With her term as Ontario Medical Association (OMA) president winding down, Rose Zacharias has been travelling Ontario to speak with her peers about cracks in the province’s health-care system.
The Orillia-based physician has served as OMA president for the past year, advocating on behalf of Ontario physicians, residents, and the health-care system, and in recent weeks she has travelled to Queen’s Park, Sudbury, Ottawa, Hamilton, and elsewhere to learn from fellow doctors and meet with government officials.
Across the province, backlogged surgeries, doctor shortages, and even emergency room closures have become the norm following the pandemic.
In her 20 years of experience as a physician, Zacharias said she has never seen the health-care system in this state.
“I've been an emergency department doctor for 20 years and (I) never thought I'd see the day where we would be closing emergency department doors, but that's what's happened over this last year,” she said. “I have never seen our health-care system in a state like this.”
When the provincial budget was released in March, Zacharias had the opportunity to speak with Premier Doug Ford and Minister of Health Sylvia Jones. She highlighted three key issues that need to be addressed: access to palliative care, the province’s surgical backlog, and the doctor shortage.
There are currently over one million elective surgeries backlogged throughout the province, ranging from hip replacements to cataract surgeries, Zacharias said, as surgeries were delayed through the pandemic.
Hospitals are struggling to meet demand in other areas as well. While in Sudbury, Zacharias said the city’s hospital had 36 of 37 emergency room beds occupied.
“It's really straining the health-care team’s ability to provide good care, and (what) comes with it is a degree of distress on behalf of physicians,” she said.
“We really have a deep moral conviction to do right by our patients and care for them in the best way possible, but when you don't have a place to actually effectively evaluate a patient in an emergency department, you get by with what you have – and it's less than ideal.”
High occupancy rates in hospital beds are the result of compounding issues, Zacharias said, pointing out that a lack of palliative care resources has led to many end-of-life patients occupying acute care beds in hospitals.
“This is really stressful for patients and caregivers, and it's a really poor use of health-care resources,” she said. “We know that Ontario spends about $208 million a year on patients who are dying, who are waiting for a bed in a more appropriate setting.
“We need to take the money that we currently spend on end-of-life patients who are occupying these acute care hospital beds and spend it instead on providing care in home and community settings," she suggested.
Over one million Ontarians are currently without a family doctor, Zacharias said, adding early retirements and administrative burdens are compounding the shortage.
“We need to both find more doctors and keep the ones we have by reducing the administrative burden, which is one of the leading causes of physician burnout,” Zacharias said, noting physicians can spend a full day per week on paperwork.
“We actually think the doctor shortage is expected to grow as a large number of physicians are approaching retirement age, and then others retire early or even scale back their practices because of burnout, so this must be an urgent priority," Zacharias stressed.
A big part of the solution is finding ways to get more doctors now, and increasing the supply of doctors in the future.
She said there are hundreds of internationally trained physicians in the province who are unable to practise yet.
“We know there are several hundred … internationally trained physicians that are currently kind of in limbo. They're requiring documentation, they need to write some exams and do some assessments,” she said. “We're definitely agreeing that you need to be evaluated if you haven't received your education … in Ontario, in Canada, but that can be expedited.”
For long-term solutions, Zacharias said more medical schools, student spots, and residency positions need to be created.
In 2021, OMA published a “prescription” with 87 action items, across five areas, for the province to consider, which may be read here.
In February, the federal government announced it will invest nearly $74 billion in Ontario’s health-care system over the next decade, but Zacharias said the investment is not enough to address the province’s issues.
She said the OMA called for the federal government to increase its spending to 35 per cent of Ontario’s needs, noting it has been as low as 22 per cent in recent years, when the original agreement was a 50-50 split.
“It's less than expected and it is less than what's needed to address the gaps and stabilize our health-care system going forward,” Zacharias said. “We don't spend enough money in Canada on health care. The recent provincial federal deals are … a good downpayment … but it's not enough to build a long-term, sustainable health care into the future.”
At the provincial level, too, Zacharias said she has seen progress in the 2023 budget, but there is still need moving forward.
“We did see a commitment to home care and community care, which is good. We did see a commitment around mental health and addictions care, more team-based community care when it comes to mental health and addictions,” she said.
“Where I would like to see more emphasis is on access to primary care … that's definitely an area that I think could use more focus.”
Zacharias’ term as OMA president comes to an end May 5.