Help wanted? (What's wrong with this picture? - XI)

The Canadian Medical Association is running a Help Wanted campaign to convince politicians and the public that Canada needs more doctors.

Here's the eye-catching ad that ran in the Globe and Mail yesterday:




Earlier in the week, I received a CMA mail-out containing a postcard. There was an exhortation to mail the postcard to the Prime Minister to draw his attention to Canada's physician shortage.

I didn't mail it.

Some times I ignore similar calls for political action purely out of apathy. This time, it's a stand on principle. I reject the premise that having more doctors will solve problems of access and quality in Canadian healthcare.

It may be part of the answer, but this campaign (see "alarming facts") ignores some broader issues.

"Do it yourself?" over the picture of a man suturing his own wound is a dramatic demonstration that some medical care should be provided by trained professionals (pace Rambo). But, is there an opportunity to educate patients to manage aspects of their care that currently "require" a physician? Why not DIY?

Most diabetics manage their own insulin to control their blood sugar. We trust patients to self-administer their prescription meds. What other "medical" duties can we educate our patients to perform? Can other personnel free up physicians to do the tasks that truly require their expertise?

The "More doctors. More care." slogan suggests that we're doing a great job already; we just need to more of it. There's remarkably little nuance to this argument.

What if we're not operating at maximum efficacy? If we crank up the number of practitioners, we'll multiply waste and poor quality.

Please note that I ask about operating at maximum efficacy , not efficiency. Many physicians are already putting in long hours and would find it difficult to work harder/more efficiently. But what are the outcomes of those long hours? Are we making a positive impact on chronic disease? How often do we really need to review the stable hypertensive's blood pressure? Or, in my practice, the man with an undetectable PSA after he's had surgery for prostate cancer?

Are we even asking ourselves these questions, or are we completely occupied with the struggle to keep our heads above the ceaseless demand for medical services?

Over the last year in my office, we've reevaluated many of our practices/traditions/habits as part of our Advanced Access practice. Many of our procedures don't add value for our patients, and (by definition) are wasteful to the system. We're trying to change, but it's challenging, given the demands of a busy surgical practice. And (let's not ignore the 800 lb. gorilla in the room) the absence of fee-for-service remuneration for quality improvement efforts.

How much waste could be trimmed if the CMA put some of its "Help wanted" budget into quality improvement training, mentoring and support for physicians? How much physician time would this free up for additional patient care?

Dr. Day, show me some creativity beyond the sledgehammer approach of expanding the physician workforce.

Then, maybe I'll sign your postcard.