As Health Minister Dorothy Shephard winds up her health reform consultation tour and the hard work begins on making tough decisions and implementing changes that not everyone will agree with, the government should be commended for starting this process in a meaningful way. While she may not find widespread agreement on what reform should look like, it seems everyone agrees that change is needed and the system in its current form is not sustainable.
New Brunswick has done remarkably well managing the pandemic and we should all be thankful for that as it seems that even relatively minor outbreaks of COVID-19 put immense stress on the health system that at some point it will not be able to handle. This is primarily due to pre-existing challenges that the pandemic has underscored and made top-of-mind for many. I would encourage all New Brunswickers to read the government’s discussion paper Striving for Dependable Public Health Care as it concisely explains the challenges in plain language and puts forward seven objectives that hit the mark.
The Fredericton chamber has been involved with physician recruitment and health care advocacy for more than a decade and one of the more frequent questions I am asked is how is that a business issue? Physician recruitment first came onto our radar as we started to hear from members that they were having trouble attracting employees to the province as often the first question the recruit would ask was how do I get a doctor, which eventually became can I get a doctor? As we became more involved in the health sector it became clearer to us that what we should be asking is can I access primary care? And answering this question has become the basis of our health care advocacy. Family doctors are obviously still critical to effective health care, but the current solo-practice physician model can no longer form the basis of primary care.
The future of primary care must involve family health teams, community care clinics, nurse practitioners and allied health. Not only are these models more efficient but they provide better access for patients, leading to better primary care and as the discussion paper states – new physicians also want this model as it provides a better work-life balance for them.
Health care in the province is facing both internal and external pressures that are complex and will require bold thinking and change if we want to address them in a meaningful way.
Externally, the province’s population is aging and has been nearly stagnant over the past decade – although there have been small signs of optimism recently. This presents both funding and care issues as (on average), the vast majority of health care required comes in the last 5-10 years of life and the same time as people are leaving the workforce – limiting the province’s ability to generate the revenue needed to pay for the care that people need and deserve. I encourage New Brunswickers to read the work of economist Richard Saillant, particularly A Tale of Two Countries, which argues (amongst other things) that in order to meet the Canada’s goals of providing equivalent health care throughout the country, federal health transfers should be weighted to reflect an older population – currently the formula is primarily based on a straight per-capita basis.
Internally, the strain on the people that provide care was great prior to COVID-19 and has been exacerbated exponentially over the past year and half. To highlight a couple of alarming stats, more than 15,000 people in the Fredericton Region (and 44,000 provincially) are currently without a family doctor and therefore mainly rely on after-hours clinics and emergency rooms. Just last week it was reported that there are currently more than 700 vacant nursing positions across the province. Many of us probably know at least one nurse and have heard the stories about staffing issues, stress and burnout. In many ways nurses are the glue that holds health care together.
Throughout the province and across units – health care workers are feeling gravity of the situation and are increasingly ringing alarm bells. I’m left with two big questions – are we listening? Are we willing to do anything about it before it’s too late?
Krista Ross is CEO of the Fredericton Chamber of Commerce, a nationally accredited organization with more than 1,000 members, is an active business organization engaged in policy development and advocacy that affects the competitiveness of our members and the Canadian business environment. The Chamber’s vision is ‘Stronger Community Through Business Prosperity’.