Breaking the Cycle of Cynicism in Health Care

Dr. Colin McMillan
President
Canadian Medical Association
National Press Club
Ottawa, April 19, 2007

Good afternoon.

It is my pleasure to be here today in the venerable National Press Club.

Just as the Press Club has faced some challenges recently, so too has another important Canadian institution - our Medicare system.

Much has been said and written recently about health.

Including that it is a "done deal" - checked off and replaced as the issue by the environment - or the recent victim of another political "gimmick" aimed at capturing votes, not helping patients.

My members, the doctors of Canada are increasingly demoralized by this crushing cycle of cynicism.

As the ones on the front lines who, along with our patients, have the most to lose when our health care system fails, it would be easy for me to stand here and lash out with criticism.

I'm not going to do that today. I believe my patients, and those of my colleagues deserve better.

Today, I will try to do my part to break the cycle of cynicism by sharing my top reasons why I am cautiously optimistic about the future of our health care system.

I will then provide a reality check on the progress achieved in providing more timely access to care for Canadian patients. That reality check comes in the form of the Wait Time Alliance spring report card.

Finally, I will share some thoughts on how we can overcome the serious challenges that remain on the pathways to progress.

Breaking the cycle of cynicism
As I said, I am cautiously optimistic about the future for the health care system and I can give you my reasons as to why.

1. Last month's federal budget saw a $1.1 Billion investment in net new federal funding for wait times. Provinces and territories must now use this money for the intended purposes and ensure it buys at least $1.1 billion in improved access.
2. The federal investment has provided for provincial and territorial trust funds to help finance out of province or out-of-country referrals when a patient has waited too long for needed health care services.

   This is the equivalent of the Canada Health Access Fund for which the CMA has called for repeatedly.

3. The federal government, at our urging, has provided some important leadership, but we realize that the real heavy lifting in reducing wait time is being done at the provincial and territorial level.

2010 is a long way off for those worried now.

Yet we contend that the different gold standards across the country will encourage provinces to race to the top, not to sink to the lowest common denominator.

1. Governments have begun to realize that doctors, nurses and others in the system aren't cost centres, but service and value centres, and we need a lot more doctors and health care professionals to achieve our goals.

   We have a long way to go, but we have seen a marked increase in enrollments to medical schools and the beginnings of a concerted effort to better employ immigrant health care providers.

2. We are seeing the beginnings of electronic health records across the country.

   The $400-million provided for by the government in the federal budget is nothing more than a down payment on the future, but the CMA and others are committed to making a portable electronic health record for patients a reality.

3. All Canada's health professionals are working together like never before to find ways to better respond to patient needs in the community.

   But collaborative care models need to be just that, collaborative, and not jut a transfer of blame or of work from one set of busy hands to another set of even busier hands.

   Now governments are beginning to realize that it will take a pan-Canadian approach to turn things around to ensure we have enough doctors, nurses and other health care professionals to meet the needs of patients.

4. Canadians will continue to keep the government of Canada's feet to the fire to continue to take the Canadian view, a national view.

In 1967 legislation that was passed unanimously by Parliament has evolved in stages ever since.

There is no room for any federal politician believing that he or she can roll back the clock.

Canadians won't tolerate it and I can tell you without hesitation, Canada's doctors won't stand for it!

Clearing the air
Turning more specifically to wait times, five years ago developing a national approach to wait time benchmarks seemed like mission impossible.

Even three years ago, naysayers said getting medicare back on track couldn't be done.

We couldn't even conceive of wait time benchmarks for timely access to care in clinical areas, much less a care guarantee.

The 10-Year Plan to Strengthen the Future of Health Care changed that by building a strategic approach - with a timetable and deadlines - to carry out specific action to address wait times.

The 10-year Plan, with its funding and concrete timelines for action, made renewing health a mission possible and gave Canadians a way to focus the minds of politicians by making them accountable to specific deadlines.

Also in the fall of 2004, the CMA and six national medical specialty organizations united to form the Wait Time Alliance, or WTA. The WTA has monitored carefully and graded governments on their collective commitments, and whether health care systems - in each province and nationally - achieved the meaningful reductions in the five priority areas identified in the 10-Year Plan.

Today, I commend the release of the WTA spring Report Card. This is the next important step in monitoring progress on wait time reduction.

The WTA is reporting that governments are on the right track when it comes to cutting wait times. In terms of meeting specific commitments governments get a:

• Grade of B and C respectively for hip and knee replacement;
• Grade of B for meeting benchmarks for cataract surgery;
• Grade of A for bypass surgery, and;
• Grade of A for radiation oncology.

The report card released today by the WTA shows significant progress toward benchmarks.

This should be cause for both providers and patients to be more optimistic about the future.

But we can not overlook the fact that in terms of diagnostic imaging and the narrow focus in the field of cardiac care, governments are still not achieving a passing grade.

We must recognize that the report card and report released today underscores many challenges and some significant failures.

Let me explain

Pathways to Progress
The report card, and accompanying report, warn that health ministers have to date only established a partial list of benchmarks.

The paucity of benchmarks for diagnostic imaging and for a broader array of cardiovascular services must be addressed.

Also, the wait for treatment in radiation oncology is still longer than the WTA recommended benchmark.

We must maintain progress and take the next critical steps to create a pan-Canadian wait-time guarantee, a wait time guarantee that actually works for patients.

Canadians now need their political leaders to move forward from here and not backward.

We must extend our focus beyond the first five priority clinical areas to provide benchmarks across the continuum of health care services.

First, the WTA is doing just that by expanding to establish maximum, medically acceptable benchmarks in emergency care, psychiatry, facial reconstructive surgery and gastroenterology.

I am pleased that we have been joined today by representatives from the Canadian Anesthesiologists' Society, the Canadian Association of Emergency Physicians, the Canadian Association of Gastroentorology, the Canadian Psychiatric Association and the Canadian Society of Plastic Surgeons.

These five groups are the newest members of the expanded Wait Time Alliance. Secondly, in a separate, but related initiative, the CMA is delighted to be joining with the College of Family Physicians of Canada to consider wait-time benchmarks or performance goals in the area of primary care.

This is particularly important given the fact that Statistics Canada reports 14% - or over 3.6 million - Canadians report having no family physician.

These two important initiatives move us further to our ultimate goal: The establishment of wait time benchmarks or performance goals in all categories of health care delivery all with the same high standards.

The fact is, having been given a taste of progress, Canadians now expect their political leaders to press the advantage.

Our political leaders must work with doctors and others to maintain the momentum and come forward with new ideas and initiatives to improve access to health care services.

While there has been progress, we cannot afford to stand still.

We cannot, and will not, let governments rest on their laurels.

For that reason, the physicians of Canada, on behalf of their patients challenge governments to keep their commitment to Canadians on timely access to quality health care. Accomplishing that means all governments must:

• Establish wait time benchmarks in all five priority areas by the end of the year. As stressed earlier, to date we have no benchmarks for either diagnostic imaging a comprehensive array of cardiac care procedures.
• Create and announce specific dates by which time patients can count on governments meeting those benchmarks or performance targets in each of the five priority areas.
• Commit to expanding wait time benchmarking process to other areas of specialty and primary care, as identified by the Wait Time Alliance.

Before I conclude, I would just add a reminder that there are other areas of health care that need our immediate attention.

Reinvestment in aboriginal health is one area that needs to be at the top of everybody's list.

Reinvestment in federal health research funding is another.

The dramatic needs for reinvestments in our capacity and hospital infrastructure also must not be ignored.

The duty of leadership is to recognize and salute progress, be realistic about the challenges the future holds and not be too afraid to chart a bold course forward.

I want to tell the patients of Canada that they should continue to have confidence in their health professionals being there for them.

I want to tell the politicians of Canada that we appreciate the efforts to date to right the Medicare ship, but we're only half way there.

I want to tell my colleagues across Canada that the CMA will continue its fight to help you help your patients.

Conclusion
So in conclusion, Canada's health care professionals have noted that governments - provincial, territorial and federal - of all stripes are working to improve timely access to quality health care services for all Canadians.

It is by no means mission completed, but it is mission possible.

Fulfilling our mission requires that we break the crushing cycle of cynicism that greets any attempt to improve access to care for patients.

As the WTA Spring Report Card did, we must continue to help Canadians hold our political leaders to account.

The physicians of Canada, on behalf of their patients, will support the "race to the top" by challenging governments to fulfill their promise to establish multi-year targets as outlined in the 10-Year Plan to Strengthen Health Care.

This is the next critical deadline and would mean that all governments that have not yet done so, would announce their timelines for going forward and implementing the agreed-upon benchmarks.

We have a plan to move forward.

We have momentum to keep us going.

We are not going away.

Thank you.