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New Brunswick needs a long-term plan for health

Health care sustainability is one of the top issues across the country. New Brunswick is no different from other provinces in that respect. New Brunswick’s doctors are part of a movement led by the Canadian Medical Association and the Canadian Nurses Association, launched years ago, calling for transformational change in our healthcare system to achieve long-term sustainability. We have long recognized the need to sit down and re-think the way we deliver health care.

Almost a year ago, the Alward Government toured the province to develop a new Health Plan for the province. The New Brunswick Medical Society, backed by comments from four hundred doctors across the province, submitted dozens of recommendations aimed at achieving sustainability. We’ll be honest - none of them were easy solutions. That’s because there are no easy solutions. All require collaboration, commitment, and a lot of thought.

People understood that long-term change is required. The Telegraph Journal editorial called our plan “required reading for members of government,” a “prescription worth filling,” and “wise advice.” Acadie Nouvelle concurred, saying “nous sommes d’avis que leur engagement pourrait permettre de transformer plus rapidement tout l’appareil de la santé.” Sadly, we have yet to see evidence of any long-term plan for health care from the government.

We see the lack of a plan as a serious problem. Doctors are trying to lead changes in our system, but what we see, absent any thoughtful consideration, is short-term thinking trying to fix long-term problems. We have long-term economic problems too, and while there are many ideas for those problems, we’ll stick to what we know. Our health care system is facing sustainability challenges. We were among the first to hit the call bell on this, because while we can manage our system much better, we also know that health care is mostly driven by patient needs.

Every time you see your doctor, they get paid by Medicare. More visits equals higher cost - and we have a lot of visits. We are the second-oldest population in Canada. Seniors have longer visits to the doctor, and have them more often; they require five times as many health care resources as younger people. We are among the unhealthiest people in the nation. 60% have at least one chronic disease; 13% of those people are on six or more medications. We have the second highest rate of disability in Canada. We have the third highest rate of diabetes, and the third highest rates of cancer. We are the second heaviest population, with two-thirds of us being overweight or obese.  These are serious long-term problems, which can’t be capped on a spreadsheet. They won’t go away in two years, but we do need to work on them right now.

We see 20,000 patients a day and live these statistics. We also know our patients expect us to work with government. That’s why we first called for negotiations with the Province in January of 2012, and were put off. We asked again in August, and were put off. The government finally came to the table in November for a day before stalling again. Then we met another day before they cancelled the next meeting. Finally, six weeks before the budget, the Minister arrived to tell us that we must cut $20 million in patient services right away – or else, and he won’t talk about it at our formal table. We asked him to have the discussion through formal negotiations, shelved all of our other proposals, and offered to get it done in his timeframe. Now we’re hearing that doctors won’t cooperate, and that our call for mediation in the negotiations process will drag things out for “months.” He wants solutions, and he wants them right now.

The good news is that it’s pretty clear that doctors are willing to talk and to find solutions. However, we categorically reject that a unilaterally imposed limit on medical services to patients is one of them. The fixes are complicated and require full commitment from both government and health care providers. Conversations need to happen in an environment of respect where each party appreciates the expertise and knowledge of the other.

Instead, we have impulsive and short-term decisions like a cap on Medicare. What does a cap on medical services mean for patients? We know what it means, because we’ve been through this before. This cap will mean that someone on a waiting list to see a specialist, or for a hip replacement, will likely wait longer. Those without a family doctor will continue to seek primary care at walk-in clinics and emergency rooms. Some small medical problems will become more important, difficult, and expensive to treat. While this is happening, we’ll see our system increasingly crunched while we wait for a real plan to tackle our long-term problems.

Hearing this is tough if you want solutions – now. It’s not easy to talk about health care changes with doctors because we don’t have easy answers. Ours are hard, because we actually understand the long-term nature of our current problem. Every decision has a potential impact on patients and long-term cost of care that is not necessarily evident to lawmakers. But like our decisions with patients in our offices, good decisions aren’t impulsive or reactive. Good decisions are made by consulting experts, examining the evidence, investigating the problems, and adhering to a long-term plan.

The people of New Brunswick deserve for both government and health care providers to demonstrate a focus on a long-term, evidence-based plan for sustainability. Our patients care about the health system, and New Brunswick’s doctors care about them. Let’s get rid of the short-term cap on medical services, and come up with a real plan to address our real challenges together.

Robert Desjardins, MD FRCPC
President, New Brunswick Medical Society