Still four months away from his confirmation as the next president of the Canadian Medical Association, Jeffrey Turnbull is becoming a hero to a new generation of idealistic physicians, preaching a redesigned vision of public health care and a commitment to the poor at home and abroad.
The 58-year-old chief of staff at the Ottawa Hospital was the lead speaker last month at a conference on medicare organized by student doctors and nurses from across Ontario.
He spoke of his own volunteer service at hospitals in the developing world and with the homeless in Ottawa. He talked of restructuring Canada's health-care system to ensure equal access to poor, rural and aboriginal Canadians. He proposed measures that would simultaneously cut costs in the system and make it more efficient.
Dr. Jack Kitts, the president of the Ottawa Hospital, described Dr. Turnbull as "without a doubt the most caring and compassionate physician I have ever worked with."
Under the CMA's electoral rules, every province and territory gets an opportunity in turn to elect a president. Dr. Turnbull is Ontario's choice after defeating two other candidates. If his election is ratified this summer at the CMA's general meeting, he will take office in 2010.
The CMA's current and previous presidents have supported a bigger presence of private or parallel medicine alongside Canada's public system, but Dr. Turnbull is a strong opponent of two-tier health care.
He said his election means "that the doctors of Ontario, at least - and I think the doctors of Ontario are representative of doctors in the rest of the country - feel that there is a desperate need for meaningful change in the way we deliver medical services.
"But they want to see that done in the context of the publicly funded health-care system. They don't want to move to a two-tiered system. If I can bring anything [to the CMA president's job], it's a cohesive vision of health care that everyone can buy into."
His candidacy for the CMA presidency was endorsed by student leaders, former Médecins sans frontières (Doctors Without Borders) president James Orbinski and medical academics - including two medical faculty deans - from across Ontario.
Michaela Beder, 28, a University of Toronto psychiatry resident who worked on Dr. Turnbull's campaign and was one of the organizers of the student conference at which he recently spoke, said medical school curriculums are increasingly focusing on the socio-economic determinants of health.
"That is why Dr. Turnbull is really exciting," Dr. Beder said. "He offers a role model. We haven't seen poverty issues reflected in the past few CMA presidents."
Michael Hayden, a world-renowned medical geneticist at the University of British Columbia, said the intense competition to get into Canada's medical schools has meant the schools are looking at more than grades; they are also choosing students who bring compassion and commitment, and a public-service component.
"They're looking for people who are not just in it as a way to earn a living but to contribute to the betterment of society," Dr. Hayden said.
University of Toronto medical dean Catherine Whiteside said her students have initiated 27 community projects, including a clinic in downtown Toronto, and have become engaged in aboriginal, rural and international health work.
Dr. Turnbull, awarded the Order of Canada for his work with Ottawa's homeless and his achievements as a medical educator, in an interview cited his own hospital as an example of how huge amounts of money are wasted in the public system and access to services is blocked because the system is being misused.
For months the hospital has been running at 107 to 110 per cent occupancy, he said, even though repeated studies have shown a hospital operates at peak efficiency at 92 per cent occupancy.
"While 30 to 35 patients are waiting for hospital beds, at the same time 134 patients are waiting to go to long-term care," Dr. Turnbull said.
"Take the long-term-care patients out of the hospital, we'd have no one cancelling surgery, no waits in the emergency department, staff would not be burning out and we'd be providing the tertiary care that's necessary to our community. We wouldn't be turning anybody away. We wouldn't be saying, 'Sorry, we're full.' "
Dr. Turnbull said the presence of so many long-term-care patients in his institution is a typical result of what he called the silo approach to Canadian health care: Every major hospital in the country is likely experiencing the same problem.
And yet, he said, analysts have done the demographic modelling, they know what the medical requirements of an aging population are going to be, they know how many people will need to be moved out of high-cost hospital beds into low-cost long-term-care beds, but the knowledge hasn't been turned into concrete action.
"We're the ones who are going to be stuck with the system," said Dr. Beder. "We'll have to deal with patients and provide care with whatever system exists 20 years down the road."
Dr. Turnbull said that during his CMA presidency he will not cut back on his work overseas or with the homeless.
