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North’s health care crisis: Ontario’s ‘double standard’ means northern patients lose out

During her visit to the city, Dr. Nadia Alam, president of the Ontario Medical Association, heard from local doctors who are frustrated with under-funding in health care and who describe a strained relationship with HSN executives 

Dr. Nadia Alam now “gets” why people say health care is in crisis in Northern Ontario.

The Georgetown family physician and president of the Ontario Medical Association visited Sudbury this week as part of a tour of Northern Ontario communities.

She concluded “there is a double standard in terms of the resources that patients up North can access versus the patients down south.”

Alam addressed the annual general meeting of the Sudbury and District Medical Society on Monday where physicians shared their frustration about an under-funded health care system, the lack of a contract between the OMA and the Government of Ontario, and staff cutbacks at Health Sciences North.

Doctors told her their relationship with the leadership at HSN is “strained” due in part to the elimination of several dozen health-care positions at the hospital, many of them registered nurses.

Sudbury physicians feel “powerless to be able to affect administration,” said Alam, “which is a bizarre feeling when you’re a doctor.”

Alam heard that while doctors understand the need to balance hospital budgets, cutting even one allied health professional can hurt patients. For instance, ophthalmologist Dr. Stephen Kosar said the elimination of a technologist who works with him doing eye imaging for injections for diabetic retinopathy has a “profound impact” on a hospital that is a tertiary care centre for Northeastern Ontario.

A family physician from Little Current, Dr. Stephen Cooper, told Alam that “if Health Sciences North doesn’t work, the entire northeastern Ontario doesn’t work.”

Cooper is chief of staff at Manitoulin Health Centre and chair of the OMA’s rural medicine section.

In a telephone interview Tuesday morning, Alam told “I’m driving by HSN and I’m looking at the 426-bed hospital and I’m like, ‘Yeah, this place needs to work. It needs to work well to serve the vast geography that it does.’ ”

Alam said health care is a team sport and “to lose key players like this, it’s disheartening because it makes your job that much harder. Everybody has to stretch to fill the gaps and, at some point, you can’t stretch any further. You’re just done, you’re done.”

Cutting so many front-line staff is “worrying because it’s already a hard enough job to take care of patients” in Northern Ontario, she said.

Alam also heard doctors’ concerns that they haven’t had a stable contract with the province going on five years. That’s creating uncertainty among doctors who want to put down roots and is being felt “particularly keenly up North”. Sudbury has done a good job of recruiting physicians, but a stable contract would help retain them. Alam visited Parry Sound, where health care leaders are struggling to recruit physicians. 

“(Doctors) were burning out trying to fill the gaps and trying to make sure their patients were cared for and seen. It’s heart-breaking.”

She saw evidence of health care disparity between Northern and southern Ontario on her tour. 

“It’s human nature to see the world through your own eyes and through your experiences,” she said.

Some southern Ontario communities are struggling to recruit doctors but, because their regions are more densely populated, people can drive a short distance to another community for care.

For instance, she can refer Georgetown patients to Brampton, Mississauga, Oakville or Guelph is services aren’t available in her town. 

“You can’t do that up north. You just can’t,” she said. “The reason why Northern Ontario is breathtakingly beautiful is the exact same reason why it’s breathtakingly isolated. The geography makes that particular problem much, much, much worse, magnitudes of times worse.”

Alam is working on a master’s degree in health policy where the conversation sometimes turns to having to accept a “certain amount of inefficiency just to maintain equity of access” in communities hundreds of miles apart.

Her concern “mirrors” that of many people “that the North had been forgotten,” said Alam.

Sudbury doctors need to partner with management at HSN and with government to find solutions that work here. 

“We all get these are hard times for Ontario, these are hard times for Ontario’s hospitals, but we’ve got answers and by working together we don’t end up alienating the people who are providing care.” If that happens, health care providers will “burn out and they’ll leave.”

Health care leaders must be convinced that short-sightedness will cost the system more in the long run and must partner with others to make their voices bigger – “so big that the government can’t keep ignoring them.”

Alam will use the findings of her tour to “amplify the message” that the North deserves better health care and to advocate for it at Queen’s Park.

HSN responds

The following is from Health Sciences North president and chief executive officer Dominic Giroux, who was asked to respond to comments from some doctors that their relationship with HSN leadership is “strained.”

“HSN has a productive and collegial relationship with its medical staff executive. We meet on a regular basis and have candid conversations about current issues of common interest. We take to heart what is relayed to us by the medical staff leadership. That's in part why our approved budget contains no bed closures and minimal reductions in surgery blocks. It's also why our approved budget provides more resources in acute care programs and about $7 million less in clinical support and support areas. Our medical staff told us this year that they want us to implement regional electronic medical records to improve patient care, and as a result we are making this a priority. Our medical staff leadership asked us this year to improve turnaround times for CT and ECG reading, and we have done that. These are just a few examples.  
“When we consulted the medical staff leadership this spring about our proposed budget, the advice we received was to proceed swiftly and return to a balanced budget as early as 2019-2020 as opposed to doing the ‘death by a thousand cuts’ with annual reductions over three years. We are following that advice. For the first time in many years, we are on track with our approved annual budget. 
“When we released our 2018-2019 budget on April 16th, our news release quoted the President of the Medical Staff Executive, Dr. Killian de Blacam, who stated: ‘The process had clear budget parameters since November, thorough benchmarking and departmental reviews, effective consultations of key stakeholders, recommendations to invest more in clinical departments and less in non-clinical areas, with no bed closures and minimal reductions to surgery blocks. It gives a clear vision of HSN going toward a path of success and a return to a balanced budget in 2019-2020.’ ”
“Eliminating an $11.3-million deficit is no easy task. Two things were unusual this year: the magnitude of the budget changes required; and the fact that the LHIN had asked HSN to not engage with anyone while the third-party validation of the approved budget was underway. These two factors have limited our ability to engage more broadly on some specific changes.”

Carol Mulligan is an award-winning reporter and one of Greater Sudbury’s most experienced journalists.