Opinion: Canadian health care is always ready for emergencies – but what about the rest?

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Dr. Tony Sanfilippo is a cardiologist, professor of medicine and adjunct professor at Queen’s University. He is the author of The Doctors We Need: Rethinking Doctor Recruitment, Training and Support..

Recent news out of Ontario highlights a growing trend: rural communities are offering more financial incentives to attract doctors. For example, the city of Huntsville offers an $80,000 signing bonus to doctors who commit to working there for at least five years. Although this method can provide short-term relief, experts warn that it can produce a The Hunger Games-a competitive trend among smaller municipalities, which may exacerbate the problem in the long run.

This situation highlights an important aspect of our health care system: unequal and often insufficient access to medical care, especially in non-urban areas. Although these financial incentives are well-intentioned, they are a Band-Aid solution to an administrative problem. What if, instead of pitting the public against the fight for doctors, we could rethink our entire approach to health care delivery?

Think about it: Anyone in our state (or country) suffering from a heart attack, stroke, serious injury, or any other similar life-threatening condition can feel confident that with a call to 9- 1-1 they will receive the best care possible. It will be on time, efficient and effective – as good or better than anywhere else in the world.

This is not an idle boast. It is indeed verifiable because the proceedings in such matters are closely followed and publicized. It is also evident to anyone who has suffered or watched a family member treated for such urgent conditions. However, once the need changes from acute to with less urgency – to chronic or preventive conditions, for example – it is equally apparent that the performance of our health care system declines significantly.

For example, if a person has a heart attack due to a blocked coronary artery, he will be treated as effectively and efficiently as possible, because the guidelines for such intensive care are established worldwide and explored. But, once he recovers, it may take the same patient several months to receive a heart treatment known to be effective in returning people to full function and reducing the risk of other heart problems. Such care, if it is available at all, is hard to find, spread across many providers in our communities, and poorly coordinated.

I suggest that the main reason for this difference is that intensive, critical and complex care has been entrusted to institutions and administrative organizations established and financed for that purpose. We call these hospitals.

Originally designed to participate and care for patients with any medical problem, hospitals have evolved to focus exclusively on providing urgent and complex medical care that is very much needed today. This is not intentional, but the result of the need to prioritize despite limited resources and expanding needs – completely understandable given the constraints that hospitals operate under.

Instead of complaining about shortcomings, focusing on what works may provide valuable insights that can be applied more broadly. What is it about hospitals that allows them to deal with these urgent and complex needs so effectively?

For one, they have a clear mission and are allowed to focus their efforts on providing intensive and complex care. They also have well-qualified and dedicated leadership, including management teams and boards of directors put in place to ensure that those goals are met.

Hospitals help everyone and anyone in need. Wherever you live, you will be served by the nearest. You do not need to sign in as a member. You don’t need to be a member of any specialty doctor or be on any list. It is a non-discriminatory public institution.

They are also integrated internally. Their data and patient management systems are designed to allow safe, efficient and reliable transfer of critical information between different departments, wards and people. And they get money that enables them to do what they need to do. Their guiding principles are about a common goal: to ensure that the communities they serve provide intensive and critical care.

Ultimately, hospitals are responsible. They must meet high-level, results-based goals, and do so while working within the constraints of their budgets.

Meanwhile, those other aspects of health care delivery – although not immediately dangerous but important for individuals and for the delivery of care in general – are subject to conditions and conditions different from our social contract. I am talking here about the management of non-urgent medical conditions, chronic and progressive health conditions, and disease prevention.

Imagine a “hospital” dedicated not to disasters, but to these non-emergency needs. A place that brings together the people and resources needed to address those goals. A place where you’re automatically welcomed upon arrival (like your local ER), where your medical information flows seamlessly between departments, and a team of professionals collaborates on your health. , not specific symptoms, to prioritize prevention. treatment.

Sounds expensive, right? But think about this: How much are we already using in our fragmented system? What are the costs of absenteeism, absenteeism and preventable disease?

In 1997, Steve Jobs excitedly encouraged us to “think differently” about computing. It’s time we do the same for health care in Canada. By extending the hospital model to all aspects of health care, we can create a system that is not only efficient, but also cost-effective.

Instead of cities like Huntsville using massive signing bonuses, we could have a system where medical professionals are drawn to rural areas not just for financial incentives, but for the opportunity to work. in well-equipped, integrated health care facilities. This approach can address the root causes of health care delivery problems, rather than just treating the symptoms.

Our current system for non-urgent care is collapsing, and the bidding war for doctors in rural areas is a clear indication of this. It’s time to learn from what works in our intensive care settings and apply these lessons broadly. By doing so, we can create a health care system that truly works for all Canadians, regardless of where they live.