The Agenda with Steve Paikin (Audio) - Why Health Care is a Priority in Ontario's 44th Election

Episode Date: February 22, 2025

The Agenda's week in review examines the state of hallway medicine, Ontario's doctor shortage, and to what extent the four major parties are addressing these and other ailments in our health care system.See omnystudio.com/listener for privacy information.

This is from The Trillium, one of the fine digital publications at Queen's Park. Goes back to September 2024. In 2017-18, which is the first time that data on so-called unconventional hospital spaces was tracked, it was about a thousand patients a day that were being treated that way. But by 2024, the number had doubled to 2,000. In terms of hospital beds in the province, in 1990, there were 50,000 per about 10 million people. By 1999, that number had dropped to almost 32,000, even as the population had risen to 11.5 million. Capacity increased only slightly in 2018 to nearly 32,000 again, while the population

had grown to 14 million. And today, of course, Ontario is close to 16 million. Another factor is people waiting in hospitals for alternative levels of care. In mid-2024, there were 6,100 people waiting to complete their treatment at home or waiting for a space in long-term care. All right, let's get some ideas as to why this is happening. Samir Sinha, come on in here and tell us about what's one main reason why all these things are happening? One of the main reasons we're having a lot of hallway medicine is that we actually have a system that was designed in the 50s when the average Canadian was 27 years of age. So we designed a system for a much younger population. We focused

on hospitals and we focused on physicians, but we didn't focus on enshrining long-term care services or even prescription drug coverage as part of our healthcare system. So we have a system that I like to say the patients have changed, the system hasn't. And right now, one of the reasons why we have 6,000 people waiting in hospitals, which means that we have 2,000 people waiting in unconventional spaces, is because we don't have enough home and community care and other community-based services that would allow more people to age in their own homes longer and not end up in hospitals or be able to get out of hospitals sooner. Paul Woods, what would you add to that? Well, I would say it's just a mismatch between inpatient capacity and demand for those services

that are just driven by an aging population and a growing population. It's just a math problem is one of the big issues. Joanne, you've looked into this. What would you add? Well, I would say that hallway medicine is really the thing that patients see, but it is a symptom of all of the backlogs in the healthcare system from too few family doctors to deficits in hospitals, aging buildings, long-term care weights

and adequate home care. It's really a symptom of all of the loggams in the system. Rosalie? Well, I think I agree that it's a symptom of the problem, less the actual disease, and that it really is just that when there's no other alternatives for Canadians, they're going to go to an emergency room, even if they know it's not an emergency. If they need care they know that they can get it there so they end up being crowded when other parts of the system aren't available. And they'll wait 20 hours if they have to. They will if they have to. Which they often have to. Natalie,

what would you add? So I agree with mostly what everyone said except for maybe that comment actually but but except for one thing that alternate level of care patients about half of them are waiting for another type of hospital bed. So they're waiting for a rehab bed in a rehab hospital. They might be waiting for complex continuing care bed. So about half of them are actually waiting for hospital care. Just that's important to know. The rest are waiting for long term care. If they can discharge you to home care, they discharge you whether or not the home care is in place, as we know.

People wait at home with no care at all. So if they can get you out, they get you out. It may be people waiting because they've had a stroke and their home has to be renovated so they can get back in it or something like that. There are some people waiting for home care, but mostly they kick them out. So to us, I mean, the cuts.

Ontario has the fewest hospital beds left of any province in Canada. Per capita. Per capita? Yeah, by far. Ontario needs 3,500 family doctors, and we need them now. So I'm going to come to you, Dominic. How do we go about doing that?

A part of this is gonna be making family practice attractive again for medical students and then also for existing doctors. I'm a president at the OMA, but also a teacher for medical students and residents. What I'm hearing is that they're seeing the reality of the unsustainable workload, the fact that family medicine is no longer seen as a viable career for many

of our colleagues in this province. So let's make it attractive again to be a family doctor. That'll bring family doctors in. But just as importantly, it'll keep the doctors that we already have in this province ready to work doing the practice of family medicine. All right. Jobin, I'm going to quote Dominic.

He had mentioned, you know, it's sort of like a hunger games when it comes to recruiting doctors. And it's not, you know, we have the scene of people waiting in line, but let's talk about the municipalities and the communities that are fighting to get these doctors to come to that. With that, how do we go about it? It's a big issue, but how do we go about doing that?

I think it's scary. 2.5 million people is just not okay. There's too many people who are waiting to get a family doctor and we need to get to the point where everyone has access but like Dominic said it's critically important that we get those family physicians supported by teams and having the right technology at their fingertips. I'll use an example if I am working with a patient who had a car accident and now has a concussion, I'm going to have paperwork to do for their insurance company,

for their work, to be able to get them back to work. Having things like an artificial intelligence scribe could allow me to document more effectively and be able to help get that person back to work at a sooner rate. On top of that, if we had things like centralized referral systems, it would also allow us to more effectively pass through the healthcare system. All right, Dr. Sarah Newberry, we know you've been

in this game trying to recruit when it comes to the north. This is not an issue, and here we have Joe been talking about AI. We're in a whole new world here, it's very interesting. So I'm curious, with the fight that you guys have and what you guys need to do, what is sort of the solution in terms of fixing that shortage?

I think this is a really important question, Jayan. And I think one of the pieces that feels profoundly important is the creation of a rural and northern health workforce strategy. So I think what Dominic and Jobin have highlighted are a couple of tactics that are important that would make practice more manageable, but there is a whole swath of tools and opportunities that we have at every level,

from the federal government and tax incentives to the provincial government and how we create infrastructure supports like Dominic and Jobin have referenced to recruitment and retention incentives to more robust team-based care. But part of what we need is to align all of those tactics in a coherent strategy that we can implement and drive over these next four years to achieve the target that's been laid out and that we can measure and evaluate as we move forward. All right, Sarah, I'm gonna stick with you. The OMA also estimates that almost 40% of those practicing

now are considering retirement in the next few years. I was in Wawa a few months ago and I was talking with Dr. Cotterill, someone who's been practicing with his partner since 1998 and you know when you start thinking about succession plans and what's next there's a lot of concern there and I'm curious should we be trying to convince them to stay? Is that part of the solution or is it trying to get new people in? How do we what do we do with that sort of,

the people that have been there who've made those connections, what should we be doing with them? So I would say absolutely it is not an either or, it is a both and. We have made some really important decisions as a province about the expansion of medical schools and post-graduate training programs. We've made some really important decisions about how we will welcome and support internationally trained physicians to the province. But we need to remember that medical education is not bums in seats in lecture halls, it is a shoulder to shoulder apprenticeship

with clinicians, with doctors who have experience in the community. And so if we want our medical trainees to practice in communities that need them most, we absolutely need to be retaining the doctors, Cotterall and Oberoi and Wawa and seasoned clinicians wherever they are so that they can do that training and apprenticeship.