TIME DOING ROUTINE
FOLLOW-UPS OF PATIENTS.
TO GIVE THE SPECIALIST THE
BENEFIT OF THE DOUBT
SOMETIMES THEY SAY THEY HAVE
TO DO THAT BECAUSE THE
PRIMARY CARE BEING GIVEN BY
FAMILY PHYSICIANS ISN'T
ADEQUATE FOR SO REASONS
WE'VE TALKED ABOUT EARLIER
SO WITH WAITS FOR
SPECIALISTS, IF YOU REALLY
LOOK AT THEM YOU CAN FIND
THERE'S A LOT OF PATIENTS
SEEING SPECIALISTS THEY
DON'T NEED TO SEE.
PATIENTS JUST AS FAMILY
PHYSICIANS,
SHOULD BE CONSULTING WITH
HOMECARE PRACTITIONERS,
SPECIALISTS SHOULD BE
SPENDING A LOT OF TIME ON
THE PHONE.
A LOT OF TIMES YOU DON'T
NEED A CONSULT EIGHT FOR AN
HOUR WITH A SPECIALIST, YOU
NEED TO PICK UP THE PHONE,
TALK TO A SPECIALIST FOR
FIVE MINUTES, THEN YOU CAN
DEAL WITH THE PROBLEM --

Maureen says OKAY, AS A
FAMILY PHYSICIAN, WOULD THAT
BE SOMETHING THAT WOULD HELP
YOUR PATIENTS, TO BE ABLE TO
TALK TO SPECIALISTS ON THE
PHONE?

Doctor Rosser says DEFINITELY, BUT THE
CURRENT -- IN THE CURRENT
SYSTEM, THAT'S SOMEWHAT IMPRACTICAL, BECAUSE
FIRST OFF, EVERYBODY'S
OVERLOADED.
FAMILY DOCTORS AND
SPECIALISTS WITH JUST SEEING
PATIENTS.
SOME OF IT MAY BE
INEFFICIENT, BUT THE
WORKLOADS ARE SUCH THAT IT
WOULD BE VERY DIFFICULT TO
SPEND THE TIME ON THE
TELEPHONE DEALING WITH THAT
TO START WITH.
AND THEN SECONDLY, NEITHER
PARTY GETS PAID FOR THAT IN
THE CURRENT FEE-FOR-SERVICE
SYSTEM.
THERE'S NO PAYMENT FOR
TALKING ON THE PHONE TO
ANYBODY, EITHER A PATIENT OR
A SPECIALIST, OR THERE'S NO
PAYMENT FOR THE SPECIALIST.
SO THEORETICALLY, YOU COULD
SPEND TWO HOURS A DAY
TALKING ON THE PHONE, BUT
THEN YOU'RE NOT PAID FOR
THAT TIME AND THAT MAKES IT
RATHER DIFFICULT.
IF YOU SHIFT INTO ALTERNATE FUNDED SYSTEM THAT TAKES
CARE OF IT.
SO THERE IS SOME ADVANTAGE
TO THAT, ALTHOUGH -- I DID
WANT TO MAKE A COMMENT THAT
MICHAEL EARLIER TOUCHED ON
THE FUNDING NOT BEING ABLE
TO BE SHIFTED INTO ALTERNATE
FUNDING.
THAT'S NOT THE CASE ANYMORE
AS A RESULT OF THE LAST
NEGOTIATION.
THERE IS AN OPPORTUNITY TO
SHIFT FUNDING INTO ALTERNATE
FUNDING AT THE PRIMARY CARE
LEVEL.

Doctor Rachlis says THEORETICALLY, BUT THE
O.M.A. AND PROVINCIAL
GOVERNMENT, ACCORDING TO
THAT AGREEMENT, HAVE TO SIT
DOWN AND NEGOTIATE THE
FORMULA BY WHICH THE MONEY
WOULD BE TRANSFERRED AND THE
LAST THING I HEARD WAS THAT
THEY HADN'T EVEN SAT DOWN
FOR NEGOTIATIONS AND FROM
WHAT I'D HEARD, THE O.M.A.
IS EXPECTING THE GOVERNMENT,
FROM MY CALCULATIONS, TO TOP
UP EACH FAMILY DOCTOR WITH
100,000 DOLLARS OF NEW MONEY TO BE
ABLE TO MAKE THE TRANSITION.

Doctor Rosser says THAT'S NEWS TO ME,
MICHAEL.
I'VE NEVER HEARD THAT
CERTAINLY NEVER HEARD --
THAT WOULD BE VERY NICE,
MIND YOU BUT I HAVEN'T HEARD
IT.

Doctor Rachlis says THIS WAS AT A CONFERENCE
IN OCTOBER WITH MARRY
KATHRYN LYNNBERG.

Maureen says WHATEVER THE
CASE THAT O.M.A. AGREEMENT
WAS REACHED SOME TIME AGO.
TO ANY KNOWLEDGE HAS ANY
DOCTOR JUMPED UP TO SAY I'D
LIKE AN ALTERNATIVE --

Doctor Rosser says OH, THERE HAVE BEEN QUITE
A FEW.

Maureen says BUT IS IT
ACTUALLY HAPPENING?

Doctor Rosser says NO, IT HASN'T HAPPENED.
THE MINISTRY OF HEALTH --
THE MINISTER OF HEALTH,
COMMITTED TO BEGIN IN APRIL,
THE COMING APRIL 1st.
THAT WOULD BE WHEN THE
PRIMARY CARE REFORM WOULD
START TO ROLL OUT.
HOWEVER THERE'S BEEN A LOT
OF NEGOTIATIONS --
NEGOTIATING GOING NONE THE
BACKGROUND AND THEY STILL
HAVEN'T ANNOUNCED THE
MECHANISM BY WHICH THAT IS
GOING TO HAPPEN.

Maureen says LET ME READ AN
E-MAIL THEN WE'LL GO TO A
CALL.
JEN IN HANOVER SAYS I THINK
WE'RE VERY LUCKY TO HAVE A
HEALTHCARE SYSTEM AT ALL.
WE TAKE FOR GRANTED WE DON'T
HAVE TO PAY THE DOCTORS OUT
OF OUR POCKETS AT EACH VISIT
OR INSURANCE TO TAKE OUT
HOSPITAL STAYS.
WE NEVER GET TURNED AWAY
FROM HOSPITALS BECAUSE WE
CAN'T AFFORD TREATMENT.
PEOPLE IN THE U.S. HAVE LOST
THEIR HOMES TO PAY FOR
MEDICAL TREATMENT.
I THINK WE TAKE FOR GRANTED
THE HEALTHCARE WE RECEIVE
AND WE SHOULD BE THANKFUL
FOR WHAT WE DO HAVE AND STOP
COMPLAINING ABOUT WHAT WE
DON'T HAVE.
THANKS VERY MUCH, JEN.
MAGEE IS IN WATERLY.
HI MAGEE.
GO AHEAD.
WHAT DO YOU THINK?

Magee says WELL, I'D LIKE TO
COMMENT ON THE LAST E-MAIL
YOU JUST READ.
THAT WAS SOME OF MY THOUGHTS
AS WELL.
IT'S BEEN A REALLY
INTERESTING DISCUSSION, AND
I HAVE TO AGREE WITH BOTH OF
YOUR GUESTS THERE TODAY.
I'VE LIVED IN BOTH ONTARIO
AND IN EUROPE, AND I'VE HAD
TO PAY FOR PRIVATE
HEALTHCARE.
FORTUNATELY, I'VE NEVER HAD
TO VISIT TOO MANY
SPECIALISTS, SO I HAVEN'T,
YOU KNOW, HAD TO GO BROKE
EITHER WAY.
BUT WHAT I CAN SEE -- AND I
HATE TO LIKEN THIS TO THE
EDUCATIONAL DILEMMA WE HAVE
IN ONTARIO RIGHT NOW, BUT IT
SEEMS TO ME THAT THE TEAM
APPROACH IS MISSING.
NUMBER ONE, YES, I THINK WE
DO ABUSE THE HEALTHCARE
SYSTEM.
I THINK, FOR INSTANCE, LAST
YEAR A LOT OF PEOPLE WENT TO
EMERGENCY WITH FLU SYMPTOMS
WHEN THEY DIDN'T HAVE TO DO
THAT.
AND I COMMENT -- DOCTOR RACHLIS
MENTIONED ABOUT THE NURSE
PRACTITIONERS.
THERE'S LOTS OF OPTIONS IF
WE ALL SAT DOWN AND WORK
THIS OUT.
ALTERNATE PAYMENTS AND WHAT
NOT.
I UNDERSTAND EVERYBODY HAS A
VESTED INTEREST BUT I THINK
BASICALLY WE'D ALL LIKE TO
SEE A BETTER HEALTHCARE
SYSTEM.

Maureen says WELL LET ME ASK
YOU MAGEE, THE ONLY WAY TO
GET THIS DONE THEN I GUESS
IS POLITICALLY BECAUSE THE
WILL SEEMS TO BE THERE, EVEN
ON THE PART OF THE
HEALTHCARE PRACTITIONERS BUT
IT STOPS AT THE POLITICAL
SYSTEM.
ARE WE IN CANADA READY TO MAKE
THIS AN ISSUE IN AN
ELECTION?
WE DIDN'T IN THE LAST
FEDERAL ELECTION.
THE NDP TRIED AND WE DIDN'T
LISTEN?

Magee says I DON'T KNOW,
THAT'S A VERY GOOD QUESTION.
I THINK CANADIANS HOLD
PUBLICLY-FUNDED HEALTHCARE
DEAR AND NEAR TO THEIR
HEARTS IN A WAY.
I THINK NUMBER ONE THAT THEY
TAKE PRIDE IF THAT THAT
DISTINGUISHES THEM FROM
AMERICANS IN THE WAY WE
ALWAYS HOLD UP THE FLAG AND
WAVE IT AND WE APPRECIATE WE
GET THAT RECOGNITION
WORLDWIDE, ON OUR BACKPACKS
OR WHATEVER SO I THINK IN
ONE SENSE WE HAVE THAT
SOCIAL CONSCIENCE.
I SEE SOMEONE SMILING, THAT
WE LIKE TO GIVE OURSELVES
THAT PAT ON THE BACK.

Maureen says LET ME ASK
DOCTOR RACHLIS, BECAUSE YOU'RE
WITH THE TOMMY DOUGLAS
INSTITUTE, AND YOU KNOW,
TOMMY IS SORT OF THE FATHER
OF THE CURRENT NDP, TOO.
WHAT WENT WRONG IN THE LAST
ELECTION.
THEY TRIED TO MAKE CANADIANS
SIT UP AND SAY, SAID TO THEM
“MEDICARE IS IN DANGER HERE,
FOLKS” AND THEY LOST SEATS.

Doctor Rachlis says YEAH, I THINK -- FIRST OF
ALL I HAVE TO MAKE IT CLEAR
THAT I'M NOT AN EMPLOYEE OF
THE TOMMY DOUGLAS RESEARCH
INSTITUTE.
MY OTHER AUTHORS WERE
CONTRACTED TO WRITE THE
PAPER FOR IT SO I HAVE TO
CLARIFY THAT.
BUT I THINK THAT YES, IN THE
LAST ELECTION THE NDP DID
FOCUS ON TRYING TO SAY THAT
THERE WAS TERRIBLE PROBLEMS
WITH THE SYSTEM AND TRIED TO
BLAME THE LIBERAL GOVERNMENT
FOR IT.
BUT ON THE OTHER HAND WHAT
THEY DIDN'T PLAY UP, WHICH
I -- WHICH I FOUND
INTERESTING, WAS THEY DIDN'T
PLAY UP THE REST OF THEIR
PLATFORM.
AND FOR ANYBODY WHO LOOKED
AT ALL THE PARTY'S PLATFORMS
ON HEALTHCARE, WHICH I HAD
TO DO TO ANALYZE THEM, THE
NDP PLATFORM WAS FULL OF
SUPPORT FOR PRIMARY
HEALTHCARE REFORM, THE
COMMUNITY HEALTH CENTRE
MODEL, THE USE OF NURSE
PRACTITIONERS, ET CETERA, ET
CETERA, BUT THEY DIDN'T PLAY
THAT PART UP.
AND I THINK THAT IT'S
INTERESTING THAT FOR THE
PARTIES ON THE LEFT OF THE
POLITICAL SPECTRUM, I THINK
THAT THERE'S SOME -- I THINK
IT'S TIME TO DO A LITTLE BIT
OF SOUL SEARCHING ON THIS.
BECAUSE TYPICALLY ON THE,
WHEN THE NDP HAVE BEEN IN
OPPOSITION IN PROVINCIALLY,
FOR EXAMPLE, AND NOT JUST IN
ONTARIO BUT OTHER PROVINCES,
THEY TEN TO JUST BLAME THE
GOVERNMENT FOR WHATEVER
PROBLEMS ARE IN THE
HEALTHCARE SYSTEM WITHOUT
NECESSARILY RAISING PUBLICLY
THE ALTERNATIVES AS WE'RE
TALKING ABOUT THEM NOW.
NURSE PRACTITIONER,
COMMUNITY HEALTHCARE CENTRE,
PROTOCOLS, ET CETERA, AND I
THINK THAT ONE OF THE THINGS
THAT WE WERE STRUCK BY, WHEN
OUR REPORT CAME OUT, WAS
THAT PEOPLE REALLY LIKED,
EVEN GROUPS OR INDIVIDUALS
THAT CRITICIZED SO POLITICAL
PARTS OF OUR REPORT, THEY
LOVED THE IDEA OF THE NEW
IDEAS WITHIN THE SYSTEM.
I THINK IT'S TIME FOR PEOPLE
WHO REALLY BELIEVE IN
MEDICARE, AND CERTAINLY THE
NDP, I GUESS, AS IF ANY OR
ALL PARTIES HAVE CONTRIBUTED
TO IT, THAT INSTEAD OF JUST
SAYING THE HEALTHCARE SYSTEM'S
A MESS AND BLAMING WHICHEVER
IS IN POWER, I THINK THAT
THEY SHOULD BE MORE
CONSTRUCTIVE AND BRING
OUT -- FOR EXAMPLE, I THINK
THAT THE PROVINCIAL
GOVERNMENT IN ONTARIO RIGHT
NOW SHOULD BE EXTREMELY
SUSCEPTIBLE FOR CRITICISM
THAT THEY HAVE BEEN SITTING
IN THE BACKROOMS WITH THE
O.M.A. FOR THE LAST SIX
YEARS FIDDLING AWAY WITH
SOMETHING CALLED PRIMARY
HEALTHCARE REFORM WHILE THE
WORLD IS BURNING.
AND RATHER THAN SIMPLY BLAME
THE PROVINCIAL GOVERNMENT
FOR WHATEVER CRISIS THERE IS
IN HEALTHCARE, LET'S GET
INTO THE DETAILS OF HOW WE
CAN GET THE COMMUNITY
HEALTHCARE CENTRE --

Maureen says BUT THE FLU
VACCINE IS GOOD --

Doctor Rosser says WELL, I'M NOT SURE ABOUT
THAT MICHAEL, I THINK THE
PROBLEM IS THAT -- AND IT'S
BEEN ADDRESSED BY OUR CALLER,
SAYING THAT IT'S -- MEDICARE
IS NEAR AND DEAR TO
CANADIANS' HEART.
SO MUCH SO THAT I THINK THE
POLITICIANS ARE VERY AFRAID
TO DO ANYTHING TO THE SYSTEM,
BECAUSE THEY KNOW AS SOON AS
THEY BRING IN ANYTHING,
SOMEONE'S GOING REACT.
BECAUSE AS WAS SAID BY
ANOTHER CALLER, THERE ARE
MANY VESTED INTERESTS, AND
AS SOON AS YOU START DOING
ANYTHING WITH THE HEALTH
SYSTEM AND LOOK AT THE CLOSE
YOU'RE OF HOSPITALS, YOU
BRING PEOPLE OUT OF THE
WOODWORK.
SO ANY POLITICAL PARTY, IT
DOESN'T MATTER WHICH ONE IT
IS, IS GOING TO BE RELUCTANT
TO START MAKING MAJOR
CHANGES IN A SYSTEM BECAUSE
THEY KNOW IT'S GOING TO
RAISE A HUGE AMOUNT OF --

Maureen says BUT THIS IS
WHERE DOCTORS COULD BE SO
HELPFUL, BECAUSE PEOPLE DO
TRUST THEIR DOCTORS.
AND IF THEY CAME OUT AND
WERE MORE VOCAL ABOUT
SUPPORT FOR PRIMARY
HEALTHCARE REFORM, MAYBE THE
PUBLIC --

Doctor Rosser says WE'VE COME OUT, WE'VE HAD
PRESS CONFERENCES AND THE
MEDIA DOESN'T PAY ANY
ATTENTION TO IT BECAUSE IT'S
NOT NEWS WORTHY.

Maureen says THE MEDIA COMES
UNDER FIRE IN THIS REPORT.

Doctor Rosser says IF WE SAY WE'RE IN FAVOUR
OF NURSE PRACTITIONERS,
GROUP PRACTICES, ALTERNATE
FUNDING, EVERYBODY YAWNS AND
SAYS WHO CARES.

Maureen says YEAH, YEAH.
LET ME GIVE THE NUMBERS.
IF YOU'RE JUST JOINING US
WE'RE TALKING ABOUT CANADA'S
HEALTHCARE SYSTEM, PRIMARY
HEALTHCARE REFORM.
DO YOU THINK THERE'S A
CRISIS IN THE SYSTEM?
DO YOU THINK IT CAN BE
FIXED?
GIVE US A CALL, AND TELL US
WHAT YOU THINK.
IN TORONTO DIAL 416 484-2727
WE’VE GOT A TOLL FREE LINE IF
YOU’RE LONG DISTANCE
1-888-411-1234
AND YOU CAN E-MAIL YOUR COMMENTS
TO MORETOLIGE@TVO.COM
MY GUESTS THIS
AFTERNOON DOCTOR MICHAEL
RACHLIS AND DOCTOR WILLIAM
ROSSER.
JEANIE IN KEANE.
HI JEANIE.

Jeanie says HOW ARE YOU
TODAY?

Maureen says GREAT THANKS.

Jeanie says WHAT GREAT SHOW.

Maureen says THANKS.

Jeanie says I REALLY DON'T
THINK THERE'S THAT MUCH OF A
CRISIS.
THERE'S SOME THING, THERE
IS.
MY DOCTOR'S THE GREATEST.
YOU KNOW, I DON'T GO THAT
OFTEN, BUT HE IS REALLY
GOOD.
HE SENDS ME TO SPECIALISTS
WITHOUT ME EVEN ASKING.
AND I LIKE THESE NURSE
PRACTITIONERS.
I LIKE THEM.
WE'VE GOT ONE AROUND MY
AREA.
AND SHE DOES ALL THE --
EVERYTHING FOR HER PATIENTS
AND THEN SHE TALKS TO A
DOCTOR IF THERE'S ANYTHING
SERIOUS.

Maureen says SO LET ME GET
THIS STRAIGHT.
GO IN AND THE FIRST PERSON
YOU SEE IS THE NURSE
PRACTITIONER.

Jeanie says THAT'S RIGHT.

Maureen says AND SHE DECIDES
WHETHER YOUR PROBLEM NEEDS
TO GO ON FURTHER TO THE
DOCTOR OR WHETHER YOU JUST
GO HOME.
SHE CAN'T PRESCRIBE MEDICINE
THOUGH, RIGHT?

Jeanie says NO, BUT SHE CAN
GO AND TALK TO SOMEBODY ON A
COMPUTER OR A PHONE, AND IF
THERE'S A SERIOUS THING LIKE
THAT THEY GET BACK TO HER
ABOUT WHAT THE PROBLEM IS.

Maureen says DOCTOR ROSSER, YOU
HAVE A FEW RESERVATIONS
ABOUT NURSE PRACTITIONERS
DOING SORT OF TRIAGE.

Doctor Rosser says WELL YES, ESPECIALLY IN A
MEDICAL OFFICE.
NOW THIS MAY BE A DIFFERENT
MODEL, IF THIS IS A NURSE
PRACTITIONER IN A COMMUNITY
WHERE THERE IS NO DOCTOR
AVAILABLE, THAT'S DIFFERENT.
BUT I THINK OUR CONCERN IS
THAT WE THINK THAT A NURSE
PRACTITIONER -- FIRST OFF,
THE NURSE PRACTITIONERS, BY
THE WAY, CAN PRESCRIBE --
THERE'S A LIST OF DRUGS.
IT'S SOMEWHAT LIMITED BUT
THEY CAN PRESCRIBE
MEDICATION.
WE THINK THAT THE BEST ROLE
FOR A NURSE PRACTITIONER IS
TO WORK COLLABORATIVELY WITH THE
PHYSICIAN, LOOKING AFTER A
GROUP OF PATIENTS.
AND WE THINK THAT THERE'S A
PARTICULAR ROLE -- FOR
EXAMPLE IN WELL BABY CARE.
WHERE THERE'S A LOT OF
TEACHING INVOLVED, WHERE
IT'S A WOMAN TO A WOMAN,
USUALLY, AND I THINK THERE'S
SOME BENEFIT TO THAT, AND
THEY CAN HAVE A LOT OF
DISCUSSION ABOUT CHILD CARE,
CHILD REARING ET CETERA.
A IF THE WITH A LOT OF OTHER
PEOPLE PRESSURING THEM IS
NOT GOING TO DO THAT VERY
WELL, AND HISTORICALLY, I
DON'T THINK WE EVER HAVE
DONE IT VERY WELL.
I MENTIONED EARLIER DIABETIC
PATIENTS.
DIABETIC PATIENTS, THERE'S
NOW A NUMBER OF THINGS THAT
EVERY DIABETIC SHOULD HAVE
DONE, EITHER EVERY SIX
MONTHS OR EVERY YEAR, AND WE
KNOW THAT IF THOSE THINGS
ARE MONITORED CAREFULLY, IF
THEIR SUGARS ARE MONITORED
CAREFULLY, THEY WILL NOT
HAVE THE SERIOUS
COMPLICATIONS.

Maureen says YOU SEEM TO BE
HAPPY TO LET THEM DO THINGS
ONCE THE DIAGNOSIS HAS BEEN
MADE BY A DOCTOR.

Doctor Rosser says WELL, THE THING IS --
WELL THERE'S TWO REASONS FOR
THAT.
ONE IS THAT FIRST OFF JUST
BEING A TRIAGE PERSON AND
JUST SAYING THIS PERSON IS
SICK AND THIS PERSON ISN'T
IS A DEMEANING ROLE, I
THINK.
I THINK NURSE PRACTITIONERS
ARE BETTER TRAINED THAN
THAT.
SECONDLY, THE FAMILY DOCTOR
PUTS A GREAT DEAL OF
IMPORTANCE ON THE
RELATIONSHIP THEY HAVE WITH
THEIR PATIENTS.
TRUSTING RELATIONSHIP.
WE'VE HEARD THAT FROM
VARIOUS PEOPLE, AND THEY
FEEL THAT -- WELL, IT'S A
BIT OF A LONG EXPLANATION,
BUT A LOT OF THE PEOPLE THAT
COME TO SEE A DOCTOR MAY
COME AND SAY I HAVE A SORE
THROAT OR A HEADACHE BUT IN
FACT THEY HAVE SOMETHING
ELSE GOING ON.

Maureen says SO YOU'RE SAYING
THEY WANT TO -- THERE'S
CONFIDENTIAL THINGS
THAT THEY WANT TO TALK
ABOUT.

Doctor Rosser says THAT'S RIGHT.
THEY HAVE THEIR FAMILY,
THEIR MARITAL SITUATION MAY
BE IN TROUBLE, THEY MAY
HAVE LOST A RELATIVE, BE
GRIEVING --

Maureen says AND YOU THINK
DOCTORS GIVE THEM THE TIME
IN ALL THOSE ISSUES RIGHT
NOW?

Doctor Rosser says WE'RE CERTAINLY TRAINING
PEOPLE.
THEY MAY HAVE TROUBLE DOING
IT, BUT GENERALLY YES.

Maureen says WELL WHAT DO YOU
THINK OF HIS ROLE MODEL.

Doctor Rachlis says WELL I THINK -- I
DISAGREE SOMEWHAT WITH WHAT
DOCTOR ROSSER IS SAYING BUT I
THINK IN THE END IT DOESN'T
MATTER.
I DISAGREE THIS THAT I THINK
THAT I'M LOOKING FOR MORE
EGALITARIAN TEAMS THAT
I'M -- I THINK THAT WE
SHOULD RECOGNIZE THAT
ACTUALLY THE TRIAGE IS
ALMOST ALWAYS DONE BY A
NON-PROFESSIONAL.
WHEN YOU CONTACT A DOCTOR'S
OFFICE, YOU'RE ALMOST ALWAYS
TALKING TO A RECEPTIONIST.
THEY HAVE TRAINING BUT
THEY'RE NOT HEALTH
PROFESSIONAL.
AND FOR EXAMPLE, IN SOME
COMMUNITY HEALTH CENTRES IN
ONTARIO, THE QUEBEC
COMMUNITY HEALTH SYSTEM,
THEY'RE THE ONLY PROVINCE
WITH A FULL NETWORK OF
COMMUNITY HEALTH CENTRE, IF
SOMEBODY CONTACTS THE OFFICE
AND SAYS THEY'RE HAVING
TROUBLE WITH ONE OF THEIR
KIDS' BEHAVIOUR, THEIR
INITIAL APPOINTMENT IS WITH
A SOCIAL WORKER AND IT'S UP
TO THE SOCIAL WORKER TO --
IF THERE'S A SERIOUS MEDICAL
PROBLEM POTENTIALLY, THEN
SHE REFERS THE PATIENT BACK
TO THE DOCTOR BUT THEY DON'T
HAVE TO SEE THE DOCTOR
FIRST.
SO I LIKE, I LIKE THAT
MODEL.
AND I THINK THAT PEOPLE HAVE
ENOUGH JUDGMENT, AND THE
STUDIES -- THERE ARE A
COUPLE OF STUDIES DONE
COMPARING THE COMMUNICATIONS
SKILLS OF NURSES AND
PHYSICIANS.
NURSES TEND TO TAKE A BETTER
HISTORY AND TO LISTEN
LONGER.
THEY'RE ALSO MORE PROTOCOL
DRIVEN, MORE LIKELY TO
FOLLOW THE PROTOCOLS BUT
THE REASON I SAID IS IT
PROBABLY DOESN'T MATTER SO
MUCH IS WE HAVE SO FEW
EXAMPLES OF HI FUNCTIONS
NURSE PRACTITIONER TEAMS
RIGHT NOW THAT I THINK THAT
THE FIRST GOAL SHOULD BE TO
GET TO GO WHERE PEOPLE ARE
AT.
THERE'S A LOT OF PHYSICIANS
INTERESTED IN THE CONCEPT IN
NURSE PRACTITIONERS AND
BEING PAID ON A
NON-FEE-FOR-SERVICE BASIS,
TAKE THE PHYSICIAN WHOSE ARE
MOST INTERESTED IN THE MODEL
AND LET'S START WORKING WITH
THEM.
AND I THINK ONE OF THE
THINGS THAT THE HISTORY IN
THIS AREA CAN TELL US IS
THAT WHEN PHYSICIANS AND
NURSES START WORKING
TOGETHER, IF THERE'S THE
APPROPRIATE SUPERVISION
GOING ON, THAT GOOD TEAMS
WILL BE DEVELOPED.
SO THAT YOU NEED, YOU NEED
TO MAKE SURE THAT THERE IS
SOME TEAMWORK GOING ON, BUT
YOU HAVE TO START THE
PROCESS.
RIGHT NOW WE HAVE SO FEW
EXAMPLES THAT IT --

Maureen says IT DOESN'T
REALLY MATTER.
LET'S GET T.J.'S CALL IN IN
INNISVILLE.

T.J says HI, I WAS
GESTATIONAL DIABETIC AND
WELL CARED FOR IN '95 AND
THE DIABETES CLEARED UP
RIGHT AFTER CHILDBIRTH AND
LIFE WAS LOVELY.
I BECAME SICK AGAIN ABOUT
SIX MONTHS LATER, EVEN
THOUGH I'D ALREADY BEEN
TAUGHT TO DO THE INSULIN AND
EVERYTHING, I HAD TO --
EXCUSE ME ONE SECOND.
MAX, PLEASE BE QUIET.
(LAUGHING)

Maureen says MOMMY'S ON TV.

T.J says AND EVEN THOUGH I'VE BEEN
INSTRUCTED ON HOW TO USE THE
INSULIN BECAUSE DURING MY
PREGNANCY, I WAS PUT ON A
LIST TO SEE THE SPECIALIST
AGAIN.
AND THEN WHEN I FINALLY SAW
HER, THEN I WAS PUT ON A
LIST TO SEE THE V.O.N. TO
COME IN AND INSTRUCT ME TO
DO IT AGAIN.
AND THROUGH THIS IT ENDED UP
TO BE ALMOST A SIX MONTH
ORDEAL, I LOST 44 POUNDS, MY
HAIR FELL OUT.
I COULD HAVE BEEN A POSTER
CHILD FOR THE ETHIOPIAN
FAMINE.
I WAS DYING.
I CAN'T EVEN EXPLAIN TO YOU
THE HELL I WENT THROUGH WITH
THAT.
AND THEN I EXPERIENCED WITH
MY FATHER GETTING CANCER, HE
ALMOST GOT TO DIE IN THE
BOND STREET HOTEL, AND THIS
IS A MAN THAT NEVER TOOK
ANYTHING FROM THE HEALTHCARE
SYSTEM.
YOU HAD TO PAY FOR HIM FOR
EIGHT DAYS --

Maureen says HE COULDN'T GET
TREATMENT?

T.J says THEY, THEY DIDN'T HAVE A
BED TO KEEP HIM, AND THEY
DIDN'T WANT HIM TOO FAR FROM
SAINT MIKE'S, AND WE HAD NO
FAMILY IN TORONTO, AND IT
WAS OVER THE CHRISTMAS
HOLIDAY.
THERE WERE TWO NURSES.
I COUNTED THEM, EVERY TIME
THAT THEY WOULD ADMIT HIM
AND PUT HIM IN A BED, THERE
WERE ONLY TWO NURSES ON THE
WHOLE FLOOR, ON THE
NEUROLOGICAL CARE FLOOR.
HE DIDN'T RECEIVE PROPER
TREATMENT.
I HAD TO WASH MY FATHER'S
PRIVATE PARTS BECAUSE HE WAS
A CLEAN MAN AND COULDN'T
STAND TO BE DIRTY IN THE
BOND STREET HOTEL BECAUSE
THEY JUST TURNED UP THEIR
PALMS AND SAID WE'RE SORRY.
AND I WANTED TO YELL AND
SCREAM AT THE NURSING STAFF,
JUST WITH MY -- LIKE WITH MY
DIABETES AND SCREAM AT THESE
PEOPLE, BUT I COULD NOT
SCREAM AT PEOPLE THAT WERE
STRETCHED SO FAR, THEY WERE
GOING TO SNAP.
AND THE BIGGEST POINT I WANT
TO MAKE IS WE ARE HOLDING UP
THE KEY TO THIRD WORLD
COUNTRIES, THE KEY TO
SUCCESS IS HEALTHCARE AND
EDUCATION, YOU KNOW?
PEOPLE HAVE TO READ BACK TO
THE WINNIPEG GENERAL STRIKE
TO UNDERSTAND WHERE WE WERE,
WHERE WE'VE COME TO, WHY
WE'RE GREAT AND WHY WE CAN'T
LET THE CONRAD BLACKS AND
THE --

Maureen says WELL T.J., YOU
SAME TO BE SAYING THERE IS A
CRISIS IN HEALTHCARE, BUT DO
YOU THINK THE SOLUTION IS
MORE -- I THINK YOU'RE
SAYING THE SOLUTION -- YOU
AGREE WITH DOCTOR RACHLIS, IS
NOT MORE PRIVATIZED
HEALTHCARE.

T.J says DEFINITELY NOT
BECAUSE THEN ONLY THE RICH
AND POWERFUL GET THE
TREATMENT.
AND THAT -- AND I DON'T
BEGRUDGE MY DOCTORS ANY
MONEY, BECAUSE I SAT AND
LISTENED IT A GUY A FEW
WEEKS AGO THAT INHERITED A
FRONT END LOADER AND
BULLDOZER AND WHEN HE
EXPECTS TO MAKE OFF HIS
INVESTMENT IS FAR MORE THAN
ANY BLOODY DOCTORS --

Maureen says OKAY, ALL RIGHT,
I WANT TO TELL YOU FOR
THANKING YOUR STORY.
ARE FAMILY PHYSICIANS ADEQUATELY
PAID UNDER THE CURRENT
SYSTEM, FEE MORE SERVICE?
THERE'S CAPS, SOME OF THEM
STILL CLOSE THEIR OFFICES
TOWARD THE END OF THE FISCAL
YEAR.

Doctor Rosser says THAT'S A VERY DIFFICULT
QUESTION TO ANSWER IN THAT
HOW DOES SOCIETY JUDGE WHAT
SOMEBODY SHOULD BE PAID I
MEAN, IF BASEBALL PLAYERS
GET PAID 6 MILLION DOLLARS FOR
PLAYING A GAME ALL SUMMER,
HOW CAN YOU COMPARE THAT TO
A SURGE JOHN OR A FAMILY
DOCTOR WHO'S DOING THE WORK?
SO I CAN'T ANSWER THE
QUESTION DIRECTLY.
I THINK THERE'S A SENSE THAT
THE INCOMES OF FAMILY
DOCTORS HAVE BEEN FALLING
THE LAST TEN YEARS,
DEFINITELY, BECAUSE THERE
HAVE BEEN BASICALLY NO
INCREASES IN THE FEES FOR
SERVICE SYSTEM UNTIL JUST
LAST APRIL.
AND SECONDLY THEIR COSTS
HAVE BEEN GOING UP.
AND A THIRD FACTOR IS THAT
THE SYSTEM, WHICH IS A VERY
FRUSTRATING PART OF IT, IS
BECOMING MORE AND MORE
BUREAUCRATIC.
THERE'S MORE AND MORE
REQUIREMENTS FOR PEOPLE TO
HAVE FORMS FILLED IN TO DO
VARIOUS THINGS, IN
PRESCRIBING DRUGS, TO HAVE
TO FILL IN SPECIAL FORMS FOR
CERTAIN DRUGS.
SO THAT DOCTORS ARE FINDING
THEY ALL ARE SAYING I'M NOW
SPENDING ONE OR TWO HOURS A
DAY FILLING IN FORMS WHEN I
COULD BE SEEING MORE
PATIENTS AND BEING MORE
EFFECTIVE IN THE SYSTEM.

Maureen says OF COURSE,
DOCTOR RACHLIS, I THINK WHAT
THE AVERAGE FAMILY PHYSICIAN
IS WORRIED ABOUT, WHEN HE
HEARS ABOUT GOING ON --
GOING ON SALARY IS HIS
INCOME WILL DROP.
AND I DON'T KNOW THAT THE
REPORT EXACTLY ADDRESSES
THAT CONCERN.

Doctor Rachlis says AND CERTAINLY AGAIN, I
WANT TO MAKE THE POINT THAT
SOME PEOPLE HAVE SAID, WE'VE
TALKED ABOUT CONSCRIPTING
FAMILY DOCTOR,
FORCING THEM ON SALARY.
WE'RE NOT SAYING THAT AT ALL
BUT SURVEYS INDICATE UP TO
50 percent OF DOCTOR, MAYBE EVEN
MORE ARE AT LEAST INTERESTED
IN A VALERIE AND THEY'RE
WILLING TO CONSIDER IT.
SO THERE'S POTENTIALLY
THOUSANDS OF ONTARIO FAMILY
PHYSICIAN WHOSE ARE AT LEAST
INTERESTED IN SOMETHING
DIFFERENT.
AND I SHOULD SAY THAT BEING
A FAMILY DOCTOR, IT'S NOT
LIKE -- BASEBALL PLAYERS ARE
PAID PRIVATELY.
98 percent PLUS OF FAMILY
PHYSICIANS' INCOME COMES
FROM BILLING THE ONTARIO
HEALTH INSURANCE PLAN.
AND SO IF WE LOOK WITHIN THE
PUBLIC SECTOR, ONE OF THE
THINGS THAT THAT'S STRIKING
IS THAT SOME FAMILY
PHYSICIANS MAKE A LOT OF
MONEY AND MAY NOT WORK ALL
THAT HARD FOR IT.
OTHER FAMILY PHYSICIANS WORK
VERY HARD FOR NOT VERY MUCH
REWARD AND YOU DON'T FIND
THESE DISPARITIES IN OTHER
PARTS OF THE PUBLIC SECTOR,
SO THAT IN FAMILY MEDICINE,
EVERY MOMENT OF EVERY DAY,
WHEN YOU CHOOSE TO PRACTICE
BETTER MEDICINE, YOU MAKE
LESS MONEY AND SPEND LESS
TIME WITH YOUR FAMILY.
WHEN YOU TAKE ANOTHER MINUTE
TO ASK A PATIENT A QUESTION
ABOUT A POTENTIAL DRUG
REACTION TO ASK ANOTHER
QUESTION OF A PATIENT WHO
MIGHT BE SUICIDAL, WHEN YOU
TAKE THAT EXTRA TIME OR
WHEN YOU HIT YOUR BOOKS
AFTERWARDS -- I MEAN, I USED
TO -- MY WIFE WAS A
PHYSICIAN AND USED TO BE IN
ROUTINE FAMILY PRACTICE.
SHE'S NOT NOW AND WHEN SHE
WAS IN FAMILY PRACTICE ON
FEE-FOR-SERVICE I WOULD JOKE
WITH HER I'LL BET YOU SPENT
THE LAST HOUR TALKING WITH
PEOPLE ON THE PHONE AND HE
SAID YES AND I SAID WHY
DON'T YOU GET THE SECRETARY
TO BOOK THREE OF THOSE
PATIENTS IN TO SEE YOU, AND
OUR FAMILY INCOME WOULD HAVE
GONE UP 20,000 DOLLARS A YEAR.
THE AMAZING THING ISN'T
THERE ARE SO FEW FAMILY
DOCTORS PROVIDING
COMPREHENSIVE CARE, THE
AMAZING THING IS THERE ARE
ANY DOING IT.
WHEN DOCTORS PROVIDE GOOD
COMPREHENSIVE CARE, THEY
HELP PEOPLE DELIVER BABIES
AND DIE AT HOME THEY'RE
DOING IT FOR VERY LITTLE PAY
OR NONE AT ALL.
ON THE OTHER HAND IF YOU SEE
60 OR 70 AND THERE ARE
DOCTORS IN ONTARIO ARE SEEING MORE
THAN 80 PEOPLE DAY, SEND
COMPLICATED PATIENTS TO THE
EMERGENCY DEPARTMENT OR OFF
TO SPECIALISTS AND THAT
DOCTOR COULD JUST WORK 40 OR
40 OR 45 HOURS A WEEK, NET
300,000 DOLLARS OR MORE AND THERE'S
A DOCTOR ACROSS THE HALL
WORKING 70 HOURS A WEEK WHO
ISN'T NETTING 100,000 DOLLARS, I'M
NOT GOING TO RUN A TAG SALE
FOR ANY OF THESE PEOPLE, BUT
HOW CAN YOU RUN A HEALTHCARE
SYSTEM WHEN YOU PRACTICE BAD
MEDICINE YOU MAKE THREE
TIMES AS MUCH AS WHEN YOU
PRACTICE GOOD MED SIGN.

Doctor Rosser says THAT'S
PRECISELY OUR ORGANIZATION
HAS PROPOSED A REFORM.
AND WE'VE SAID ONE, WE WANT
THE DOCTORS -- WE WANT
COMPREHENSIVE CARE TO BE
REWARDED.
AND RIGHT NOW IT ISN'T.
WHAT YOU'RE SAYING IS
EXACTLY RIGHT.

Maureen says OKAY.

Doctor Rosser says WHEN OUR RESIDENTS
GRADUATE FROM THE PROGRAMME
AT THE UNIVERSITY OF TORONTO,
MANY OF THEM GO AND WORK IN
WALK-IN CLINICS AND THAT'S
VERY FRUSTRATING FROM OUR
POINT OF VIEW BECAUSE WE'VE
TRAINED THEM TO BE
COMPREHENSIVE DOCTORS.
AND THE REASON THEY DO THAT
IS THEY HAVE 100,000 DOLLARS OF
DEBT, THEY SAY “HOW CAN I
EARN THE MOST MONEY WITHOUT
HAVING TO INVEST ANYTHING IN
SETTING UP A PRACTICE,”
EXCEPT FOR THE CAPITAL, AND
I CAN GO WORK AT A WALK-IN
CLINIC, WORK 30 HOURS A WEEK
AND MAKE 250,000 DOLLARS.
IF I GO OUT AND SET UP A
STANDARD PRACTICE I HAVE TO
GO FURTHER IN DEBT IT'LL
MAKE ME A YEAR TO BUILD UP
THE PRACTICE, OR WON'T IN
MOST PLACE NOW, IT'LL TAKE
THREE WEEKS.
BUT EVEN SO, IF I PROVIDE
OBS STET CAL CARE, I PROVIDE
24 HOURS COVERAGE AND I DEAL
ALL THE PROBLEMS THAT MY
PATIENTS BRING TO ME I'LL
BRING IN HALF AS MUCH OR
LESS.

Maureen says LET ME READ THIS
E-MAIL AND WE'LL GO TO
ANNETTE.
“WOULD EITHER OR BOTH OF
YOUR GUESTS LIKE TO COMMENT
ON THE GOVERNMENT'S
ANNOUNCED SERVICE OF
TELEPHONE MEDICAL ADVICE
WHICH IS SOON TO BE
IMPLEMENTED?”
I THINK THEY'VE BEEN TRYING
IT UP NORTH ON A PILOT BASIS.
QUICKLY, BOTH OF YOU?

Doctor Rosser says WHERE IT'S BEEN MOST
TRIED IN SOUTHERN ONTARIO IS IN PARIS,
ONTARIO, WHERE IT'S BACKING
UP WHAT ARE CALLED PRIMARY
CARE REFORM SITES, WHICH ARE
ACTUALLY DOING A LOT OF THE
THINGS THAT WE'VE BEEN TALKING
ABOUT, THEY HAVE NURSE
PRACTITIONERS.
THEY'VE FOUND IT VERY
SUCCESSFUL.
PATIENTS THINK IT'S
WONDERFUL BECAUSE THEY CAN
PHONE 24 HOURS A DAY AND GET
ADVICE AS TO WHETHER THIS IS
A CRISIS OR NOT, BECAUSE A
LOT OF PEOPLE DON'T KNOW
THAT THEY'RE ABLE TO GET
GOOD RICE AND IF THEY NEED
HELP THEY'RE REFERRED ONTO
WHEREVER THEY GET IT
APPROPRIATELY.
CUTS DOWN THE USE OF
EMERGENCY ROOMS, WHICH IS A
VERY EXPENSIVE WAY OF
DELIVERING CARE FOR SORE
THROATS, ET CETERA, AND THE
DOCTORS FIND IT HELPS
ORGANIZE THEIR PRACTICE MUCH
MORE EFFECTIVELY AS WELL.

Doctor Rachlis says BRIEFLY, I THINK IT IS
GENERALLY A GOOD IDEA.
I DON'T LIKE THE ONTARIO
MODEL BECAUSE IT'S A PRIVATE
COMPANY UP NORTH THAT'S
DOING IT, AND I WORKED IN
FULL-TIME FAMILY PRACTICE
FOR EIGHT YEARS ON SALARY IN
A COMMUNITY HEALTH CENTRE IN
TORONTO AND WE DID OUR OWN
TELEPHONE ADVICE WITH OUR
OWN STAFF.
THAT'S THE MODEL I WOULD
LIKE TO SEE.
I WOULD LIKE TO SEE THAT IF
WE HAD A GROUP PRACTICE OR
THE COMMUNITY HEALTH CENTRE
MODEL, AND IF YOU HAD ENOUGH
OTHER STAFF THERE, THEN YOU
COULD PROVIDE YOUR OWN
TELEPHONE ADVICE, AT LEAST
12, MAYBE UP TO 16 HOURS A
DAY AND THEN AFTER HOURS YOU
COULD FOLD IT BACK TO A
REGIONAL NUMBER SO I LIKE
THE IDEA OF TELEPHONE ADVICE
BUT LET'S HAVE IT INTEGRATED
WITH REFORM PRIMARY
HEALTHCARE BETTER THAN IT IS
NOW.

Maureen says OKAY.
ALL RIGHT.

Doctor Rosser says I THINK IT IS, ACTUALLY
IN THESE PRIMARY REFORM CARE
SITES.

Doctor Rachlis says WILL IS MORE TELEPHONE
ADVICE RIGHT THERE.

Doctor Rosser says THE TRIAGE TAKES PLACE
REALLY ONLY WHEN THEY'RE NOT
FUNCTIONING IN THEIR
PHYSICAL FACILITY.

Maureen says ANNETTE, WELCOME
TO THE PROGRAMME.
HI.

Annette says HI.
I WANT TO TALK TO
DOCTOR ROSSER.
HE SAID THAT DOCTORS DON'T
GET PAID FOR TELEPHONE
CALLS.
WELL I KNOW THAT THIS DOCTOR,
HE NOT ONLY CHARGES FOR THE
CALLS, YOU CAN'T EVEN TALK
TO HIS NURSE WITHOUT BEING
CHARGED, PLUS HE CHARGES FOR
EVERYTHING ELSE, ANY FORM OR
ANYTHING HAS TO BE PAID FOR.
A YEARLY FEE.

Doctor Rosser says AH, OKAY.

Maureen says YEAH, THERE ARE
THINGS -- AND SOME DOCTORS
ASK YOU TO BUY IT ALL IN AN
ANNUAL BASIS FOR 100 DOLLARS AND IT
COVERS ALL THESE THINGS.
I'VE NEVER PAID MY DOCTOR
FOR ANYTHING.

Doctor Rosser says WELL MOST -- THERE ARE
SOME DOCTORS THAT ARE
CHARGING A COMPREHENSIVE FEE
THAT COVERS -- THEY SAY WHAT
IT COVERS IS TELEPHONE
ADVICE.
I THINK WHAT I WAS REFERRING
TO IS YOU CAN'T BILL
O.H.I.P. FOR TELEPHONE
ADVICE, BUT YOU CAN -- SOME
DOCTORS DO CHARGE THAT.
MOST DOCTORS DON'T IN MY
EXPERIENCE.

Doctor Rachlis says IT'S A PRIVATIZED PART OF
THE SYSTEM.
I THINK THAT THIS IS THE
KIND OF STUFF THAT WE SAY IN
OUR REPORT IS THE WRONG WAY
TO GO.
THAT IF SOMETHING IS AN
ESSENTIAL SERVICE, AND PHONE
ADVICE DEFINITELY IS, THEN
IT SHOULD NOT BE SOMETHING
THAT A DOCTOR CHARGES FOR
PRIVATELY.
SO I'M SYMPATHETIC TO THE
FAMILY DOCTOR WHOSE ARE
CHARGING THESE FEES, BUT I
DON'T LIKE IT.
AND IT'S ONE OF THE MANY
ETHICAL DILEMMAS THAT FAMILY
DOCTORS FACE, BUT I REALLY
DON'T, I DON'T LIKE IT
BECAUSE THERE'S NO QUESTION
THAT SOME PATIENTS FEEL THEY
HAVE TO PAY THE FEE, EVEN
TO -- TO BE A MEMBER OF THE
PRACTICE.
NOW THEY MAY NOT BE TOLD
THAT AND THEY'RE NOT SUPPOSED
TO BE TOLD THAT BUT THAT'S
THE PRESSURE THEY END UP
FEELING, THAT YOU HAVE TO
PAY THE MONEY.
AND SECONDLY IT MAKES YOU
FEEL LIKE IF YOU CAN'T PATE
MONEY YOU'RE GETTING SECOND
CLASS CARE AND MAKES
CANADIANS FEEL LIKE YEAH,
THAT'S RIGHT, THERE'S BETTER
CARE IF YOU CAN AFFORD TO
PAY IT.
SO AGAIN LET'S DO WHAT WE'VE
TALKED ABOUT FOR YEARS,
CREATE THIS NONE
FEE-FOR-SERVICE PRACTICE
HAVE COMMUNITY HEALTHCARE
CENTRES, HAVE OTHER REVAMPED
PRIVATE PRACTICE AND THE
TELEPHONE CARE PART OF THAT
CARE.

Doctor Rosser says MICHAEL, I DON'T
UNDERSTAND WHY YOU'RE SO
OPPOSED TO FEE-FOR-SERVICE.
I THINK THERE'S MULTIPLE
WAYS TO PAY PHYSICIANS.
COULD BE SALARY, COULD BE
CAPITATION FEES,
FEE-FOR-SERVICE --

Doctor Rachlis says I'M NOT TALKING ABOUT
ELIMINATING FEE-FOR-SERVICE
BUT I'M TALKING ABOUT
GETTING RID OF IT WHERE IT'S
A DISINCENTIVE.
AS A SALARY DOCTOR FOR
YEARS, WHERE I GOT UP IN THE
MIDDLE OF THE NIGHT AND I
SAW A PATIENT, I FELT LIKE
WELL, IT WOULDN'T HAVE BEEN
SO BAD, IF YOU SIGH A
PATIENT IN THE MIDDLE OF THE
NIGHT MAYBE GET PAID FOR
THAT BECAUSE OR NOT WORRIED
A DOCTOR'S GOING TO ABUSE
THAT AND PROVIDING AN EXTRA
INCENTIVE AT THAT POINT MAY
BE A RIGHT THING TO DO.
I DON'T THINK
FEE-FOR-SERVICE HAS TO BE
ELIMINATED BUT AS THE MAJOR
METHOD FOR PAYMENT, I THINK
YOU AGREE WITH THIS,
PARTICULARLY FOR FAMILY
MEDICINE, IT IS THE WRONG
WAY TO GO.

Doctor Rosser says YES WHAT WE HAVE ARGUED
IS A BLENDED FUNDING SYSTEM
THAT DOES PAY
FEE-FOR-SERVICE FOR SOME
SERVICES.
POSSIBLY A CAPITATION FEE
AND POSSIBLY EVEN A SALARY
COMPONENT TO IT, MAYBE THE
BEST WAY TO DO IT WHICH
REALLY GIVES THE PHYSICIANS
SOME INCENTIVES.
WE TALKED ABOUT THE NEGATIVE
INCENTIVES IN THE CURRENT
SYSTEM.
PROVIDED COMPREHENSIVE CARE
IS NOT REWARDED.
FRAGMENTED SMALL PIECES OF
CARE IS REWARDED AND
THAT'S --

Maureen says WOULD YOU AGREE,
DOCTOR RACHLIS IT DOESN'T
REALLY WORK FOR THE
PHYSICIANS WHO JUST WORK IN
EMERGENCY ROOMS?
BECAUSE IF IT'S A SLOW NIGHT,
YOU KNOW, THEY WOULDN'T GET
ANY PAY FOR FEE-FOR-SERVICE.
THAT WOULD BE AN AREA --

Doctor Rachlis says WELL THAT'S BEEN A BIG
PROBLEM.
THAT'S RIGHT, IN ONTARIO,
WHERE THEY HAVE NOT BEEN
ABLE TO STAFF SMALL
EMERGENCY ROOMS AND NOW
THEY'VE HAD TO START PAYING
ON TOP OF THE
FEE-FOR-SERVICE.
BUT AGAIN, WHAT'S STARTING
TO HAPPEN IN ONTARIO, IT
STARTED A FEW YEARS AGO,
IT'S JUST LIKE YOU THOUGHT
YOU BOUGHT AN ALL INCLUSIVE
TRIP FOR SOMEWHERE AND THEN
YOU GET THERE AND YOU FIND
YOU HAVE TO PAY FOR ALL
THESE OTHER THINGS AND GIVE
TIPS TO PEOPLE, THAT'S
WHAT'S HAPPENING WHERE THE
GOVERNMENT THINKS IT'S PAID
FOR ALL THE MEDICAL SERVICES
AND BEFORE YOU KNOW IT
DOCTORS ARE SAYING WAIT A
SECOND, BEING ON CALL
DOESN'T PAY, WORKING IN A
SMALL EMERGENCY DEPARTMENT
DOESN'T PAY, DOING PAPP
SMEAR DOESN'T PAY SO BEFORE
YOU KNOW IT, YOU CAN
UNBUNDLE EVERYTHING, SO THAT
YOU'RE CHARGING -- SO WHAT'S
HAPPENING IN ONTARIO NOW IS
INCREASINGLY THE ONTARIO
MEDICAL ASSOCIATION IS
GETTING THE GOVERNMENT TO
PAY EXTRA FOR THESE THINGS
THAT PAY POORLY ON A
FEE-FOR-SERVICE BASIS EVEN
THOUGH MANY OF US WOULD SAY
THE REAL PROBLEM IS THE FEE
SCHEDULE ITSELF, WHICH
GREATLY OVER COMPENSATES FOR
EPISODIC ACUTE CARE AND
UNDER COMPENSATES FOR
LISTENING AND THINKING AND
TAKING LONG-TERM CARE.

Maureen says DAVE IN STOUFFVILLE.
HI DAVE?

Dave says YES, I'VE BEEN
SIGNATURE WATCHING YOUR SHOW
HERE VERY CLEARLY, AND THE
DOCTORS HAVE BEEN STATING
ALL ALONG THAT WE'VE GOT A
SHORTAGE OF DOCTOR, SHORTAGE
OF DOCTORS.
I ALSO LISTEN TO OTHER
PROGRAMMES ON OTHER NET
WORKS, AND THERE ARE SO MANY
EUROPEAN DOCTORS OR OUT OF
THE COUNTRY DOCTORS -- I
DON'T CARE WHERE THEY COME
FROM, WHY CAN'T A COMMITTEE
OF SPECIALISTS OR DOCTORS OR
SOMETHING NOT GET THESE
PEOPLE TO WRITE EXAMINATIONS
IF THEY PASS, THEY'RE IN THE
SYSTEM WITH PROOF OF
IDENTIFICATION THAT THEY
SERVED THEIR TIME, OR SAY NO,
YOU LOST IT.
NEVER MIND HEAD FENCING LIKE
EVERYBODY'S DOING ALL THE
TIME ABOUT IT.

Maureen says OKAY,
DOCTOR ROSSER?

Doctor Rosser says WELL ACTUALLY THAT ISSUE
IS BEING ADDRESSED.
THE PROVINCIAL GOVERNMENT --
IT'S ACTUALLY NOT THE
DOCTORS THAT RESTRICTED
FOREIGN GRADUATES, AS
THEY'RE CALLED, FROM COMING
INTO THE PROVINCE.
IT WAS THE GOVERNMENT,
BECAUSE THEY WERE TRYING TO
CONTROL THE NUMBER OF
DOCTORS.
AND IF YOU -- DOCTOR RACHLIS
MAY HAVE CONTRIBUTED.
IF YOU ARGUE THERE'S A
SURPLUS OF DOCTORS AND IT'S
COSTING THE SYSTEM TOO MUCH
MONEY THEN YOU RESTRICT THE
NUMBER OF DOCTORS COMING IN
THE PROVINCE HAS REALIZED
THERE'S A SHORTAGE AND
THEY'VE INCREASED THE NUMBER
OF FOREIGN GRADUATES TO 40
AND UNDERSTAND THERE'LL BE
80 NEXT YEAR.
SO THEY'RE INCREASING THE
NUMBERS COMING IN.
THERE'S A GREAT RELUCTANCE
ON THE PART OF THE COLLEGE
OF PHYSICIANS AND SURGEONS
OF ONTARIO TO LOWER THEIR
STANDARDS FOR PEOPLE COMING
IN FOR FROM OTHER COUNTRIES.
AND YOU HAVE TO UNDERSTAND
THAT THE MEDICAL EDUCATION
SYSTEM IN MANY COUNTRIES IS
VERY DIFFERENT THAN IT IS IN
CANADA.
IT MAY NOT BE INFERIOR BUT
IT'S VERY DIFFERENT AND THE
PEOPLE THAT ARE TRAINED IN
AN AFRICAN COUNTRY OR
ANOTHER CAN'T YOU FLEE
EUROPE MAY NOT HAVE A
TRAINING THAT'S APPROPRIATE
FOR CANADA.
SO THEY REQUIRE THESE PEOPLE
TO DO AT LEAST TWO OR THREE
YEARS OF TRAINING, AND THAT
PROCESS IS GOING ON NOW.
IT'S BEING EXPANDED EACH
YEAR, AND AS I SAY, I
BELIEVE THAT THE COMING YEAR
THERE MAY BE 80 OR EVEN A
HUNDRED FOREIGN GRADUATES,
WHERE TRADITIONALLY IN
ONTARIO THERE'S ONLY BEEN 24
ALLOWED EACH YEAR.

Maureen says CAN YOU QUICKLY
ADDRESS THE ISSUE OF FOREIGN
DOCTORS?

Doctor Rachlis says AGAIN, THERE ARE SOME
CAUTIONS THAT I THINK
DOCTOR ROSSER HAS RAISED
APPROPRIATELY BUT AGAIN I
THINK LET'S DO WHAT WE'VE
ALWAYS TALKED ABOUT, MORE
NONE FEE-FOR-SERVICE PAYMENT,
BETTER USE OF NURSE
PRACTITIONERS, AND I IN
PARTICULAR LIKE THE
COMMUNITY HEALTH CENTRE
MODEL.
HUNDREDS OF NURSE
PRACTITIONERS ARE NOT
WORKING TO THEIR POTENTIAL,
DOZENS OF COMMUNITIES WANT
THESE CENTRES, WE KNOW WE
CAN EXTEND THE NUMBER OF
WORKING PHYSICIANS WELL THAT
WAY.
SO I SAY IF YOU'RE DESPERATE
ENOUGH TO CONSIDER LICENSING
ALL SORTS OF FOREIGN
PHYSICIANS AND DRASTICALLY
INCREASING FOREIGN
ENROLMENT ARE YOU DRASTIC
ENOUGH TO CONSIDER THE USE
OF YOURS.

Maureen says WE'VE BEEN
TALKING ABOUT FAMILY CARE
BUT ONLY ADDRESSED
SPECIALISTS A BIT.
OPHTHALMOLOGIST WAS IN
RECENTLY AND TOLD ME THE
REAL CRUNCH IS COMING WHEN
ALL OF US SPECIALISTS WHO
ARE MY AGE RETIRE.
AND HE SAID IT'S COMING AND
THEN YOU'RE GOING TO SEE A
REAL CRISIS IN MEDICARE.
NOW I KNOW YOU THINK
SPECIALIST'S TIME ISN'T
BEING USED WISELY NOW, BUT
WILL THAT REALLY TAKE CARE
OF THE MAJOR PROBLEM?
WE DON'T HAVE ENOUGH
GASTROENTEROLOGISTS OR
PSYCHIATRISTS.
I COULD GO ON AND ON.

Doctor Rachlis says THERE'S A WONDERFUL MODEL
WE GIVE IN OUR PAPER OF
SOMETHING THAT STARTED IN
TORONTO AND HAMILTON.
SOME PSYCHIATRISTS IN
TORONTO WITH THE TORONTO
HOSPITAL HAVE BEEN WORKING
WITH A GROUP OF SIX
COMMUNITY HEALTH CENTRES.
IN HAMILTON, WE'VE GOT
PSYCHIATRISTS WORKING WITH
PRIVATE PRACTITIONERS IN THE
HEALTH SERVICE ORGANIZATIONS
OR H.S.O.S, ALSO NOT PAID
PRIMARILY ON A
FEE-FOR-SERVICE BASIS AND
THESE PSYCHIATRISTS ARE
PROVIDING WHAT'S REFERRED TO
AS SHARED CARE.
THE MAJOR PART OF THE CARE
FOR PATIENTS WITH
PSYCHIATRIC PROBLEMS ARE
PROVIDED BY FAMILY
PRACTITIONERS AND NURSE
PRACTITIONERS AND SOCIAL
WORKER, THE PSYCHIATRISTS
COME TO THE HOSPITAL A
COUPLE TIMES A MONTH, SEE
PATIENTS DIRECTLY BUT SPEND
MOST OF THEIR TIME
DISCUSSING CASES WITH STAFF.
AND OFTEN AGAIN, YOU KNOW,
YOU JUST NEED TWO MINUTES
WITH A SPECIALIST TO DISCUSS
SOMETHING AND YOU DON'T NEED
A FULL CONSULTATION.
AND I THINK IF WE DID THAT
FOR ALL SPECIALIST ACE CROSS
THE PROVINCE WHICH WE WOULD
HAVE TO MO MOVE AWAY FROM
FEE-FOR-SERVICE TO DO IT I
THINK WE'D FEEL MUCH LESS
CRISIS ABOUT A SHORTAGE OF
SPECIALIST.

Maureen says 15 SECONDS TO
SAY YEA OR NAY.

Doctor Rosser says I GAVE THE KEYNOTE
ADDRESS AT THE MEETING OF
THE SHARED CARE LAST SPRING.
IT'S A WONDERFUL MODEL,
WORKS VERY WELL AND WHETHER
IT WOULD ADDRESS ALL THE
SHORTAGES, I'M NOT SURE.

Maureen says I THINK THE
MESSAGE HERE TODAY IS LET'S
GET ON WITH IT, RIGHT?

Doctor Rachlis says WITHIN A PUBLIC SYSTEM.

Doctor Rosser says DEFINITELY.
DEFINITELY.

Maureen says THANK YOU VERY
MUCH FOR THIS.
DOCTOR WALTER ROSSER IS THE
CHAIR OF THE DEPARTMENT OF
COMMUNITY AND FAMILY MET SIN
AT THE UNIVERSITY OF TORONTO
AND PAST PRESIDENT OF THE
ONTARIO COLLEGE OF FAMILY
PHYSICIANS.
DOCTOR MICHAEL RACHLIS IS A
HEALTH POLICY ANALYST AND
THE CO-AUTHOR OF
REVITALIZING MEDICARE,
SHARED PROBLEMS, PUBLIC
SOLUTIONS.
YOU CAN GET THIS REPORT ON
THE WEB.
GO TO WWW.TOMMYDOUGLAS.CA
THANKS FOR PARTICIPATING
AND WATCHING TODAY’S PROGRAM.
I’M MAUREEN TAYLOR INVITING YOU
TO JOIN US AGAIN MONDAY THROUGH FRIDAY
AT 1 O’CLOCK.

Watch: Health Care Crisis?