Rwede wrote:Cactusflower wrote:After reading that, plus the summary of the first link, I'm convinced that our doctor shortage could be solved with some tweaking of the regulations set out by the regulatory bodies.
*removed*We've worked hard to have world class health care in this country. Diluting requirements and standards to remove responsibility from Dix and Horgan's putrid record on this file (now and in the past) is not the answer.
That will make a nice new avatar.
Nobody has said we should dilute standards. Just improve the mechanics of obtaining the certifications to meet the standards.
But as I have said, that is a small part of the issue. There still won't be enough doctors. You MIGHT pick up enough so that the problem of family physician shortages does not get worse for 2-3 years. That can be deduced from this report:
https://www.cfms.org/files/meetings/sgm-2016/resolutions/16-_IMG_Backgrounder_Proposal.docxIn particular, family medicine is challenged. Anecdotally, there are graduates in other medical specialties that have trouble finding work in Canada. We don't know, as far as I can tell, how many of the IMG physicians stuck without Canadian certification that would qualify or want to go into family medicine. IF it follows the pattern of graduates, then only roughly 35-40% of those "stuck in limbo" would be family physicians - far short of "filling the gap".
Like it or not, the system model of physician front line care is not going to be able to cope.
Chronic care needs continue to rise, and are forecast to accelerate. Not only is there the fact that we will not have enough physicians to meet that growing need (we already don't), but cost and efficiency needs dictate we are going down an expensive rabbit hole if we focus on maintaining/improving the status quo.
Some of the products of our status quo system is just dumb. Here is my personal and simple case:
I have risk factors for developing glaucoma, so it makes sense to monitor my eyes for untoward developments.
1) getting an appointment with an ophthalmologist can be a lengthy wait, which indicates that there are not enough to go around
2) a visit to the ophthalmologist isn't cheap for the system, monitoring requires at least 2 visits per year
It took some convincing, but my care for that is now organized in a much more cost effective way:
1) the necessary additional test is added to my annual optometrist eye exam which I pay for, and that avoids an ophthalmologist visit
2) additional testing is scheduled with the optometrist at a lower cost to the system, and that avoids more ophthalmologist visits
3) test results are forwarded to the ophthalmologist and an exam every 4 years is done by him.
What that does, by thinking outside of the box just a little, is compress 8 ophthalmologist visits into 1, which both saves the system $$$ and frees up 7 ophthalmologist visit spots for patients who really need that specific attention.
The outcome, for me, as a patient, is every bit as good, and more convenient. IF the optometrist sees any sudden changes/reasons for concern, then it is back to the ophthalmologist.
The outcome for other patients is that it is easier to get an appointment with the ophthalmologist.
The outcome for the system is lower cost.
Win-win-win.
That simple example shows the kind of small changes that can be done if the SYSTEM is rationalized and modernized through better and more efficient management systems like Lean methodology that allow changes to come from the health care professionals.
What would that accomplish? Go back to my case. Let's throw some ballpark numbers at it:
1) assume an ophthalmologist can see 16 patients per day
2) assume that 20% of her/his patients are similar to me
220 working days x 16 = 3,520 patient visits.
3520 x .20 = 704 visits by patients like me.
15/16 of those 704 visits could be handled by the patients optometrist = 660 visits.
660/3,520 = 18.75% more ophthalmologist visits available.
So it is possible that that single item of rationalized care would improve patient access to ophthalmologist care by 18.75%, yet not one single additional ophthalmologist need be hired.
When you start thinking about those kinds of things, the possibilities are very large. How many patients with stable/under control blood pressure have to visit the doctor to get their meds renewed? etc. etc. How many other "ongoing" chronic conditions could be viewed as candidates for "team care"?
I honestly don't know, but what I do know is that when such thinking is applied in industry, the results can be very significant (and most industry settings are nowhere near as bureaucratic as our health care system has become). Yes, soft and human issues are subject such applications of system change, worker health and safety has improved dramatically through such methods.
IF I had to guess, we could improve our health care system by 25-30% just by getting the SYSTEM status quo out of the way of our dedicated health care professionals.
Part of that is how we perceive and measure things. MORE physician visits does not necessarily = better health care (especially if they are unnecessarily as I detailed above). Yet every single measurement study I have seen weights to number of physicians/capita, number of physician visits, etc. That is partly because WE view it that way.
What do WE really want? Health care when we need it, and reasonably close to where we are. IF we remove the unnecessary burdens on physicians, and we modernize the systems (tele-medicine etc.), then WE may find that WE do have enough doctors. I don't care if my health care comes from a doctor, a nurse practitioner, nurse, or other appropriate medical professional so long as it gets the job done.