An election is on the horizon. Politicians across the country of every party are trying to appeal to their constituents by promising to improve the healthcare system. They are paraphrasing Freud and declaring to their aides: “Oh God, what do doctors want!” as doctors, burnt out by the COVID crisis, are retiring early or leaving clinical medicine for less stressful gigs. Like Freud and the early psychoanalysts’ attitudes towards their female patients, politicians regard physicians as fractious, capricious and entitled. They know they need us, but they want to keep us under strict control because they don’t really trust us. As we sometimes say in doctor talk, this is “not untrue.” There will always be Docs among us who will try to game the system. They will try to earn the most money and do the least possible work, sometimes to the point of fraud.
However, the vast majority of physicians and surgeons across this country are doing their best. We are trying to care for patients under increasingly difficult circumstances in an increasingly complex system with what seems to be ever diminishing resources. The fact that health is a provincial jurisdiction makes the matter even more confusing, so that what is expected in one province is anathema to another. Doctors want what most people want from their working conditions: respect, flexibility, freedom of movement, the chance to do good work. Trying to turn physicians and nurses into indentured servants is inherently flawed, as the COVID epidemic has revealed to us. We are ready to work hard when needed and even to risk our lives for the good of our patients but not if it comes with a side of coercion and contempt.
I am not a health economist or a policy expert but a simple household and garden family doctor who has been working in the trenches for a long time. I do, however, have some ideas:
1: Can we have easily transferable licensure? Why do physicians who have passed the national Royal College or CFPC exams need to go through a whole song and dance when they move from province to province?
2: A national drug plan- it makes no sense that the drug plans are so wildly different from province to province. If we had National Pharmacare, there would be benefits in terms of negotiating power with the industry.
3: True multidisciplinary care with access to mental health care, physiotherapy, and primary dental care for all, not only in select clinics but for all practitioners. I have had patients who ended up on disability payments for life because they had no access to physio. The only explanation is that the funds come out of different pockets, although the government still pays. The fact that it is sometimes easier to access Coronary Bypass Surgery than Cognitive Behaviour Therapy is also an enigma to me. And why can’t people get their teeth cleaned and filled when we know that poor oral hygiene leads to disease?
In my home province, Quebec, governmental micromanaging of regional licensing gives provincial “functionaires” the decision power limiting who can work where. Who gets permission to work in which neighbourhoods seems to be arbitrary. This has led to is a prolonged exodus of doctors from the province. It used to be that francophones were relatively captive here, but this is the Internet generation, and most francophone medical students are pretty fluent in both languages. In the past few years I have seen several of my francophone residents, Université de Montreal grads, who have taken off to the States, Vancouver, Ottawa, Toronto and even just across the border in Ontario and continue to live in Montreal. It seems senseless to invest in the education of physicians only to chase them away by being rigid about where they can work and what they can do.
But the truth is that politicians don’t care what doctors want. They do, however, care about what their constituents think. While most patients don’t like doctors in general, they often love their own doctors, the ones who bind their wounds, try to save their lives and nudge them down the path to health.
So let’s remember this, and advocate for our patients and try to push the politicians to do what they need to do so that we can continue to do what we need to do.