The Family Clinic in Marathon, Ont. on Nov. 11, 2022.David Jackson/The Globe and Mail
Dr. Tony Sanfilippo is a cardiologist, a professor of medicine and a former associate dean at Queen’s University. He is the author of The Doctors We Need: Imagining a New Path for Physician Recruitment, Training, and Support.
Recent news from Ontario highlights a growing trend: rural communities offering substantial financial incentives to attract doctors. The town of Huntsville, for instance, is now offering an $80,000 signing bonus to physicians who commit to practising there for at least five years. While this approach may provide short-term relief, experts warn it could spark a Hunger Games-style competition among smaller municipalities, potentially exacerbating the problem in the long run.
This situation underscores a fundamental issue in our health care system: uneven and often inadequate access to medical care, particularly in non-urban areas. While these financial incentives are well-intentioned, they are Band-Aid solutions to a systemic problem. What if, instead of pitting communities against each other in a bidding war for doctors, we reimagined our entire approach to health care delivery?
Consider this: Anyone in our province (or country) afflicted with a heart attack, stroke, serious trauma, or any similarly life-threatening condition can feel confident that with a call to 9-1-1 they will receive the best care possible. It will be timely, efficient and effective – as good or better than anywhere in the world.
This is no idle boast. It is in fact verifiable because performance in such matters is closely tracked and publicized. It is also apparent to anyone who has suffered from or watched a family member treated for such urgent conditions. Yet, once the need shifts from the acute to the less urgent – to chronic or preventive aspects of care, for example – it’s similarly apparent that the performance of our health care system drops off rather dramatically.
For example, if a person has a heart attack because of a blocked coronary artery, they will be treated as well and efficiently for that problem as possible, because guidelines for such acute care are internationally established and monitored. But, once recovered, it may take that same patient several months to get the cardiac rehabilitation that is known to be effective in getting people back to full activity and reducing their risk for further cardiac problems. Such care, if available at all, is difficult to access, scattered through multiple providers in our communities, and poorly co-ordinated.
I would submit that the major reason for this difference is that acute, critical and complex care is entrusted to institutions and management structures that are established and funded for that very purpose. We call these hospitals.
Originally designed to centralize and care for patients with any medical issue, hospitals have evolved to focus specifically on providing the urgent and complex medical care that is so critically needed today. This is not by deliberate intention, but rather a result of the need to prioritize in the face of limited resources and ever-expanding needs – wholly understandable given the constraints under which hospitals operate.
Rather than lamenting the shortcomings, focusing on what works may instead provide valuable insights that could be more widely applied. What is it about hospitals that allows them to address these urgent and complex needs so effectively?
For one, they have a clear purpose and have been allowed to focus their efforts on the goal of providing acute and complex care. They also have well-qualified and dedicated leadership, including executive teams and boards of directors who are put in place to ensure those goals are achieved.
Hospitals serve everyone and anyone in need. Wherever you live, you will be served by the nearest one. You don’t need to join as a member. You don’t need to belong to any specific doctor or be on any rosters. It is a non-discriminatory public institution.
They are also internally integrated. Their data and patient management systems are designed to allow for the secure, efficient and reliable transfer of critical information among various departments, wards and people. And they receive funding that enables them to do what they need to do. Their marching orders are about overarching goals: to ensure that acute and critical care is provided for the communities they serve.
Lastly, hospitals are accountable. They are required to achieve high-level, outcome-based goals, and to do so while operating within the constraints of their budgets.
Meanwhile, those other aspects of health care delivery – while not as immediately life-threatening but essential for both individuals and for the overall delivery of care – exist under different terms and conditions of our social contract. I am speaking here of the management of non-urgent medical illness, chronic and continuing medical conditions, and disease prevention.
Imagine a “hospital” dedicated not to crises, but to these non-urgent needs. A place that brings together the people and facilities required to address those goals. A place where you’re automatically accepted upon arrival (just like with your local ER), where your medical information flows seamlessly between departments, and a team of experts collaborates on your overall health, not just isolated symptoms, to prioritize prevention as much as treatment.
Sounds expensive, right? But consider this: How much are we already spending on our fragmented system? What’s the cost of redundancy, lack of integration and preventable illnesses?
In 1997, Steve Jobs famously urged us to “think different” about computing. It’s time we did the same for health care in Canada. By extending the hospital model to all aspects of health care, we could create a system that’s not just more effective, but potentially more cost-efficient, too.
Instead of towns like Huntsville resorting to hefty signing bonuses, we could have a system wherein medical professionals are drawn to rural areas not just for financial incentives, but for the opportunity to work in well-resourced, integrated health care centres. This approach could address the root causes of our health care distribution problems, rather than just treating the symptoms.
Our current system for non-urgent care is crumbling, and the bidding wars for doctors in rural areas are a clear sign of this. It’s time to learn from what works in our acute care settings and apply these lessons more broadly. By doing so, we might just create a health care system that truly serves all Canadians, regardless of where they live.