The Op Ed by Dr. Paula Keating, published on December 17 by Brunswick News, was refreshing. It was a delight to see the President of the NB Medical Society strongly advancing the concept of integrated, multi-disciplinary primary health care. It was refreshing because it is a concept, well developed in other areas, that has been advanced in New Brunswick for nearly 20 years yet the traction has been slow to realize. In recent years some innovation has been sparked not because of government innovation or direction but out of sheer common sense when physicians themselves take the bull by the horns to create models that better serve the public in 2023.
The medical society itself, a very influential body, has advanced models in the past that seem tentative and not filling the definition that Dr. Keating articulates. The Department of Health has not been able to get serious vision cast regarding integrated and multi-disciplinary primary care.
In recent years, the enablement of nurse practitioners and now physician assistants to play key roles in primary care has represented progress. But the secret to great and sustainable excellence in health care, be it primary, secondary, or tertiary levels, is in the integration of several care providing groups working together in teams. Yet for too many years we have had, and continue to have, groups organized and financed still in silos.
My first lesson in the power of multiple professions working together in an integrated manner came in my first real job in health administration. That was at the IWK Hospital for Children in 1970 when I was, and was part of, the structure that brought some of the most talented doctors, nurses, technologists, researchers, diagnosticians and others together…and the rest is history. Again, I saw it at Kingston General Hospital where persons were referred from far and wide to be investigated and treated by teams of people with great talent. In both situations, the teams together accomplished what none of them could accomplish independently.
And, so it is with primary care and the apparent missing link seems to be a clear articulation of a vision and plan by the province to pave the way for a model of primary care that departs from the old models that served well in their day but need to adapt to 2023 and beyond.
A mentor once told me his life mantra: “if you keep on doing what you’ve always done, you’ll keep on getting what you always got!” It is a simple way of describing why things don’t change as we think they should. We keep getting hospital beds filled with persons waiting for long-term care and we keep on getting long waits in Emergency or for major surgical procedures because we keep thinking about these dreadful issues with old, conventional thinking.
People get set in their ways, be they physicians, nurses, union leaders, government officials, and basically all of us. The same mentor told me that the only people who want change are babies with wet pants; otherwise, we all have points of resistance depending on our values, our culture, our religious heritage, the people we hang out with, our training and education.
Resistance to change is not abnormal nor should it be seen as terrible. When you click on social media you see some startling things with people expressing perspectives and points of view that are often diametrically opposed to my way of thinking. My way of thinking does not make me a fossil, a resistor, an extremist, or any other character labelled by people who think differently than I do. It simply means that my view, based on 79 years of history, will not be identical to those who came on the work scene in the last decade. We have not had the same experiences, perhaps not the same educational opportunities, same values and interactions with persons who influence thinking.
I have wondered over the years, as I have observed issues that plague the NB health and long-term care system get worse, how is it that in directing health and long-term care in our beautiful province we seem to ignore trends and developments in other provinces. In 1992, the McKenna government touched off the reform of health care and, while successful, found just how angry rural communities can be when they feel threatened. It was a tough pill to swallow but time has shown that starting with creating regional boards was a smart thing to do for the hospital system. New Brunswick was now on the leading edge of health reform. Some of us who were involved naively thought that this would usher in a reform of the entire health and long-term care system that would require many years to complete.
But it seems that politicians and public servants alike got spooked by the level of political push-back from rural doctors, rural communities and more. So, farewell to reform.
So now we pay the price with overcrowded emergency departments, long waits for essential specialist care, thousands of people without access to efficient primary care if any at all.
It is overly simplistic to assert that “every province has the same issues” as an excuse for the current system issues. True enough, there are issues in common but it has taken a pandemic and crisis level issues to get the system to do some of the things that have been unthinkable for decades. Accelerating the process of assessing credentials of graduates of foreign nursing and medical schools? Unheard of until now. Getting physician assistants to function at full scope of practice? Same thing. And getting interdisciplinary primary health clinics developed, three decades after other successful models existed in Canada?
For decades the question has been posed about the use of highly expensive diagnostic equipment on weekends and evenings. The machinery in question, costing taxpayers millions of dollars, has traditionally been booked “during normal business hours” which typically means 8 a.m.-4.30 p.m. Monday to Friday. Similarly Operating Room theatres which are highly costly to build, equip and operate. Weekend surgery perhaps?
In an environment in which it is said to take a year for a specialist appointment and many months, sometimes years, for important surgical interventions, along with all the other major challenges in the system, all options should be on the table.
As I write, I am seeing first hand that all that we do in health care can be organized more efficiently. In Georgia with family, I am seeing how diagnostic services and specialist appointments can be integrated for greater efficiency. I am seeing how ambulatory procedures requiring light anaesthetic can and should be delivered outside the main acute care hospital.
Simplistic responses for decades have been: “oh, that’s for profit.” “Or that is the US!” We can make systems work better by focusing on making them more efficient, effective, regardless of whether it is New Brunswick or somewhere else. Trite, simplistic responses are not helpful.
Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at email@example.com or www.kenmcgeorge.com
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.