Canada’s health system is “collapsing around us,” Dr. Katharine Smart, president of the Canadian Medical Association, said recently.
Those are unusually harsh words from the CMA. The group representing Canada’s 92,000 physicians tends to be cautious and small-c conservative.
So, should we be alarmed by the alarmist tone?
In a word, yes.
The evidence of collapse is all around us, mostly in the form of ever-worsening waits.
We wait longer and longer for care in emergency rooms; if hospital admission is required, that wait can easily stretch into days. In St. John’s recently, an 85-year-old patient with Alzheimer’s waited a mind-boggling 20 days and nights in an ER because no bed was available.
Increasingly, emergency rooms are closing for periods of days or weeks for lack of personnel, particularly in rural areas.
Elective surgery has become maybe-someday surgery. With procedures like hip replacement and cataracts, wait times have gone from months to years. Lately, we’ve seen hospitals in major cities like Calgary unable to perform emergency surgeries because they lack surgeons. We can’t even get children – those most vulnerable – treated promptly.
One in seven Canadians don’t even have a family doctor, and little hope of finding one. The CBC recently reported the story of a PEI man who has been on a patient registry for 11 years and still has not found a family physician.
Good luck getting an ambulance in some jurisdictions. How about waiting six hours for medical transport after falling and breaking your hip, as an 88-year-old woman in Calgary did recently?
It’s hard to think of a part of the Canadian health care system that isn’t struggling. These are anecdotes, of course, and scientists caution that anecdotes are not evidence.
There are about 17 million ER visits and three million hospital admissions in Canada each year. Most of them go well. But the gross failures on the margins cannot and should not be easily dismissed, especially when virtually all patients and practitioners have horror stories to share.
Collapse doesn’t happen suddenly. It’s the result of erosion over time until a breaking point arrives.
The degradation of Canadian health care services has been ongoing for years, to the point where all this sounds blandly familiar. But it feels like we’re on the brink now.
The COVID-19 pandemic accelerated the slow-motion crisis, in the way a torrential downpour can lead to the collapse of a cliff that has been slowly crumbling for years.
Health care workers are taking a beating. The demands on them have grown tremendously. Physicians, nurses, personal support workers and more are all leaving in droves, exacerbating waits and making care more perilous.
Workers are leaving because they are burned out, and feeling they can no longer deliver care promptly, effectively and safely.
That is the ultimate sign of collapse – when unsafe conditions, including long wait times, understaffing and overcrowding, are normalized.
If the system is collapsing, it is largely because the people who have been holding the system together are on the verge of collapse themselves.
There are those who worry that all this gloom-and-doom talk does no good, that saying things like “the system is collapsing around us” will only accelerate the exodus.
After years – no, decades – of systemic neglect, there is no magical snap-your-fingers solution.
But it’s clear that a turnaround won’t happen without dealing with the ever-worsening health human resources problem. Health care is ultimately about people caring for people.
We need to start by fixing the workplace. With actual staffing plans. And a long list of small changes that empower workers so that we can recruit and retain the staff we need to deliver care effectively and safely.
It’s not about doing more of the same. Nor is more money the answer.
We spend plenty on health care – $308-billion last year, or about $8,000 per capita – and that’s comparable to other wealthy countries, most of whom do a much better job of delivering care to their populations.
We need to build an actual system, with proper governance and accountability, and prioritize getting value for money.
It’s all fixable. We can stave off collapse.
The question is: Do we have the appetite for change, on a political and societal level?
Or are we content to continue sleepwalking toward catastrophe?
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