A version of this commentary appeared in the Huffington Post, National Newswatch and the Georgia Straight
Normally provincial medical association elections are not national news. The one vote difference between first and second place in the race for president of the Doctors of BC — later declared a tie after a recount — might be enough to grab people’s attention. The real story here is what’s at stake, symbolically and practically, for the future of medical practice and Canadian healthcare as a whole.
In the runoff vote ending this week on June 18th, the physicians of British Columbia need to do more than elect a new president; they must also decide which values should guide the profession: individual profit or the public good.
The polarizing figure that has brought attention to this race, and put into stark relief the choices before us as a nation, is Dr. Brian Day. Day is a fierce advocate for greater private enterprise in Canadian health care. He has launched a slick “Vision 2020” campaign with an emphasis on increasing privately-funded, for-profit health care. He claims that this will somehow improve the public system despite ample evidence to the contrary.
According to a provincial audit, his controversial for-profit clinics appear to have unlawfully billed patients and MSP five hundred thousand dollars in just one 30 day audit period. Day’s response to the audit was to sue the government for the right to continue doing so.
Under BC law, Day is allowed to un-enroll himself from Medicare and charge patients privately for care provided outside of a hospital or community care facility. Despite this professional freedom, he is advocating instead for an all-payer system, in which doctors in dual practice would be allowed to treat patients who pay privately to jump the queue, and those who rely on the publicly-funded system.
His opponent in the race is Dr. Alan Ruddiman, a rural family physician. Ruddiman has leadership experience in rural issues, medical professionalism and education, and believes that our health system has suffered due to a lack of federal and provincial leadership on health reform. His main message is that our health system needs strong leadership, which should unite rather than divide doctors. He believes that doctors have an unrealized potential to partner with patients, allied health professions and health authorities to make meaningful change happen, and has indicated a commitment to greater generational and gender equity within the Doctors of BC.
This election poses a number of important questions for the medical profession. Will doctors stand up for their perceived right to profit or for the system that cares for society’s most vulnerable? Will they vote with frustration and undermine the public system or will they unite to shape a better publicly-funded system that is equitable and accessible to all British Columbians? Perhaps most importantly, will they vote based on the evidence-based principles to which they are professionally obliged as physicians?
There is a large body of evidence that indicates for-profit services are more costly and often lead to poorer quality care. Yet many physicians insist that population-level evidence is outside our scope of practice, and that our job is to look after individual patients, and perhaps our individual bank accounts.
Is it truly outside our scope of practice to understand the evidence that more equitable societies benefit everyone, even the wealthiest among us — that lifting up the health and wealth of those living on the bottom rung of the economic ladder produces cost-savings and health benefits all the way up to the top rung of the ladder?
Fifty percent or more of a population’s health is determined by the social and economic conditions in which people live — this is double the impact of health services, which is responsible for at most 25% of population health. Thus it is no surprise that the OECD’s commonwealth nations with high levels of income inequality are also the worst performing in this ranking: the US and Canada.
Income inequality has grown in Canada as its health system performance ranking has declined. In BC, poverty costs us $8-9 billion annually, whereas eliminating poverty would cost us $3-4 billion. This is where real potential lies for us to improve health and the cost-effectiveness of our system.
There is a growing recognition among physicians, young and old, of the responsibility of the profession to the population as a whole. This is accompanied by a greater interest in addressing the upstream factors that influence health outcomes.
This election is an opportunity to choose between a socially accountable profession that improves health outcomes for all, and a self-interested profession that maximizes profit at the expense of quality, accessible and affordable health services.
Vanessa Brcic is a family physician in Vancouver, board member of Canadian Doctors for Medicare, and Research Associate with the Canadian Centre for Policy Alternatives. She also is Co-Founder and Chair of Basics for Health Society, a BC non-profit that addresses poverty in clinical settings.
Ryan Meili is an advisor with EvidenceNetwork.ca, a practicing family physician in Saskatoon and founder of Upstream: Institute for A Healthy Society and Vice-Chair of Canadian Doctors for Medicare.