A sit-down with Smitherman

Let's push it along, and we'll pass the buck
Cause face it, dear voters, we don't give a fuck

I was one of forty-or-so lucky U of T med students to be invited to an evening with George Smitherman last night, hosted by our own Political Action Society on campus. It was touted as a landmark evening, where we'd discuss, in an intimate setting, the fate and future of health care in Ontario.

And you, know, after the discussion last night, I have much more respect for Smitherman as a person and as competent minister. But I have no more confidence in our heath care system than I did when I walked in the door -- and that was unfortunate, because I had gone in with an open mind. I figured that Smitherman, having held his portfolio for the last almost four years (which is an impressively long tenure given the historic contentiousness of the issues faced by the Ministry of Health and Long Term Care), must be doing something of a good job. And I guess he is.

The Liberals have planned to increase medical school enrollment by an additional 100 spots per year in the near future, the LHINs have been installed, new Community Health Centres (of which I am a big fan) will be opening within the next year, incorporation opportunities for physicians, family physician teams to encourage more people to take up family practice, and an infusion of funds ($667 M just announced two days ago). Yes, they've done a lot.

But I am concerned that we are not being forward-thinking. Where is the emphasis on health promotion? Where is the addressing of the socioeconomic determinants of health? Where are the plans to get Ontarians involved in health care planning for the future?

And you know, not a whole heck of a lot was said in the meeting. It felt like Smitherman was sort of deflecting questions more than anything else. Quick to point out the wonderful things that his government has done...but not so quick to offer solutions for the problems we currently face.

I left the meeting feeling thoroughly confused about decision-making in Ontario health care. There is so little public involvement in goal-setting, prioritisation, and planning that it makes me wonder if the true needs of Ontarians are being served. Are ER wait-times truly a priority of the public -- or should we be focusing on allocating funds for allied health services, such as dental care, physiotherapy or optometry? Why do we keep throwing money at our "biggest problems" and ignoring the ties to socioeconomic determinants and public health strategies that might actually make a difference in the health of Ontarians (not to mention the Ministry's bottom line) in the long run?

Oh. Right. There's the nerve. "Long run." And I guess that's the fatal flaw in democracy. No government has the time to plan long term because the public demands results tomorrow, and if it's not going to tomorrow, then definitely no later than next week. Otherwise -- whoosh! -- they've got the boot in the next election.

And it's too bad, because the Ministry currently takes around 40%-ish of the Ontario budget. That's ridiculously huge, made more ridiculous still by the fact that the system is still strained and strapped for cash.

So what is there to do? I guess it's obvious that we need to plan for the future. And I applaud the Liberals' few attempts at addressing aspects of health promotion (however small, through the CHCs), and the physician shortage (+ med school spots). But I feel as though we need to planning in ways that will curb the current budget growth through initiatives that will further promote health (whether it's through education, prevention, harm reduction methods) or start exploring completely different modalities (whether it's through insurance structures or service delivery).

(Don't get me wrong here, I'm not talking about going two-tier -- I think that's a horrible idea).

But we need to think differently about how we approach health care, and there are aspects of engineering (I think) that could be extremely beneficial, such as automation, lean practices, the implementation of IT tools. These will also have a huge impact on quality of service.

Beyond that, we need to start thinking about how we define our roles, and I think physicians need to really buy in to this. The integrated service delivery model is crucial to the future success of health care -- and we need to work together in teams, in interdisciplinary teams which communicate effectively, do not have turf battles, and are willing to work collaboratively to share the work load.

I also think we need more nurse practitioners (and maybe even an expansion to this role), but I suppose that's a whole other story. Maybe we need to be laying of the whole family physician thing (or at least backing off a bit) and instead pour some effort into encouraging more nurses to become NPs.

But whatever the solution is, it needs to be informed by the needs of Ontario. We need to know what Ontario wants, what Ontario expects, and what Ontario feels is a priority. They are, after all, the clients.