Appointing former federal health minister Jane Philpott to fix Ontario’s primary-care shortage was a brilliant political coup by the Doug Ford government. While it’s unlikely to benefit Ontarians any time soon, the move is just the tonic the PCs required.
With an election widely expected next spring, the Ford government is vulnerable on health care, not because it has done nothing, but because it hasn’t done enough. It is expanding doctor numbers, hospitals and long-term care beds, just not fast enough to meet increasing demand.
An Angus Reid Institute poll earlier this month showed that 60 per cent of Ontarians identified health care as their top issue and 80 per cent thought the government was doing a poor job on health. That’s a sign that action is required — or at least the appearance of action.
Enter Dr. Philpott, dean of the Queen’s University medical school and author of a bestselling book on how to fix health care. Her mandate is to connect every Ontarian to primary care within five years.
Just like that, campaigning PCs can deflect criticisms over health care by saying they have a plan for primary care with a clear goal and an expert in charge. To make it even sweeter, the Ontario Liberal party had been hoping Philpott would run as a candidate for them.
The Philpott appointment should get the PCs off the health-care hook until after the next election. In politics that’s everything. If she accomplishes nothing else, Philpott will have delivered full value for the Ford government, even at an annual salary of around $550,000.
But what about people without doctors? Looking at the magnitude of the challenge, it’s difficult to be optimistic: the solutions Philpott has been selling seem simplistic. The Ontario College of Family Physicians says there are 2.5 million Ontarians without a doctor. The Ford government says there are 1.5 million. Either way, it’s a lot. And Ontario is chasing a moving target. Five years from now, when Philpott’s primary-care nirvana is scheduled to arrive, the province’s population is expected to have grown by about two million.
Philpott’s solution compares medicine to education. We make sure every child has a school by assigning them to schools. Why not do the same for medical professionals?
She’s already laid out a plan in her writing on health reform. It involves creating a wave of new comprehensive health organizations with doctors and other health professionals working on salary. Philpott has suggested 250 of these across the province, each caring for 16,000 patients, serving 4 million people. There you go, present and future problems solved.
But this “solution” fails to grasp the actual problem. In Ontario (current population: 14 million) there are too few family physicians relative to the population. In 2019, Ontario’s ratio of family physicians to population was the worst in Canada. The number of family doctors in the province has increased since then, but not nearly fast enough.
The problem is not just the shortage of family doctors, but the administrative burden placed on them, in large part by the provincial health bureaucracy. Estimates are that family doctors spend 19 hours a week on administration. That reduces their productivity.
Philpott’s key idea would make the problem worse, not better. If her health centres are to serve 16,000 people, they will need about 13 doctors each. For 250 health centres, that means 3,250 doctors. Where would they come from? Some might be attracted to this form of practice, but shifting them from one practice model to another offers no net gain. Worse, making doctors into employees would limit their hours of work.
Worse still, it would get government even deeper into running family medicine. Philpott also proposes elected local health boards to oversee things. Great idea. Just look at how well school boards work.
The last thing any Canadian province needs is more health-care bureaucracy. Germany has a top-rated health care system that serves a bigger population with one-tenth the health bureaucrats Canada has.
In Ontario, one might have expected the Ministry of Health to plan health care, but the Ford government added an agency called Ontario Health to “connect, coordinate and modernize our province’s health care system.” Now, Philpott is being parachuted in to do the work Ontario Health can’t seem to manage, despite its $47-million annual budget.
Fixing Ontario’s family doctor shortage doesn’t need to take five years or a reinvention of health care. What’s required is doctors spending more time with patients and less time on administration. The time to accomplish that is now, with the provincial government and the Ontario Medical Association in talks on a new fee deal.
The government says there are 16,158 family doctors in Ontario. The family physician college says the average practice serves 1,251 patients. If each doctor took 10-per-cent more patients, two-million more Ontarians would have a family doctor, fixing the existing shortage. In exchange, the government should pay for physicians’ assistants, nurse practitioners and administrative staff to free up doctors’ time.
The Ford government should ask itself which is better; promising to fix a problem in five years or actually fixing it now?
National Post
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