Introduction

When I graduated medical school in 1984, one of the first things I did was to find a family doctor for my parents and sibling. Medical school had taught me that you cannot be objective when it comes to your family and that objectivity is necessary to be a doctor. A doctor has to be prepared to tell a patient what they need to hear, not what they want to hear. The difference is important.

Finding them a family doctor in the mid-80’s was not that difficult. In fact, when my father’s first family doctor left the province to go to the United States to pursue his career (more anon), I found him another. If you lived in parts of Canada termed “rural and remote,” finding a family doctor in the vicinity might have been problematic, but if you lived in or near a population large enough to be called a town, there was probably a family doctor not too far away. In any Canadian urban environment, there were enough doctors that you actually had choice. If you didn’t have a family doctor, it was probably because you had no reason to have one. When the reason arose, a family doctor could be found.

Today, not so much. Numbers vary by province and source, with government sources usually giving the lowest number of people without a family doctor. The issue is no longer one of rural and remote, small communities, or small towns. Even in urban areas, the percentage of people without a family doctor is in the tens of percent. The numbers are so significant that governments have begun counting “Primary Care Providers” instead of family doctors, using nurse practitioners in particular to make the situation appear less dire.

Many factors have contributed to this crisis (I use the word advisedly, especially as I was once told at a meeting with the provincial government that I was not allowed to use “crisis” … at a meeting about the lack of family doctors). It took a while to get here and there are fundamental flaws in the decision making in healthcare in Canada that will prevent the issue being dealt with effectively if unaddressed.

If you want the Executive Summary of what I intend to present, it is this: the structures that govern healthcare decision-making have gotten us into this mess. Healthcare governance in Canada is incapable of fixing what ails us without significant modification. As long as politicians and government bureaucrats are making decisions regarding our health care, it will remain broken.

If you want to know more, turn the metaphorical page.