Thank you very much, and good afternoon.
When I began practising medicine two decades ago, there was concern about a physician surplus in Ontario and Canada. The boomer generation was predicted to be the healthiest of all previous generations, and the need for physician services was expected to drop. Scientific advances were going to keep people healthier, shorten hospital stays, and improve patient outcomes. The growing cost of Canadian health care was a concern even then and attributed in part to physician services.
In response, medical school positions were cut across the country, hospital beds were eliminated, and hospital wings mothballed. At the same time, practice patterns changed. More years of university education prior to medical school were mandated, and an additional year of training was added to the family medicine residency. Taken together, these separate actions all combined to create our current physician shortage.
Attempts have been made to fix this shortage recently. Medical training positions have been restored to previous levels and more, but it will take several years to repair the damage. Changing demographics, technological and pharmaceutical advances, and increasing patient expectations also play a part in current and future shortages of human health resources. Some of my numbers are very similar to Dr. Fernando's, and I'm not going to repeat those. We know that there are five million people waiting in Canada for a family physician. One million of them are in Ontario.
Let's look forward. Over the next 20 years we can expect a doubling of the number of people over the age of 65, a significant increase in the need for chronic acute care as well as long-term care, and double the number of serious chronic diseases such as cancer, diabetes, heart disease, and dementia, including Alzheimer's. A serious nursing shortage is predicted, in the range of 113,000 by the year 2016. That's a number coming from the Canadian Nursing Association. As well, there's increased competition from other countries, as Dr. Fernando has said, for our human health resources.
As a front-line physician, I see first-hand the difficulties these shortages are creating for my patients and the providers I work with. Almost daily I'm asked whether I know of any family physicians accepting new patients. I used to be able to give a couple of names, but now I don't know anyone. The family health teams in my area have wait lists. Some patients who are officially rostered—that means signed up with a doctor officially—tell me that they are waiting weeks for an appointment: two or three weeks, just to get in. They may have a family doctor rostered to them, but they can't get in to see them in a timely way.
Patients are having difficulty meeting disability insurance requirements because of lengthy wait times for specialists and diagnostics. They're at risk of losing their disability insurance because they can't access the resources they need to access.
Neurosurgical and orthopedic patients wait for diagnostics, such as MRI and CT, for many months. Then they wait again for months to see the specialist. This leads to increased anxiety on the part of the patient and the physician, not to mention potential deterioration and quality-of-life issues during the wait, which requires continued evaluation.
Waits for other diagnostics are rising in my area; patients are waiting months for a simple ultrasound. Some of this has to do with the lack of diagnostic technicians. It's not just physicians, not just nurses; it's the technicians for the diagnostics as well.
In family practice, multi-senior generations present unique and complicated problems. What I mean by multi-senior generations is that the patient is in their 90s and the children are in their 70s. In these cases, the provider needs to do more to arrange simple types of care. This, of course, requires additional staffing and resources, and it's very time-consuming in an office setting.
More patients are coming to me, even friends, neighbours, and acquaintances, and telling me about their dissatisfaction with the lengthy wait for care. I don't mean necessarily MRIs, CTs, and all the wait lists we see in the newspaper; this is just to get in to their family doctor, if they have one.
Staff may be discouraged that they cannot provide more timely care. We see morale suffering in the front lines.
While we look to other professionals and team care to improve the current situation, there are shortages of many other providers, including pharmacists and some of the others I've mentioned.
We can take steps to turn the tide. There are solutions, but you need to hear from us, and I thank the committee so much for inviting us here today.
As with anything else, the first step is to recognize the magnitude and the enormity of the problem. On that, the committee's work is crucial. We must develop a strategy to move forward to address the many challenges, only a few of which I've outlined, and ensure that all Canadians have timely access to quality health care.
I believe this strategy could include a cultural shift towards engaging patients and empowering them to take responsibility in their own care, including information technology improvements. I don't mean that we send things to the pharmacists so that they can get the prescription right; I mean linking patients to physicians and their staff in a direct way. We live in a modern world with modern communications. There's no reason why that can't happen, and it doesn't only have to happen with government help; it can happen with other groups.
I think we need to consider home monitoring and understand that this change involves technologies as well. It's already starting to happen. We see people doing blood glucose monitoring from home. The elderly patient does not have to drive in a snowstorm to the doctor's office, pay for parking, and wait. There are other ways to practise medicine, and family practice and physicians are crucial to that.
If the committee would do me the indulgence of remembering some of these things, I would very much appreciate it.
Thank you so much for inviting me today. Merci beaucoup.