I don’t like being spun or lied to. That’s a personal comment and also a professional one. I’m okay with unpleasant truths. Just don’t try to convince me that a bad thing is a good thing or deny that there is a bad thing.
Health Minister Sylvia Jones is trying to do one or the other, and it’s not going to work.
Let’s take a minute to set this out properly. It’s not, to be clear, Jones herself, directly and personally, that’s making the argument. It’s a legal argument being made, by her representatives, in an arbitration case between the health ministry and the Ontario Medical Association. The OMA represents Ontario’s doctors in negotiations with the province on matters such as compensation. The two parties are currently in arbitration on the issue of physician pay, and it was in that context that ministry officials wrote this in their filing to the arbitrator: “We will illustrate that there is no concern of a diminished supply of physicians. Across Canada, Ontario has the best record in attracting medical graduates to train in Ontario. Further, Ontario has enjoyed a growth in physicians that far outstrips population growth.”
Oh, well. Okay, then. Never mind.
Look, I’m a grown up, and I know there must always be room for rhetorical manoeuvring. Both politics and the law require a degree of interpretation of the facts, shall we say, and it is of course true that not every fact leads directly to a single conclusion. There is always room for persuasion. I get that. This is especially true in areas where it’s not politics and not law, but both at once. The province’s filing to the arbitrator is one of those moments. Fair enough.
But my tolerance for creative rhetorical manoeuvring ends when the ship ends up plowing into the shoals of reality. Ontario needs more doctors. It especially needs more family doctors. It has been a feature of my writing here in recent months to keep hammering away at this very point. As others have noted, and as the health ministry probably intended to convey, Ontario is not lacking for trained doctors. As a professional class, we do indeed have enough — or at least arguably enough.
But what we don’t have are trained physicians who are choosing to work as family doctors. This includes family doctors who have practised and are choosing to leave, either for other jobs or for retirement, and doctors who are graduating from medical schools and choosing to specialize in other fields. The details vary in line with each doctor’s personal circumstances, but the net effect is not hard to grasp or in dispute: we are desperately short family doctors. More than 2 million of us do not have access to one, and that figure is set to double in the next few years.
As I noted before in a column here, and not that long ago, I don’t know how to precisely define a collapsed health-care system, but one where a quarter of the population has no routine access to primary care and must rely on overcrowded hospitals for even basic needs is definitely somewhere in that general vicinity.
There are a lot of reasons that Ontario doesn’t have enough family doctors, and they aren’t all related to money. And I’m very much conscious of the fact that there is a hard limit on how much we can spend on health care. One of the weirder arguments I’ve had made to me in recent years is some variation on “Canadian health care isn’t failing — it’s being deliberately starved.” That just does not align with the reality that we are spending massively on health care. The problem with Canadian health care relative to that of our advanced economic peers isn’t a lack of funding: it’s poor value for money. Again, relative to our peers, we get low-end outcomes for high-end spending, which is an awfully good indicator of an inefficient system. It would be naive to think that we can just ram more money into the system and achieve better results. There are clearly structural issues within the system that we need to address.
Agenda segment, Aprril 11, 2024: Former health minister on Canadian health care's "arrested development"
So I’m sympathetic to the minister’s need to contain spending and don’t view “more money” as the magic solution to all our problems. But when it comes to retaining and recruiting family doctors, more money is indeed about as close to a magic-bullet solution as we’re likely to find. Hurling billions at the health system as a whole won’t fix what ails it, but spending more money specifically on increasing physician compensation, especially for family doctors, is the fastest thing we can do to retain more new ones and keep the ones we already have. Money is a blunt instrument, but sometimes, a blunt instrument works just fine.
So, for the love of God, give the family doctors more money. Stop arguing that enough people with medical degrees exist in the abstract and recognize the fact that we do not have nearly enough family doctors and that we’re having a hard time retaining the ones we have. Also recognize the fact that there are things beyond the province’s control that are making the situation worse, like tax changes and lingering post-pandemic exhaustion and burnout. Right now, Ontario is in a place where it has a major problem that is being fuelled by a bunch of factors it can’t control and one that it can.
It can control how much it spends on family doctors. It can spend more on them. Stop arguing against that and just do it. That’s the right thing to do to fix the problem we have. And it’ll also stop any more embarrassing reports coming out that suggest that the province is oblivious to the scope and urgency of this issue.
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