Alberta’s new dual medical practice model complicates an overworked system: emergency doctor

Dr. Thurst, let me just begin by getting your initial reaction. Today, Bill 11 rolls out. How do you feel? I feel it adds another confusing administrative layer to an overworked and overburdened health care system. So I don't think it's helpful, and I think it's distracting from what the core issues are. And what are those core issues, as far as you're concerned? I think anyone who's tried to access health care on any level and run into a delay or a blockage realizes that we're not providing the health care that our population requires, that Canadians, Albertans, Edmontonians require. And we're not doing it in a consistent manner. I actually had a patient ask me what kind of business I was running here. And it made me think that perhaps health care should not be viewed as a business anymore, but should perhaps be viewed as a resource vital to Canadians. OK, so let me ask you. The argument being presented by the Alberta government is that, listen, these are just some elective surgeries that a minimum amount of hours, which are yet to be determined, would need to be performed by any surgeon in the public sphere. And then they can choose to do these elective surgeries privately. And it'll just open up space for the public to get more care in the public system. Just walk me through why you're concerned about this argument. So if we use the resource analogy, let's pretend that health care is water. OK, so we all need water to live. We all will need health care at some point in our life, presumably to live longer or better. And so if we view health care as restricted in terms of supply, so we don't have very much water, so we're rationing it, which is what we've been doing with health care workers, right? Rationing numbers, limiting medical school enrollment, limiting nursing enrollment, keeping the numbers constrained. So there's not people to look after people. And then on top of that, we limit how you can access it. You have a hospital. You have a clinic. You have long-term care. We give you only a few places where you can go as a citizen to access it. So it's like having a water pipe in a few distribution centers. Now you have a queue. You have a lineup of more people need the water than can get it out of the pipe at any one time. And it doesn't matter how many layers of administrators we put on top of the pipes. At the end of the day, the water's got to flow through the pipe and into my bucket or my container or my glass. And so I can use the water. So if we queue up and line up, and now we're saying, well, a few people who have a blue glass and money get to jump to the front and get their water filled. And that'll make it better for everyone. I think that we can all recognize that's probably not true, right? They're just queue jumping and finding a reason to queue jump and making it sound like it's reasonable and OK. And for the individual who's jumping at the front of the queue who was in the back of the queue somewhere, it's totally reasonable because it makes sense, right? They have a blue glass, and they'd like their water. And we all want our water. So I get it. But for the rest of us, it's not great. And then we haven't talked about the second half of it, which I think is even more problematic when viewed in the water queue line. Which is what? Well, I think that if we put someone in a private system of any description at any time, once they've gone to the private system, what do we do with the, you know, the outfall of complications and problems with the private system? So let's pretend I go get a new hip or a new knee or whatever surgery is being proposed. We know surgery comes with risks and complications and side effects. So when my artificial joint dislocates, when I get an infection, when I have a complication called a heart attack, a stroke, a blood clot, any of the risks that we sign on the dotted line and say, I accept the risks to get my health care, when those happen, where are those people going to go? Are they going back into the private system? Are they going back to the surgical site and saying, I now need a cardiologist because I'm having a heart attack? No, they're going to go to the public queue. And even worse, they're going to line up at the front of the queue. So everyone is waiting, say, in my emergency department for their health care is going to watch that person with the surgical complication or this private complication come through. We see that today. People can go to Mexico and get a surgery when they come back with an infection, a complication. Where do they come? They come see me. And, you know, they're a burden to the private system, even though they went elsewhere to get their health care. They went private. So we have not thought through the rest of this in a health care ecosystem or as a resource. And now these people will be coming to the front of the line, saying my blue glass is empty or chipped. It broke. I need a new one. And so they're going to bump everyone back in the queue. And you won't even see it in the back of the queue if you don't have a blue glass or the ability to pay and access this unique little section of private health care being offered. So, Dr. Thirsk, how do we fix this? Because you're right to bring up the example of Mexico. Anecdotally, I can tell you, seniors that I know who have gone to the United States or Costa Rica or Turkey or India to get the medical support that they need. And they talk about how great it is because they had the financial means to get wonderful health care abroad. And we've got an aging population in this country that increasingly needs medical support that will need long term care and would prefer to stay in their homes. What do we need to do to fix the problem? I think we need to view it like with an analogy like this, where we view it as a resource and we say we were supplying water. How would we do this? And would we be OK with someone going to Mexico to get a bottle of water? And then when it's empty or broken, returning to the front of our queue and demanding, you know, more services when we can't supply locally what the services are? I think we'd ask ourselves questions like if we don't have the supply for the population now in terms of resources, health care operating in times, where do we think they're coming from? Where if we're not training enough staff to work our public system, where are they going to find the private time? And why are we going to create a new administration to police them to make sure that they're doing some public work and on top of the private work like it? It's kind of poorly thought out. And it wasn't thought through in a in a proper way because the system's complex. And I think we lose sight of the complexity. And it's only when we use a simple water and pipe analogy, we start saying maybe we need more pipes. We need a bigger reservoir. We need to work on resourcing it. Dr. Warren Thirsk, thank you very much for your time today. Thank you for having me. My pleasure.