How a healthcare system should function remains disputed, as the shortcomings of Quebec’s health system continue to affect us all. Seen throughout the province, worried patients and doctors are concerned about a plethora of issues, which are rooted in the deficiencies produced by our healthcare system. In a discussion with an oncologist and McGill professor who works at the university health center – referred to as Dr. Y to preserve anonymity – these issues will be tackled to better understand what he terms the “health state” of our healthcare system.
If the cause of the main issues of the system were apparent, it would be easier to find a solution. In reality, various factors are at play. As seen below, when asked about the main cause of what creates the issues that health care faces, Dr. Y states the following:
“There isn’t a clear answer for what is the problem of healthcare. Some would tell you there aren’t enough physicians, others will say there aren’t enough nurses, or not enough beds for hospitalizations, not enough space in the ORs, no private or public clinics that could address non urgent cases. There’s a lot of causes, I think, there is not only one.”
Certainly, there is but not one cause to blame, as the healthcare dilemma is multi-faceted. What one may ask, however, is if the existing system has properly been maintained or updated to address the shortages that it faces today. Dr. Y explains these shortcomings of the system:
“How some people answer, where I agree, is that our system had been set up in the 70s and hasn’t been kept upgraded or updated. A large number of people in Quebec don’t have family physicians and are left on their own. There aren’t the right investigations and assessments that are done on time. What happens is that most people go to the emergency rooms, which are filled with high levels of patients, when they could be treated in clinics, outside of the emergency room. But there isn’t the capacity. The Canadian system is facing a major problem because there is no alternative system, and this creates pressure. Our emergency room has 250 capacity. When people don’t have physicians or the right person to guide them without a GP, they go to emergencies.”
With the shortages of family doctors, most people turn to what appears to be the most accessible solution, the emergency room. Dr. Y explains how the system is not sufficiently refined to account for the high demands of patients or provide a parallel service outside of the emergency room. Furthermore, as with the shortages of physicians and limits on capacities, there are excessive waiting times with or without a family general physician. When it comes to waiting lists for services, Dr. Y explains:
“There are many people waiting for non-elective surgeries, the waiting can be up to one to two years. This is a major problem, there are not enough doctors to manage the high numbers of cases. There is not enough space in the operating room. When you ask some surgeons how many days they spent in the operating room, some of them tell you a maximum of two days in a week. Why? ‘I don’t have an operating room.’ So, there are capacity and space limitations in the hospitals. If you have a GP (general physician), who asks for a CT scan, you can be waiting 2 to 6 months to get it.”
As doctors in Quebec are overworked, the brunt of our healthcare system is felt by our nurses, as well. Equal sharing of the load would facilitate the maintenance of healthcare services, but, as with the shortages of physicians, a shortage of nurses and a demand of obligatory overtime prevents this. Dr. Y, having explained the previous space limitations and GP shortages, gave me an anecdote of how their department is impacted by the lack of nurses;
“Thursday, I have a very busy and long clinic, and my schedule only has 10 spots, but I am always working double. It isn’t normal, from 9 to 1 pm, I have to fit 20 patients, and I can’t spend the same time with these 20 patients. Covid has made this more complicated because we do TeliMed. It never finishes on time; I’m having to call patients later or on the second day. Patients come to the clinic but not all the investigations are done. Since covid , CT scans are not done or are cancelled, so there are several factors that slow things down. If nurses could be doing triages and checking on patients, this could have been playing a major role, but we don’t have enough. In some clinics, they are absent and there aren’t enough nurses in outpatient clinics. They could take on part of the physician’s role, but we don’t have the privilege of having these nurses, we have shortage issues. Some nurses are not replaced, or some leave and resign to work with private networks. The private sectors come with less pressure and less overtime, where nurses can better manage work and family and are not forced to do extra hours. The main key issue is the challenging overtime for the nurses, that they are being forced to do.”
In the shortage of these needed resources and many waiting constraints, it cannot be forgotten the way patient care is impacted. With the doubling of patient cases in a given day, Dr. Y has to do extended hours to be able to run the clinic properly. It is blaringly noticeable that our healthcare system is deficient when doctors are needing to put in extra hours so that patients are able to receive adequate care. Dr. Y says that, “less than 50% of the time is medicine and the rest is tasks and administration to be sure that the patient is booked adequately. If you don’t pay attention to everything, your patient will fall into the crack and will not be followed up as needed.”
With Covid lurking in the near past, the post covid status of hospitals show a lack of resources that have not returned since the pandemic started. “ORs are closed, the shortage of nurses, the scans being closed… Covid has revealed major challenges in how to run the system. Departments have lost support and need administrative help, the number of tasks physicians have had to do is major. There are several gaps in the system which will not be addressed until parallel systems are created outside of the hospital. The system needs to be revamped, as the functioning of healthcare and communication services are not the same way as they were 30 years ago,” says Dr. Y.
Which leads us to thinking of where to look in terms of solutions or adjustments for the healthcare system. Funding? More Jobs? Systemic reform? Well, money isn’t a fix-all solution, “we are in a major need for more jobs. Injecting money into the system without revamping the major challenges will not cause change. I’ve been in the Canadian system since 2003, and if there’s been any change, it is on the worse side,” as Dr. Y expresses. What they say is needed is more working people. Through immigration, there are people who come here with foreign degrees and are deferred to other businesses. Dr. Y explains how there may be an approach in training and allowing for more of these jobs to be allotted to those trainable to join the system, as seen in the success of European countries who have adopted this method.
The concerns raised over the weaknesses of our system should alarm us to seek for better long-term solutions. In a final remark, Dr. Y talks of why the system needs to be deeply changed in order for shortage and waiting issues to be addressed;
“You need to revamp the healthcare system from 0, with strong clinics and strong networks that remove pressure, and create better access to healthcare. Access today in Quebec is poor. The time between needing something and getting it done is so long that it is beyond acceptable. It is unacceptable that when someone has a problem, their only choice is to go to the emergency. The indicator of healthcare , the time between a request and seeing an oncologist, is a good indicator to assess a healthcare system. The accessibility in Quebec is 0, it is really poor. The major challenge is our waiting times.”
Surely, we want our system to be rid of all these issues, and Dr. Y is of the strong opinion that the wiring, so to speak, of the system itself ought to be reengineered. The way Dr. Y explains it, we must address this health crisis by looking towards the potential parallel systems that could be created outside of what we have today. With a stronger access to public or private clinics, the pressure that is put on a workforce that is already lacking in numbers may be alleviated. As with global healthcare, Dr. Y points out that the government has not undertaken action to address wider issues. As discussed, the shortage that applies pressure on physicians and nurses, the lack of resources, crowded emergency rooms and lengthy waiting times, make it clear that the Quebec healthcare crisis is disturbing. Thus, it is imperative that meaningful systematic alterations are made that can help our healthcare system be restored and improved for future generations.