Doctors share their 2023 wishlist after a year of ‘crisis’ in Canada’s ERs – National | Globalnews.ca
As Canadians reflect on the last year and make resolutions for 2023, physicians on the front lines of Canada’s ailing health system are also taking stock — and they say immediate and long-term action is needed to address systemic issues.
These issues have resulted in an erosion of patient access to non-acute care, which has ultimately led to an ongoing “crisis” in emergency departments across the country, the doctors say.
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The last year has been a particularly challenging one for those working in hospitals, as patient surges from waves of COVID-19 earlier in the year and from other viral illnesses like influenza and respiratory syncytial virus (RSV) in recent months have coincided with a nationwide shortage of health workers.
This has put to what many have called a “perfect storm” of pressure on Canada’s health-care system, with fewer nurses in particular available to care for higher numbers of patients, many of whom are showing up in hospitals sicker than they should be, due to delayed or limited access to preventative care over the last three years of the pandemic.
In the summer — a normally slower time of year for viral illness — ERs across the country were swamped with patients and forced to close temporarily due to staffing shortages.
The pressure has shifted in the last few months to children’s hospitals, which have been inundated with babies and toddlers sick with respiratory illnesses and parents who can’t get their hands on basic kids’ medications, due to nation-wide shortages of children’s ibuprofen and acetaminophen.
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But as challenging as the last year has been for front-line staff, physicians working in hospitals say they remain hopeful the strains within the health-care system can be relieved. And they have a number of ideas for solutions that could help.
Global News asked some hospital physicians to provide a wish list of things they would like to see happen in 2023 that could improve the health system and address the considerable pressures within hospitals.
Here are some of the key themes that emerged from those conversations.
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Wish 1: Improve access to primary care for all Canadians
Almost every physician that spoke with Global News for this story said access to primary care through a family doctor or nurse practitioner is essential to improving patient outcomes and reducing the strain on ERs.
Nearly five million Canadians over the age of 12 did not have access to a family doctor in 2019, according to the latest available data from Statistics Canada. And that number has likely grown, as an increasing number of family physicians across Canada have been reducing their patient loads, cutting hours or leaving family medicine altogether, according to the College of Family Physicians of Canada.
But attracting more doctors to family medicine will take more investment and possibly a restructuring of how their practices are funded by provincial governments, said Dr. Melanie Bechard, pediatric emergency medicine physician in Ottawa and the chair of Canadian Doctors for Medicare.
“We need to ensure that family doctors are appropriately funded for their work,” she said.
“We also need to make sure that they have the appropriate supports they need to actually deliver good care rather than it all falling on a single physician.”
Family practices are run in many provinces as a fee-for-service model, which essentially turns family physicians into small-business owners who must run their own office, including hiring staff and dealing with tasks like commercial rents and ordering medical supplies.
They are also paid the same amount by their province for each patient visit, regardless of the severity of each case.
That’s why organizations that represent doctors, including the College of Family Physicians of Canada and the Canadian Medical Association, have been advocating for governments to move to a multidisciplinary team approach to primary care that includes funding for administrative help for family doctors as well as help from other allied health professionals, such as nurse practitioners, dietitians and pharmacists.
These group practices, sometimes called “medical homes” or “medical teams,” are beneficial not only for physicians, but also offer better care for patients, Bechard said.
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“We know that having a longitudinal primary care provider — a family doctor that knows you, knows your health status — helps to improve your health and also helps to save the system money,” she said.
“Primary care is one of the highest value areas of greatest need where we could absolutely do a better job because it really is the foundation of our health-care system.”
Dr. Darren Markland, an internal medicine and critical care physician at the Royal Alexandra Hospital in Edmonton, Alta., sees the need to rebuild primary care as not only important, but urgent.
He sees patients in his intensive care unit every day whom he describes as “dying of social neglect.”
This, he said, is a symptom of a lack of access to basic health services that leads to chronic health issues, such as severe mental illness and addictions.
“I think the most important thing, at least from our perspective, is bringing in a therapeutic relationship with people at a very primary level,” he said.
“And that’s our family physicians and care networks (that) need to be rebuilt, and that takes a massive amount of work because quite honestly, over the past three years, we’ve been decimated.”
Wish 2: Better long-term planning for surges of urgent care patients
Many of the current pressures in Canada’s health system were not necessarily created by the COVID-19 pandemic, but rather have been laid bare and, in some cases, exacerbated by the public health emergency, said Dr. Sumon Chakrabarti, an infectious diseases physician at Trillium Health Partners in Mississauga, Ont.
For example, many hospitals in Ontario were already operating at over 100 per cent of their bed capacity before the pandemic. So, when COVID-19 patients began pouring in, it was harder for these hospitals to cope.
That’s why he said better long-term planning is needed to prepare for unexpected influxes of patients — a measure that could have also helped address current patient overcrowding in ERs triggered by the flu and RSV this fall, he said.
“I think just having a little bit more capacity to be able to deal with surges would be great.”
One potential solution could be offering people alternate ways to access urgent care that is not an emergency department, Chakrabarti suggested.
“There used to be a bunch of urgent care centres across Ontario, and some of them folded during the pandemic,” he said.
“Having a centre where people can go in and, it’s not the emergency department where they’re seeing heart attacks, but still something that needs to be dealt with urgently — that kind of low-acuity, urgent care, I think can avoid that (demand on ERs).”
Dr. Laura Hawryluck, an ICU physician and professor of critical care medicine at the University of Toronto, said she also believes more long-term planning is needed to ensure the health system is more prepared for patient surges and for future health emergencies.
A lack of preparation ahead of COVID-19 resulted in a “reactive” approach, she said, which forced surgeries to be cancelled and limited access to preventative care.
And this reactive approach did not change over time, even as the world learned more about the virus and how it spreads, she said.
“It became the same response over and over again, and in the ICU, we talk about alarm fatigue. … We have so many things that beep, buzz and screech at us that you get used to them so you don’t listen,” Hawryluck said.
“I think what we’re seeing now is this alarm fatigue among the population. … So I think our messaging needs to improve, number one, and it needs to improve in a way that there’s an honesty towards people so that we don’t have this misinformation.”
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More longer-term planning could also have potentially seen the millions of workers who were sent home during the height of the pandemic enlisted to help the health system, rather than leaving the responsibility of a global health emergency on the shoulders of a dwindling number of already burned-out health workers, she added.
“There are tasks within the hospital, even in terms of helping with patient care, that we could have developed education for, trained people up to help with,” Hawryluck said.
“We could have also perhaps encouraged people to join the health-care system before we ended up in this crisis, because then maybe we wouldn’t have ended up in this crisis.”
Wish 3: Better access to home care for seniors and elders
Another strain on hospitals across the country has been a growing number of patients occupying beds who should be placed in alternative care settings, such as long-term care or home care.
While provincial and federal governments have paid lip service to improving access to home and community care — which allow elder patients to receive care at home, rather than in an institution or hospital, access still remains limited, said Dr. Samir Sinha, director of geriatrics at Sinai Health and the University Health Network in Toronto.
“Yes, there have been some investments here and there, but not the significant investments that we need to actually align ourselves with other international countries that are actually getting this right,” he said.
The pandemic exposed many critical gaps in Canada’s elder care system when residents of long-term care (LTC) were disproportionately impacted by infections and deaths.
In Canada, LTC residents accounted for three per cent of all COVID-19 cases and 43 per cent of COVID deaths, according to 2021 data from the Canadian Institute of Health Information.
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Sinha said that since then, support and demand for more home care for seniors has only grown, which is why he said his biggest wish for 2023 is for all levels of government to stop arguing over dollars and simply invest in a “strong home and community care system where workers are actually paid fairly.”
“When we talk about what’s actually needed, it’s more than lip service (needed), it’s actually real dollars and really prioritizing dollars in the right place, which is about keeping people healthy and independent in their own homes for as long as possible,” Sinha said.
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