- Thermal Audit
Common Sense Policies
for Newfoundland and Labrador
This is a complex area that needs a complete overhaul. Health Care also represents the single largest budget item. Education is number two.
1) Aging population and need for home based care. Old age homes are very expensive and a truly horrible way to end our existence. The Carbonear Long Term Care facility for example will cost $72 million. Have a look at the first row in the table in the cost of infrastructure.
2) Lack of professionals (or more precisely, no budget to hire them). If you are a MD, send in the real problems anonymously please.
3) Aging hospitals, clinics and equipment; lack of multidisciplinary clinics
4) Cost of drugs
5) An agreement of what services should be covered and what shouldn't be.
6) A strategy on how to spread the work load. When we have a cold, should we see a nurse, and then a nurse practitioner if it is more serious, and referred to a medical doctor if necessary? This way doctors would free of trivial items. When do we use distance medicine for remote communities ?
There have to be some limits, but most anything that is highly certain to work and which alleviates pain and suffering should be free. This could be a giant list for the public to vote up and down, knowing that everything can't be afforded. Examples of lower priority items could be breast augmentation, sex changes, a second liver transplant for a patient that continued to drink after the first one, expensive experimental treatments with a low chance of success, etc.
Dr. Lydia Hatcher
Dr. Hatcher is leaving Newfoundland and has been covered in local news (April 2013). Her situation parallels that of many professionals: They work hard to fix things, eventually go public and after exhausing all avenues, cut their losses and move on.
The side show "Relationship between Physicians and the Health Care System - View From the Trench" published 2011 is worth a look. A few excerpts:
- Gap in communication between specialists and family doctors
- Gap of information between regional health authorities (RHA's) and family doctors has widened
- Community physicians frustrated and angry with the perception of lack of concern for their patient?s care and treatment by the RHA's.
She provides possible solutions, and hopfully, will provide a road map for how things need to be reogoranized and it will be inserted here.
Thousands of well qualified people apply to but are rejected from medical school. These people often have degrees, sometimes multiple degrees and an interest in community service. Those that do get accepted tend to be competitive people who score highly on the MCAT exam and do not fit the profile of the well rounded family doctor that might be happy to settle in rural Newfoundland. Students often incur huge debts, and there is no guarantee of employment afterwards forcing them to leave the province. I have met under employed surgeons who can only get part time employment in Ontario because of limited hospital budgets despite the fact that there are waiting lists for their services.
Newfoundland needs to fund additional medical school slots for Newfoundland residents that commit to specialities that are in short supply, such as family doctors. Pay them a salary to cover basic expenses (as the federal government does for those that commit to work for the armed forces afterwards). Allocate additional funding to support residency positions. Afterwards, new doctors would have guaranteed employment, no debts and would be deployed where needed. If housing is scarce (Labrador or the South Coast), provide a modest residence.
Nurse Practitioners and Midwives
Most routine care does not require the personal attention of a medical doctor. The old system of training nurses in hospitals (rather than a Bachelor of Nursing) was a good one that should be reconsidered.
Currently nurses graduate from Memorial into unemployment and have to leave the province to pay back their debts. Despite this, existing staff are overworked.
Eastern Health Care
There are doctors in the system that could reorganize the organization, probably at the expense of upper management. I have heard many things I can't repeat here. If any of you wish to write up potential solutions, they will be incorporated here.
This is a very old monopoly that needs to end. Once a customer knows the lenses they need, they could simply be dispensed from a vending machine. Many prescription frames available locally are imported from China and cost between $4 and $50. Prescription lenses for those frames run about $35.