this post was submitted on 08 Feb 2024
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I hate how these articles always dance around the main issue. Yes, team-based care is great. But what we really need is to urgently train thousands of family doctors and nurse practitioners. We have a massive shortage and it's only getting worse. But nobody wants to pay for it, and even lefty outlets like The Walrus aren't calling for urgent funding. I dread what this is going to look like in ten years.
This is purely speculation on my part, but I think the Canadian Medical Association, the group which represents Canadian physicians, is interested in maintaining a shortage of physicians and, for example, would vehemently oppose graduating 5-10% more physicians starting now as a means of filling the physician gap. Their motivation is to keep existing physicians in very high demand so that they can maximize compensation and job security.
I think the ultimate problem (neoliberalism) is that there are too many people in positions of power that are trying to profiteer off of a system that's intended to provide a public service (e.g., privatization of healthcare, hospital inaccessibility in rural communities, the large number of Canadians without a primary care provider)
I don't think the CMA has much power over this. Medical school and residency spots are controlled by provincial governments, and even the provincial medical associations exist at the will of provincial governments. I'm not saying you're wrong that this might be the CRA'stake, but I don't see much of a causal relationship there.
Much more immediate, I think, is the unwillingness of (more or less conservative, and as you point out, neoliberal) governments to fund medical schools and residencies because the impact on voters would take almost a decade, which is much longer than an election cycle.
I don't know enough to comment. I believe groups like the CMA would have their voice heard in such conversations.
Any government that says "we recognize a sizeable portion of Canadians don't have a primary care provider (like a family doctor), that is a major healthcare problem that costs the system a great deal of money and other problems (e.g., overcrowded ERs), and we're going to start graduating more physicians this year to meet Canadians' needs" - would receive widespread approval I think, and from any party. I think physicians' lobby groups however would do/say whatever necessary to kill that.
The CMA sold their wealth management company, MD Financial Management, to Scotiabank in 2018 for 2.6 billions dollars. The CMA has been touring with the Globe and Mail over the last year to promote healthcare privatization (example).
Requiring proof of a causal relationship may be setting the bar so high that it can't be cleared.
I think there's an abundance of moderately strong evidence that the CMA has its members interests at heart, not Canadians who rely on public healthcare.
Here's the Ontario MA's statement on fixing issues in primary healthcare. They note 2 million Ontarians don't have a family doctor. Where on the list of their proposed solutions is graduating more doctors?: https://www.oma.org/advocacy/prescription-for-ontario/prescription-for-ontario-doctors-solutions-for-immediate-action