Wednesday, August 22, 2007

Choosing sides

It's been clear for awhile now that the Canadian Medical Association's calls for privatization are based entirely on concern for doctors' interests rather than any desire to improve patient care. And two new votes from the CMA's recent convention show just how far out of touch the CMA is with the realities facing Canada's health-care system.

First, the CMA overwhelmingly rejected the possibility of even limited prescribing by pharmacists or nurse practitioners:
At their policy meeting, CMA members overwhelmingly endorsed a motion that reads: "The right to prescribe medications independently for medical conditions must be reserved for qualified practitioners who are adequately trained to take a medical history, perform a physical examination, order and interpret appropriate investigations, and arrive at a working diagnosis."

Another motion, also adopted, states that "within a multidisciplinary practice, delegated professional prescribing is only acceptable within when led by a physician clinical leader with ultimate responsibility for patient care."

When one physician suggested an amendment saying that a nurse-practitioner could also lead a health team, it was soundly rejected.
The refused amendment regarding nurse practitioners is particularly striking in its sheer disregard for the interests of patients. In the case of remote areas, doctors may not be available to act as a "physician clinical leader", or indeed be interested in taking on the task.

Under those circumstances, the CMA is apparently strongly of the view that faced with the choice between patients having access to prescriptions under a nurse practitioner or not at all, the latter result is the better one. Which should offer a strong indication that the CMA is far more interested in fighting turf wars than promoting better patient outcomes.

Second, even while privatization poster boy Brian Day claims the CMA is aiming mostly for private delivery of care alone rather than funding, the CMA as a whole saw a need to vote on the concept of patient-paid care (including co-payments and "health savings accounts"). And even faced with a vote on what amounts to a full U.S. system (notwithstanding the protestations of the motion's supporters), the CMA rejected such a drastic and unwanted change by only a razor-thin, 50-48% margin.

Needless to say, the complete detachment between the CMA and virtually all other voices on health care should bring into sharp focus the contrast in interests between Canadian doctors (at least as represented by the CMA's delegates) and their patients. And it's worth noting that this gap isn't entirely new.

After all, while the CMA may have been relatively quiet in recent health-care debates, the medical profession was not always so. Indeed, it's worth remembering that when single-payer health care was first implemented, it was doctors who launched the most vehement attacks against the idea that wealth shouldn't dictate access to medical care.

It remains to be seen whether the CMA's views are shared by any substantial proportion of the profession. The convention votes were based on only 270 delegates, and there are certainly more than a few other doctors looking to put patient care first. But it's clear that at least some physicians see an opportunity to reshape the system for their own benefit no matter how damaging the impact on Canadian patients - and there's every reason to want to make sure that those voices aren't the ones to determine where Canada's health care system goes next.

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