justanoldcountrydoctor

Re-Post: Health Care Has Crumbled Under Eric Hoskins’ Watch

Old Country Doctors Note: This blog originally appeared in the Huffington Post on April 24, 2017. It is being reproduced here on my own website so that I can access in the future if needed, and for my own posterity.

Recently, Ontario Health Minister Eric Hoskins introduced Bill 87, a.k.a. the Protecting Patients Act. Its goal is one that no right-thinking person could disagree with, namely to identify and punish health-care professionals who sexually abuse patients. The problem is that it is sloppily written, hastily put together to deflect from other health-care stories and will have significant unintended consequences that will harm patients.

My colleague Dr. Nadia Alam wrote an exceptional piece on how Bill 87 is flawed. She detailed how it breeds a culture of fear, will negatively affect practice patterns and abandons the principle of “innocent until proven guilty.”

Predictably, some of the people who commented on her column felt that she was off base. One even argued that the provisions in the bill that supercede tenants of jurisprudence dating back to the Magna Carta were “common sense.” A feeling that doctors are criticizing this bill to protect their own interests certainly permeates the media.

Except, of course, it turns out that the critics of Bill 87 are right. Last week the Canadian Civil Liberties Association, an independent non-governmental organization dedicated to protecting the rights and freedoms of all Canadians, came out with a strong critique of the bill.

Concerns listed include:

Setting a dangerous precedent for ALL regulated professions
Open-ended provisions that allow a health minister too wide discretion
NO explicit limitation of the type of personal information to be collected
Information collection to be done solely at the discretion of one person (health minister)

What we see yet again, therefore, is another sure-to-fail piece of legislation by minister Hoskins. Frankly, to this somewhat cynical eye, this legislation is a continuation of his incompetent style of running the health ministry. The pattern all along from this minister has been to act unilaterally on issues, refuse to accept input from front-line health-care workers and, when things get “politically hot,” deflect by having press conferences on unrelated items to try and shift media attention away from just how much health care has crumbled under his watch.

The fact that all his previous unilateral actions have been failures seems lost on him.

For example, three years ago, Ontario had a significant budget deficit. In light of this, the Ontario Medical Association (OMA) offered a four-year wage freeze for physicians. In return, they asked for a co-operative, bilateral committee to identify efficiencies in the health-care system. Not good enough for Unilateral Eric, he instead implemented a series of reckless unilateral cuts that have significantly damaged the health-care system.

How reckless? Remember how he recently announced more funding to deal with the opioid-addiction crisis and mental-health issues? Did he bother to tell you that he cut funding for addiction services the year before? And that he admitted that he “found it challenging” to understand how cutting funding to a service would result in loss of that service? Economics clearly isn’t his strong point.

Or how about the ridiculous Bill 41, the Patients First Act? He was warned repeatedly by both front-line physicians and the OMA that this act would NOT help patients and would only increase the bureaucracy.

Didn’t stop Unilateral Eric. Rather than work co-operatively with others to improve the bill, he did it his own way. The result? Even the Toronto Star, which Kelly McParland states lives to promote eternal Liberal rule, was forced to admit that the supposed savings from Bill 41 may not come to pass. (My two cents — I’ve never, ever, ever seen taxpayers save money when governments increase bureaucracy).

Worse yet, his approach to dealing with any negative publicity has been to deflect by targeting physicians. Stories in the press about long wait times for joint replacement surgery? Hold a press conference and accuse an ophthalmologist of bilking the health-care system by “overbilling.” The fact that wait times for cataract surgery are growing exponentially get ignored.

Stories of children with special needs not getting home care and stories of overcrowding hit the press? Launch a diatribe suggesting that doctors should become civil servants instead.

Now, most recently, we are hearing about some wait times for assisted living called a “50-year wait,” and even delays in cancer surgery. How does he deal with that? Unilateral Eric hurriedly launches this flawed bill and shuts down debate to allow broader input. Attempts by the OMA to suggest amendments that will strengthen this bill are ignored.

Unilateral Eric barges ahead anyway. The fact that all his previous unilateral actions have been failures seems lost on him, and reports of patients suffering from gaps in care seem to be neglected. In fact, it is likely because these stories are in the press that he is rushing ahead with this bill to make it look like he is actually doing something positive.

The completely unacceptable part in my opinion is that it is going to be the real victims of abuse who suffer. The first time someone is charged under this law, the unconstitutionality of it will be challenged, resulting in a strong possibility that a perpetrator could get off on a technicality. Can you imagine the impact this will have on a victim? To see someone who harmed them so egregiously walk away without punishment?

The government of Ontario’s Premier Kathleen Wynne is in a lot of trouble. She is woefully unpopular. Her party is badly lagging in the polls. Senior members of her Liberal party have publicly asked her to resign. She has, at best, one cabinet shuffle left to try and reverse her fortunes.

Wynne may very well owe Unilateral Eric big for making her premier. It was his backstabbing of Sandra Pupatello at the Liberal leadership convention that gave her the leadership, after all. But if Wynne is serious about governing the province properly, her next step must be to shuffle the most disastrous health minister Ontario has had in recent memory out of his portfolio. She needs to replace him with a competent minister, who will at least attempt to work co-operatively with front-line health care workers. Only then can we begin to reverse the damage done to the health-care system.

It’s time for Unilateral Eric to go.

Re-Post: Dear Premier Wynne, It’s (Still) Not Too Late To Fix Health Care

Old Country Doctors Note: This blog originally appeared in the Huffington Post on May 16, 2016. It’s being re-posted here so that I can easily access if needed in the future, and for my own posterity.

The Right Honourable Kathleen Wynne

Premier of the Province of Ontario

Dear Premier Wynne,

Last week, I had written to you and pointed out that you needed to fix health care. I suggested that there were seven steps that you had to take to fix health care, and due to space constraints, I was able to provide the first four. Since you haven’t started implementing the changes yet, I’m assuming you were waiting for steps five through seven. Here they are:

5) Mandate that ALL health care software have an API by April 1, 2017

An Application Programming Interface (API) essentially allows different types of software to talk to each other. Ontario right now is a complete mess in terms of health care software. Hospitals generally use one of three different products, none of which can communicate with each other. Nursing homes use a different product. There are something like 15 different approved software systems for physicians’ offices. Pharmacies use different software. So do various allied agencies.

However, NONE of these programs “talks” to the other, which means that data can’t be transmitted from one system to another. So if a patient goes from one hospital to another, the information is not transmitted automatically to the receiving hospital.

Worse, software vendors don’t want to voluntarily add this feature, as they want people to just buy their product instead. While this makes sense from the point of the vendor’s bottom line (encourage more sales = more revenue for the company), your job as premier is to take care of the health care needs of the people of Ontario.

You can mandate the implementation of an API (meeting a provincial standard) on all health care related software by April 1, 2017. This would allow a physician’s office to communicate with hospitals (e.g. send lab results to the hospital on a patient so they don’t have to be repeated); allow nursing homes to securely communicate with pharmacies about medication renewals; home care to contact physicians about patients who are declining; and so on. This will lead to huge efficiencies.

Look up the data on the ePrescribe Project in Georgian Bay. You’ll see that the success of the project was based on tight integration/sharing data and secure messaging between pharmacies and physicians office. Imagine if this was possible between ALL health care providers. It can be with API on all the software.

N.B. I was chair of the Georgian Bay Family Health Team when we implemented ePrescribe, and I’ve seen the benefits first hand. In my opinion, it’s criminal that despite spending billions of dollars on eHealth, the rest of the province doesn’t have something we’ve had since 2009.

The software vendors will say that it can’t be done. That would be far from the truth. Some of the companies already have prototypes of APIs and it’s just a matter of having them align with a provincial standard. Force them to do it or tell them to stop selling their products in Ontario. Our health care deserves it.

6) Have local advisory committees for the MOHLTC

By now you’ve already disbanded the LHINs (see point three from last week). However, you will still need to get local input and involvement for health care decisions. Different areas of the province have different populations, all of whom have their own unique requirements.

The easiest way around this is to convert the existing LHIN boards (which are all made of volunteers, and hence don’t cost the taxpayers much) into local advisory committees that report directly to the Ministry of Health and Long-Term Care (MOHLTC). Ensure that these committees have actual teeth to provide strong recommendations. This way you can get rid of the bureaucratic cost of running the LHINs ($90-plus million dollars) but still have the local input so that communities can advocate for their own unique needs.

Frankly, from a clinical and patient care point of view, the structure of the MOHLTC makes absolutely no sense.

7) Re-organize the MOHLTC along clinical lines

Last week, I called the MOHLTC Organizational Chart a Gordian Knot. Frankly, from a clinical and patient care point of view (which is what health care is supposed to be about), the structure of the MOHLTC makes absolutely no sense. You’ve got at a minimum 16 separate departments, with too many sub departments for me to bother counting. Based on the chart it doesn’t look like the departments can easily co-ordinate with one another.

According to your chart, if you want to do a health analytics project on patients with mental health/addictions issues, the health analytics group would have to go through a minimum of five departments for the relevant approvals before getting to the Mental Health department. Yes, I know there would be some direct communication between the two, but the reality is that for final approvals, each department would have to go up their chains.

The MOHLTC should be re-organized along clinical lines. You only need three main departments. One department for institutions (hospitals, LTC homes), a community department (family health teams, home care, public health, other outpatient-based services) and the OHIP department (which pays not just physicians, but other professionals like optometrists, physiotherapists and pharmacists).

Measures relevant to each area (e.g. quality assurance, funding, information technology, regulations) can be kept in each department, improving efficiency.

So there you go, seven steps to improve health care. In case you think I’m asking you for more money for health care, I’m not. The $51 billion currently budgeted is enough, it just needs to be spent more efficiently.

There will be significant immediate cost savings from cutting the bureaucratic bloat as described in steps two, three and seven. The savings can then be put to pay for patient services (step four) and hiring more nurses. Step five will result in even more savings, but those are down the line.

Will this be enough to get you the election win you so badly desire in 2018? I have no idea. A lot of the next election will depend on just how many more times the OPP comes knocking on your door to investigate yet another spending irregularity.

You will certainly not have my vote, as I think you and your party are a wholly desultory lot. I even vacillated about sending you these ideas, as I didn’t want you to get credit for making needed changes or improve your chances of winning. But the reality is that many of my patients are suffering on incredibly long waiting lists, and many others are dying waiting for needed services. It’s time to right the health care ship. Get to it.

Yours sincerely,

An Old Country Doctor

Re-Post: Dear Premier Wynne, It’s Not Too Late To Fix Health Care

Old Country Doctors Note: This blog originally appeared in the Huffington Post on May 9, 2016. I’m re-posting on my own website so that I can keep it for easier future reference.

The Right Honourable Kathleen Wynne

Premier of the Province of Ontario

Dear Premier Wynne,

So I hear you are thinking of proroguing the Provincial Parliament, likely as a prelude to a cabinet shuffle in the hopes of raising your incredibly poor poll numbers.

While there has been no shortage of scandals for your government, the reality is the biggest issue facing you is health care. If you can fix that, then maybe, just maybe, you can pull out a victory in 2018. What’s that you say? If that’s the case, stop writing articles about how bad health care is and start offering suggestions instead? Glad you asked! Here’s how you can fix health care in seven easy steps.

Since I’m limited to 1,000 words or less on my blog post, I will give you four steps this week, and next week, we will go with steps five through seven.

1) Order an administrative review of the senior management at the MOHLTC

Start right from the top (Deputy Minister Bob Bell) and include the rest of the senior management team. There’s a real problem with morale in Ontario Health Care. Last year, Ted Ball from Quantum Transformation Technologies did a survey of health care leaders that showed damming results for just how little faith they had in the leadership and direction of the MOHLTC.

Between 50 and 70 per cent of responses were in the “Poor to Fair” categories for virtually every single question. In addition, in the comments section there were repeated calls to cut down on the bureaucracy (and this from bureaucrats!). One exasperated person simply extolled “Just do something!” This is abysmal.

Since then, a new vision, Patients First, was introduced by Health Minister Eric Hoskins. Quantum did another survey after this, and the results were worse! Amongst other deplorable numbers only 20 per cent of health care leaders have confidence in the MOHLTC to manage the enhanced LHIN’s proposed in the document.

Additionally, in the comments section, the top adjectives used to describe the managerial/leadership capacity of the MOHLTC were words like “uninspired,” “obstructionist,” “incompetent,” “autocratic” and a plethora of similar negative terms.

The people of Ontario pay a lot of money through their taxes (in the case of Bob Bell, $426,535 according to the Sunshine List) to ensure health care is run properly. It’s not happening. A formal administrative review can give the leaders some good advice as to how to encourage other leaders to follow them. It’s sorely needed.

2) Read Dr. Shawn Whatley’s blog on health care bureaucracy in Canada

Make sure you read all the excellent links. Memorize all the data that’s there. Keep those figures at hand, as you will need them when you try to push through the next set of changes you need to make.

[In 1995] people realized that in a universal health care system, cutting payments to doctors equals cutting services to patients. They will realize this in 2018 as well.

3) Get rid of multiple ‘arm’s length’ agencies

Look, every time you create an “arm’s length” agency (e.g. Cancer Care Ontario), that agency has to create an administrative bloat. Things like policy and procedure manuals, human resource departments, various administrative levels and so on. In health care, the problem is that all of these agencies have to report to the MOHLTC (who funds them). The MOHLTC, of course, has a policy and procedure manual, human resource department, administrative levels and so on. What’s worse is that the MOHLTC has departments solely dedicated to liaising with all these other external agencies.

For example, the Gordian Knot that is the MOHLTC organizational chart, clearly shows that there is an eHealth strategy and investment branch of the MOHLTC. Their job is to liaise with eHealth. So, why not just bring in eHealth into the MOHLTC and get rid of the redundant bureaucracy?

Now, I get that politically, the goal was to try and have these agencies take flak when things go wrong, so that bad news won’t stick to the health minister. But guess what, it’s not working anymore. People won’t blame Cancer Care Ontario for the stem cell disaster in the 2018 election. They will blame YOU.

So, get rid of the LHIN’s, eHealth, Health Quality Ontario, Cancer Care Ontario, CCAC and a whole bunch of others. Bring them all into the MOHLTC so you don’t need multiple HR departments and policy manuals. This is why mergers and acquisitions are in vogue in the business world. Go with it.

4) Offer binding arbitration to the doctors.

Like it or not, you can’t make a fundamental transformation to the health care system without the help of the doctors. Even though I didn’t like it much, I understood the political rationale behind trying to shame them into coming back to the table by attacking their billings. Problem is, it didn’t work. People believed their doctors, not your political stunt.

As an aside, go back to the last time an government cut payments to physicians (Bob Rae’s NDP government of 1990-1995). Go dig up their election ads. They all started with “Bob Rae has cut payments to doctors.” The thought was to portray to the public that by cutting payments to doctors, there was more money for other services. Sound familiar?

See how he did in the 1995 election (hint: it wasn’t pretty). People realized that in a universal health care system, cutting payments to doctors equals cutting services to patients. They will realize this in 2018 as well.

Giving binding arbitration to physicians puts YOU in a no-lose situation. If the arbitrator sides with physicians, you can say to the public that you have no choice but to go along with it, as it’s part of a collective bargaining process. If the arbitrator goes sides with the government, the physicians will have gotten what they asked for, and will have to go along with whatever settlement there is.

Either way, you then have physicians re-engaged in the process of transforming health care which is an engagement you badly need.

Yours sincerely,

An Old Country Doctor

Reflecting on Entering Decade Seven…

This is a somewhat personal post. I don’t share my birthday on social media (mostly because your date of birth is one of the security checks companies use to identify you). But I will allow that a little while ago, I was fortunate enough to complete decade six on this planet.

Starting decade seven felt odd. I normally think of birthdays as just another day. But, I guess as cliched as it is, hitting the big 6-0 did feel different. There was, as is typical, the comprehension that there were likely fewer days ahead than there were behind. Like many people, it also triggered a “life review,” a natural psychological process of reflecting on past decisions and unresolved regrets.

It was also somewhat bittersweet. My mother died at age 59 (stomach cancer). The realization that I have spent more time on this planet than she did certainly brought many mixed emotions.

But at the end of the day, I became aware of just how blessed I am. While my parents followed the typical immigrant path of working hard and living cramped quarters, we always had a roof over our heads. My kids may not have a yacht, but they always had food on the table and were fortunate enough to do a bunch of activities growing up that I never could. I was able to put them through school and get them a good head start on life. We were not victims of some horrific war, or famine, or natural disaster. I feel truly blessed to be healthy and for having kids without major health issues. (I’ve seen first hand just how much stress is put on families when a loved one has medical problems. I have nothing but admiration and respect for how they deal with it).

What does the future hold? Who’s to say? I can only tell you what I hope to accomplish with however much time I have left. First and foremost, I hope to be able to continue to help people who are in need (whether for health or other reasons). How I do that will likely continue to evolve as it has during my first six decades. But I think we should all try to others when we can. It’s particularly incumbent upon those of us, like myself, who have had a more fortunate time on this Earth.

Some people mellow with age. I suspect I will get grumpier. Which means more opinionated blogs with strong views as time goes on. (I’ll go out on a limb and suggest bureaucrats in general will be even more unhappy with me, which is really saying something.)

Finally, I, like many of you, also have a bucket list. I hope to begin chipping away at that while I can still stand on my own two feet. Which is why, I decided to start this decade off like this:

Wasaga Beach’s Much Needed Nursing Home Reveals Haphazard Government Bureaucracy

Recently, the Ontario government announced a hundred million dollars of new funding towards a new, 288 bed nursing home in Wasaga Beach. What’s really impressive is that the project is already ready to put shovels in the ground. Construction is expected to begin in late 2026, and it’s anticipated that the first residents will be welcomed in 2029. This will become the largest nursing home in the South Georgian Bay region.

From the development project announcement

To be abundantly clear, Ontario does need more nursing home beds. In 2017, I wrote about the then desperate need to build 35,000 nursing home beds. For reasons that I can’t fathom, the previous Liberal governments never really did anything to build up healthcare infrastructure, despite the fact that we had a growing and aging population. That particular government seemed to think that the healthcare needs of the population would simply fix themselves.

I’ve been critical of some of the things that the current Conservative government has done in health care, but they do deserve credit for significantly ramping up healthcare infrastructure builds. Whether it’s new hospitals being built, new equipment like MRIs being purchased, and yes, finally building new nursing homes, this particular government has recognized that you simply can’t provide healthcare to an aging and growing population without increasing the capacity of the infrastructure.

However, I continue to be frustrated by the fact that a government whose leader is famous for having made extremely critical comments of overlapping and haphazard bureaucracy, hasn’t done more to get the various facets of the healthcare system to be streamlined and work together.

The Wasaga Beach Nursing Home (as much as it’s needed and should be built) is a perfect example of this.

Nursing homes, by definition, have complex patients with significant health care needs. Some of them, will get sick and will need to be transferred to the nearest hospital Emergency for assessment. For Wasaga Beach, this means the Collingwood General and Marine Hospital (CGMH). Being complex patients with multiple health needs, some will be admitted to hospital.

However, as of 2024/25, the CGMH already showed over 39,000 ER visits (up 8% from the year before!) Their inpatient status showed overcapacity for the entire fiscal year. All hospitals have fluctuations and times where they are more full than others, but to be overfull for an entire fiscal year is extra ordinarily busy.

How much more stress will be added to the CGMH by the new nursing home?

Trying to find reasonable data is painfully difficult. I searched a number of sites, but the best that I could come up with was a 2018 analysis. Yes, there was fluctuation during Covid, but we are back to pre-Covid numbers. Crunching a lot of numbers (so that you, dear reader, don’t have to) gives the following, what I consider to be reasonable, projections:

The CGMH can expect about 160 ER visits per year from the new nursing home. These patients are very complex so their ER visits will take much longer. (By comparison, 288 seniors who live independently in the community would only result in 58 ER visits per year).
Given that just under half of all nursing home patients who go to the ER wind up getting admitted to hospital, we are looking at about 75 more admissions to hospital per yer.
It was even tougher trying to find out how long patients who are admitted to hospital from a nursing home will stay in hospital. That link above had some information, but hardly enough to be accurate. The best guess I could come up with was between 5-7 days per admission, so if we go with 6 days in hospital on average, we’re looking at about 450 days in hospital per year.

Now let’s keep in mind that the CGMH is already full. We no longer have hallway health care. We have chair health care (the hallways are full). So where are these patients going to go? (N.B. I do appreciate that there might be some relief as some of our hospitals Alternate Level of Care patients will now have a nursing home to go to – but I’m going to make an educated guess that the stress on the hospital will outweigh the benefit).

My three loyal readers might be aware of the fact that Collingwood is getting a new hospital. Once again, kudos to the current government for approving a badly needed new facility. However, there are still a bunch of bureaucratic approvals needed, and shovels won’t go into the ground until at least the fall of 2028. Hopefully, the project will be complete in 2033 (because government run projects always come in on time).

And this is the part that really drives physicians and healthcare workers crazy. Could there not be some common sense in the eyes of the bureaucrats at the ministry of health who approve these projects? If you are able to approve shovels in the ground by this fall for the nursing home, why can’t you do it for the hospital? You know that patients from the nursing home are going to wind up in hospital and stress an already overburdened place. You know that the new hospital’s been approved. Why doesn’t the Ministry of Health co-ordinate the builds? Do these bureaucrats from each department (hospital and nursing home) not talk to each other? (Having been involved in many meetings with many bureaucrats at different branches of the ministry when I was president of the Ontario Medical Association, I can tell you the answer to that is no.)

Overbureaucratization of our health care system has been a problem for decades now. It’s been unrelenting and farcical at times. The Wasaga Beach nursing home, as needed as it is, is just one more example of this. It’s where the real silos exist in health care and our system will not improve until we get a government that is willing to tackle the bureaucracy.

RePost: Hoskins Fails to Understand the Health Care System

NB: This article originally appeared in the Huffington Post on May 4, 2017. I am reposting on my own website as Huffington Post Canada has shut down and I want to preserve the article in case needed in the future.

Last week, the Ontario Liberal Government released the specifics of the 2017-2018 Budget. From a health care perspective, what became startlingly evident, was that the Liberals seem to be unable to comprehend exactly how the health care system functions. They are seemingly unable or unwilling to look at the big picture when trying to solve problems.

By Dr. Sohail Gandhi, Contributor

Last week, the Ontario Liberal Government released the specifics of the 2017-2018 Budget. Advertised as a prescription for a “stronger, healthier Ontario”, the budget had all the usual darts and laurels typically thrown at a pre-election budget. The Liberals claimed they balanced the budget and were making necessary investments. Their critics claimed not.

From a health care perspective, what became startlingly evident, was that the Liberals seem to be unable to comprehend exactly how the health care system functions. They are seemingly unable or unwilling to look at the big picture when trying to solve problems.

Let’s look at hospital funding. That hospitals in Ontario are under enormous stress is unquestioned. Stories of overcrowded emergency departments, long wait times, patients lying in hallways for days on end are rampant in the media. Additionally, budget pressures on hospitals continue to result in nurses being laid off despite the fact hospitals are full. Concerns raised years ago about how this will lead to adverse patient outcomes, are sadly now coming true.

In response, Ontario Health Minister Eric Hoskins has been repeatedly stating that he has ensured that hospital funding increase by $518 Million next year. A large number, but it represents only a three per cent increase in the hospital budget, which totals about $17.2 BILLION dollars (and Hoskins thought doctors were expensive!). It is also less than hospitals had asked for.

I won’t begrudge hospitals extra money. They have been starved under austerity level budgets during Hoskins leadership. But is throwing money at hospitals the only way to solve the problem? Is it the best solution?

However, one of the main issues that hospitals face is the persistently high rate of Alternative Level of Care (ALC) patients. The official definition of ALC is pretty complicated. The simple definition is patients are well enough to be discharged from hospital, but not well enough to return to their own home. The majority of ALC patients are waiting for nursing homes.

The rates of ALC patients vary in different parts of Ontario, but the provincial average is around 15 per cent. This means that if you have a hospital with 100 acute care beds, fifteen will be occupied by patients who should be in a different facility, usually a nursing home. But because there aren’t enough nursing home beds, they’re stuck in hospital.

So, when a patient comes to the Emergency department with, say severe abdominal pain due to internal bleeding, and needs to be admitted to hospital, a large part of the reason why she waits for 5 days in a hallway, is that there are no nursing home beds for the patients currently in hospital to go to.

Despite the fact that it is widely acknowledged Ontario is greying and that our percentage of seniors will rise to almost 18 per cent by 2021, there appears to be no discernable plan to actually build more nursing homes. In fact, the only investments that I can find are those to renovate existing beds. While that’s a nice enough thing to do, and will increase the comfort level of LTC residents (which I think is essential), it won’t offload the overcapacity from hospitals.

When I was the Health Links lead physician for my area, we were involved in a plan to reduce hospital admissions from nursing homes. As part of that, we found that the cost of a hospital admission was around $975 a day (standard ward bed). The cost of a nursing home? How about $143 a day? Seriously, you can fund seven nursing home beds, for the cost of one hospital bed.

So back to the hypothetical 100 bed hospital. Would it not make more sense to fund fourteen nursing home beds (at the cost of two hospital beds) to take the pressure off the hospital? Especially when we already have a nice mix of private and public companies willing to build LTC homes? And would that not reduce the costs to the hospital because hospitals are chronically paying staff overtime to handle overcapacity situations?

Now in fairness the final solution probably requires a combination of things. Hospitals do have fixed operational costs that increase yearly and need to be accounted for, and shouldget more money.

But a proper solution must also look at the big picture, and look at creative ways of reducing hospital expenses. Not only do we need 26,000 more nursing home beds right now, but given how our population is greying, we will need 50,000 more in six years. Otherwise the ALC rates will rise, and the Emergency departments will back up more. To not have a plan in place to address this shows a complete lack of comprehension of the stresses the system faces.

EricHoskins appears to only be capable of reacting to crises. Bad news story about hospitals affecting re-election chances? Throw money at them. That’s not good enough. We need leaders that understand how interconnected health care is, and how events in one part of the system, affect others.

The people of Ontario deserve better than what Eric Hoskins is offering.

Preparing for the August Covid-19 Wave in Canada

We’ve learned much about COVID-19 since the first infection was announced in 2019. This has helped us develop better treatments and better prevention strategies. We’ve learned that COVID has settled into a fairly consistent annual pattern. There’s a smaller summer wave (end of July to mid-September) and a larger winter wave (November to January). The larger wave ends around the time flu season starts.

This year the summer wave has started in the United States. Wastewater concentrations of COVID are starting to increase in southern and western states (yes they are still low, but they are trending upwards). ER visits with proven COVID cases are also growing in the southwest. So the wave is beginning.

As I write this, the Canadian wave has not yet begun. In particular, the Ontario numbers are still low overall. Local fluctuations are occurring however, and if trends hold as they have done over the past few years, we can expect the COVID wave to start in August, and peak in early September.

The current U.S. wave is due to an Omicron strain of the virus designated as Nimbus. Thankfully, it appears that the Omicron strains cause less serious infections (though may spread more quickly). This means that existing immunity from prior infection and immunizations continue to provide some meaningful protection against severe disease.

With that in mind, what should Canadians do to prepare for this summer wave? For healthy people, I actually think we’ve reached a point where it’s unreasonable to say “avoid COVID at all costs.” With COVID being so widespread and so frequent, our goal should now be to take a risk-based approach.

What EVERYONE Should Do

We all benefit from better air quality, particularly indoor air quality. While all of us love air conditioning, opening windows when practical really helps increase airflow circulation and is very beneficial. Now let’s be clear if it’s an exceptionally hot day, or if it’s a wildfire smog filled day where it looks like the surface of Venus , then obviously the windows should stay closed. But when practical, opening windows is good for air quality.

The View from my office on a recent wildfire smog filled day

Make sure you have HEPA air purifiers. I have one in every room in my office. Putting an air purifier in high volume rooms in your home is a good idea.

Social gatherings should also be outside. Fresh air and sunshine – just what your grandmother ordered.

I appreciate this next bit of advice will go over like a lead stone for some people, but I think it’s important that you keep a few well-fitted N95 masks around as well. You can buy these online. I’m not suggesting you need to wear them all the time, I believe we’re past that. However, in the event that a wave hits and you have to go to a crowded environment, or you’re feeling unwell, it’s better to have these ready and available, rather than scrambling to find one at the last minute.

Similarly rapid antigen tests are also useful to keep at home. You can get these from most drug stores. They are unfortunately a little less sensitive for Omicron than they were against the early variants, but they’re still fairly useful. Again, I’m not suggesting you swab every day if you’re feeling well. But if you do develop flu-like symptoms in August, then it’s helpful to already have the tests at home. Please note that a negative test does not completely rule out an infection, especially during the first 24 hours of illness. Doing a second test a day or two after your first test will improve the accuracy of the test.

If you do become ill, then of course, I would hope that you would have the good manners to stay at home. Symptoms of a covid infection are generally the same as most other respiratory illnesses (sore throat, cough, low-grade fever, fatigue). Most physicians now do virtual visits, and so you can still arrange to speak to a physician or video call them if you’ve got these types of symptoms, without infecting their whole waiting room. If you are sick, please have the common decency to avoid visiting people who have significant health issues, as those people, if they get COVID, have a significantly higher chance of deteriorating rapidly.

Get immunized! Most patients should get a yearly Covid shot, generally in the fall. Enough of the clot shot/fakecine/frankenshot/globalist serum/fauci juice nonsense. By Aug of 2024 over 13.7 BILLION Covid Vaccines were given worldwide (including over a 100 million in Canada). None of overwrought, neurotic claims about how we’re all going to die if we got the Covid shots have come true. Protect your self and your loved ones and get an annual vaccine (click here to get your shot).

And of course, there is the same advice that grandmothers have been giving forever. Eat right, exercise regularly, maintain a healthy weight, control your diabetes, quit smoking, take your vitamins (2,000 international units of vitamin D daily and 500-1000 mg of Vitamin C daily would be a good start for Canadians). Doing all of that will not prevent you from getting COVID, but they certainly are associated with a much better outcome if you do get COVID.

What Those Who are Elderly or Have Significant Health Issues Should Do

In additions to the above, significantly ill or immunocompromised patients might benefit in getting a Covid vaccine twice a year. Please discuss this with your doctor. Additionally, knowing that they are at higher risk, they should be prepared to avoid indoor activities with the general public during the coming Covid wave. For example, many grocery stores deliver now, so there’s no need to go shopping. Avoid larger indoor events where possible. If travelling by bus or plane, just go ahead and wear a mask during a Covid Wave. Call your doctor when you first get sick as you may qualify for some of the newer treatments for Covid.

The last word.

This year appears to be trending for a moderate COVID wave as opposed to a severe one in August. If we all take reasonable, cautious precautions, we can hopefully keep it under control.

Innovation Winter

Recently, the Ontario Government announced plans for a province wide family practice record system. I was debating what to write about it when I came across this post from Dr. Shahin on LinkedIn. While I don’t agree with all of it, it’s an important point of view. He’s kindly agreed to allow me to post this as a guest blog, and I encourage you to give his LinkedIn page a read.

Dr. Ilan Shahin is a Family Medicine specialist who serves as the Primary Care Lead for Patient Attachment for the Central West Ontario Health Team (CW OHT).

He’s also a Board Member and Secretary-Treasurer of the Ontario College of Family Physicians (OCFP), has an MD and Master of Business Administration (MBA) from McGill University and is a co-founder of ConsultLoop, a former e-referral platform. Basically a whole lot smarter than I am.

Innovation Winter is a Canadian tradition of killing off product categories with the whisper of a large procurement.

Every so often in digital health, governments see small companies sprouting around a category, and decide to procure The Thing for the entire jurisdiction. This is ambitious, well-intended, and comes with its fair share of boosters. E-consults, e-referrals, and e-prescribing all had similar stories. However, these didn’t work out as intended.

E-consults remains a clunky product with uptake well below its potential, when once there was a physician-led startup that offered a nice mobile experience that was much easier to use and even log on to.

E-referrals is still maturing when it’s been 10 years since an original RFP was won via a single LHIN with the thought that it would be rolled out across the province. There too, there was a company (which I co-founded) that built the referral platform at less than 5% the cost of that initial RFP, produced unprecedented and yet unmatched wait time data, and had pilots shut down because of whispers that e-referrals would be deployed imminently across the province.

E-prescribing has the story of Infoway’s landmark project that was shut down after hundreds of millions in spending, with market penetration that was only a few percentage points of total prescriptions despite the virtualization pressure of a pandemic. Setting standards for companies serving the pharmacy market could have harnessed their competitive drives, rather than relying on one platform with its limited agility.

In each case, government comes with good intentions, and tries to build The Thing. In doing so, they create what is effectively a monopoly, which risks insulating the product from market forces that produce better value, and lower costs.

However we don’t need a large procurement to actually have happened, for the monopoly or oligopoly to be entrenched, in order to kill innovation. Just the mere whisper that something big is coming is enough to make rational actors across the system wait and see. This also includes small businesses, which is where the imperative to listen to customers, the urgency to improve, and the competition on price and quality actually lives. Ingenuity lives there too, in the companies facing short cash runways, the incumbent complex, and the need to prove themselves as trustworthy both clinically, operationally, and ethically.

Government has to be careful about what it does to the marketplace when it acts. Sometimes in raising its hand, it ushers in an innovation winter, which has the potential to block far more value in a robust, competitive market, than it uncovers in a RFP-led closed market approach.

Let government focus on building the strongest marketplace, driving to common standards to uplift the market’s value, while ensuring fair competition to harness the cost and quality pressures that come with it.

Market-making. That’s the game. Innovation winters are signs of failure.

Were the 2025 Re-Appointments of Non-Physician Directors Compliant with ONCA?

In the aftermath of the Ontario Medical Association (OMA) Annual General Meeting (AGM), I expected the non-physician board directors to resign their roles immediately. I appreciate they have skills/experience that can provide valuable information to the Board. That is a good thing.

But at the AGM, it was made clear physicians don’t want them to have voting authority at a board level. Give advice? Sure. But have a significant block of votes that could sway a close vote at the board? 57% of physicians voted against that.

The OMA has taken a somewhat different approach, going by the exact legal letter of the motion as opposed to the spirit of the motion. Board Chair Sharon Bal announced that the three non-physician board directors would continue on until their terms ended, which in one case won’t be until 2028.

It’s disappointing to me that the integrity to do the right thing is lacking. Reminds me of how the executive at the OMA tried to stay on in the aftermath of the 2017 vote of non-confidence. At that time “only” 55% of Council voted no-confidence, which was short of the 2/3 majority. There too, it was arguably legally correct for them to continue, but wasn’t morally correct. (They eventually resigned a week later).

This mess made me review the Agenda and the minutes for the AGMs. In doing so, I noted something quite odd. The 2025 AGM Agenda did not have a motion to ratify board directors by the membership. The 2025 AGM minutes also show no election/ratification of non-physician directors occurred. Yet two non-physician board directors were automatically reappointed by the OMA. Frontline physicians like myself were not given a choice on this. The 2026 AGM Agenda DOES have motions ratifying the election of all the physician directors, and the reappointment of the non-physician director.

Wondering why the difference, I went and reviewed the Ontario Not-for-Profit Corporations Act (ONCA). I’m weird that way. Section 24(1) states,

“…at the first meetings of the members and at each succeeding annual meeting at which an election of directors is required, the members shall, by ordinary resolution, elect directors to hold office for a term …..”

Note the phrase, “the members shall, by ordinary resolution, elect directors.” There is no exception for reappointment, and no authority granted to the board to simply declare a director routinely reappointed. If there is a vacancy, the Board can, but doesn’t have to, appoint a replacement until the next AGM (Section 28). This was not the case for the OMA in 2025 obviously.

The other exception is…….ex-officio directors. Under section 23, paragraph 4, that states the bylaws of a corporation may provide for persons to be directors by “virtue of their office“. This is current legal term for ex-officio directors. Additionally, there is no requirement for ex-officio directors to vote at the Board, the bylaws can prevent them from doing so.

This annoyed me more, so I looked at the OMA bylaws. (I told you, I’m weird). Article 9.3.3 states:

” …after expiration of director term set out in section 9.3.2, all directors shall be elected to hold office for a two year term.”

The word elected appears without qualification and applies to all directors. There is no provision in the OMA bylaws permitting a board-managed reappointment track for non-physicians. This, of course, does not stop the board from seeking out candidates and somehow preventing other non-physicians from running like they seemingly did this year (they only presented one candidate for the position). But Members have to elect/ratify the candidate.

It’s unclear to me how the Board and their Chair could have allowed this situation to occur. The 2025 reappointments of two non-physician directors were inconsistent with ONCA and even inconsistent with OMA bylaws. Heck, article 12.1 of the OMA Bylaws identifies member election of the directors as a core member right. As a result, their re-appointment appears to be illegal.

Obviously, somewhere along the way, the OMA as a corporation recognized the error in 2025, as in 2026 they presented board directors for ratification at the AGM. My personal view is that this is a tacit admission of the OMA having failed to follow ONCA and OMA bylaws in 2025. But to my knowledge there has not been an “oops, sorry about that” email from the then Board Chair. Worse, the OMA has yet to remedy the 2025 error in the appointments of the two, making it appear that they were trying to sweep this under the rug and hope nobody would notice.

What does this mean? I remember talking to one of the OMA’s external legal counsels at a social event AFTER a meeting. We got to talking governance issues at OTHER corporations. That particular counsel suggested that when appointments/decisions are made in good faith, and without being able to prove that there was malicious intent in any board decisions (apparently a very high bar), reversing or changing any decisions as a result of this would not happen. Similarly, attempting to remove board directors retroactively would be challenging.

There is apparently a remedial path called curative ratification. The OMA could hold a special meeting of the members to ratify the non-physicians. However, considering the outcome of the 2026 AGM, and the revelation that the OMA has sat on this issue with no negative consequences to their legal team, I doubt this will happen.

Given all of this, probably the best way to fix this mess is for both of them to resign early, then have elections where physicians are chosen to replace them. (I would suggest the third should resign as well). This would remove the thorny issue of how legal their re-appointments were to begin with, and frankly do what they should have done in the first place.

Will the OMA do the right thing?

Please Don’t Move to the Georgian Triangle (Collingwood, Clearview, Wasaga Beach)

Wait, doc, what’s this all about? You’re asking people not to move to where you live?!?

Yes. Please don’t move to this area.

But you always tell others how wonderful an area this is!

This is indeed true. I love living here. I consider myself very blessed for having come here 34 (!) years ago. We are a few minutes’ drive away from the world’s longest freshwater beach, a few minutes’ drive away from ski hills. There’s golf, boating, too many outdoor activities to list. I enjoy the trails myself and often bicycle to my office during the warmer months. A true four seasons resort area.

Is the problem the people?

Not at all. The people here are kind, generous and extremely supportive. Plus there’s an old farmers mentality in a lot of them (that’s a good thing). I’m grateful they have allowed me into their lives. It’s an honour to help them.

Is the problem the growth in the area?

I’d be lying if I said I was completely happy with the increase in the population over the past ten years. The towns have gotten quite crowded, and the roads are busy. Bicycling on the roads is now classified as a survival sport. And yes, I have seen traffic jams, which is something I never thought I’d see. But no, that’s not it exactly.

Okay, doc, you’ve got me really confused. What exactly is the issue then?

It’s the healthcare system.

That makes no sense. You’ve often talked about how proud you are of the fact that you were the inaugural chair of the Georgian Bay Family Health Team, and how closely the doctors in the area worked together to form a really cohesive medical community.

This is true. The Georgian Bay Family Health Team, under the leadership of their Grand Poobah (inside joke), Maria LaRose, is, in my opinion, the best health team in the province. The doctors and allied health care staff all work well together. We formed the first community wide Electronic Records system in the Province. It’s still the only one in Ontario that is integrated with other health care partners. It’s the best medical community in the province.

Okay, so is it the hospital? Goodness knows you’ve had issues with administration in the past.

Actually, we’ve been very fortunate to have better administrators at the hospital the last couple of decades. The nursing staff and other allied healthcare professionals (physiotherapists, occupational therapists, pharmacists, respiratory therapists, and so on – apologies to those I missed) really are excellent and hardworking as a team. They really want to help patients. The problem, of course, is that they are overworked.

So then your issue is with the capacity of the local healthcare system?

Exactly. You see, currently, we have seven thousand people in our neck of the woods who don’t have a family doctor. If you move to the area, you will be number 7,001. Therefore, you will wind up going to our after hours clinic, or the hospital emergency department, which will increase the stress on those facilities.

This is, of course, not the fault of the individual physicians, nurses, allied health care workers. The blunt reality is the health care infrastructure is not there.

But I thought you guys were building a new hospital?

We are. BUT. We’ve known we’ve needed a new hospital since the early 2010’s, and despite many pleas, won’t start digging until 2029. We are hoping to complete in 2032. Various layers of inept government bureaucracy at the Ministry of Health have thrown many roadblocks in the construction process. As a result, our over burdened hospital puts patients in “unconventional places.“

You mean like hallway medicine?

Actually, I believe the term now is “chair care“because even the hallways are full.

Wonderful. Are the local townships not doing enough to recruit doctors?

It’s not really a township responsibility to look after the healthcare system. Now, there are some local efforts (with a bit of success) to get more family doctors in the area. However, that’s a slow process until the wider provincial problems are fixed.

You’re saying don’t come to the Georgian Triangle, but don’t these issues occur elsewhere?

Absolutely. I mentioned the Georgian Triangle just because it’s the area I know the best. Ontario has many beautiful areas for people to live in. Lots of different type of communities to suit all needs from small town, to large urban settings. But, if you currently live in an area where you already have a family doctor and you have a number of health issues, you really may want to reconsider moving until you can assure yourself of getting continuous, comprehensive, ongoing care in the community. Without a local family doctor, you will be getting itinerant care seeing different doctors at walk in clinics or Emergency departments, and that’s not good for your health.

So don’t move anywhere if you already have a family doctor?

Well look, people often have to move for many reasons. Work, family, retirement. I get it. BUT, I would encourage you, if at all possible, to scope out not just the amenities of the area you are thinking of, but also check the local health system out. That is something most people don’t do, they just expect health care to be there for them. That mentality needs to change.

And don’t move to the Georgian Triangle?

Yah, don’t move here. Our doctors (and hospital, and home care) are full.