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Commentary - Dr. Tom Barry, Regional Chief of Medical Staff

1970 model of health care does not support present reality

March 29, 2016 - In 1970, most of us had three or four channels on our television sets, channels that we changed by walking to the TV and turning a dial. Very few cars had seat belts, cigarettes were less than a dime a dozen, and they were smoked everywhere by the vast majority of the population.

That was the approximate year in which our health care system was designed.

Since then, technology has changed so much that everything we do has been affected; all major industry has modernized or disappeared. We have home computers, laptops, smartphones and smart cars. We have hundreds of channels at our fingertips. We know more today about disease treatment and prevention. Our world has changed so that the youth of today think we're joking when we tell them what the world was like in 1970.

Everything has changed ─ everything except the structure of the health care system in New Brunswick.

Obviously, changes to diagnostics and treatment have occurred since we adopted that 1970 model of medical and nursing care. We've seen significant changes in areas such as general medical care, cataract surgery, hernia surgery and appendectomies.

Even some joint replacements are now conducted as day surgeries, and many conditions that used to be treated on an inpatient basis, including cardiac abnormalities, clots in legs and lungs, uncontrolled high blood pressure and kidney failure, are now all treated on an outpatient basis. In fact, most cancer care services are now done in a clinic.

To continue to follow the 40-year-old model is simply ineffective, inefficient and ill advised.

New Brunswick has 21 acute-care hospitals serving a population of 750,000 people. Most provinces have long since dealt with this excess of hospitals. Saskatchewan was the first to modify its number of inpatient hospital beds and to transition these to community health centres.

At a recent meeting of our medical staff leaders, most physicians agreed that significant changes to the health care system are needed and needed soon. As well, the President of the New Brunswick Medical Society has stated that New Brunswick primary care must reform to improve access.

Despite our efforts to develop a strategic plan to improve community and tertiary health care for rural and urban populations of New Brunswick, we all have been unable to make changes and investments where they are needed most. Decisions, although unpopular, must be made.

Statistics Canada predicts New Brunswick's aging population, those over the age of 65, is expected to increase by 40% by the year 2026. Ten years from now!  The health implications of this are obvious. Our obesity rates remain very high, yet we have made very little investment in preventive care. We have long wait times.  Our various Community Health Needs Assessments, written by our local community leaders, consistently identify lack of adequate personnel to deal with adult and youth mental health, senior home care assistance and transportation as key gaps. Finally, the surgical wait lists for joint replacements, and waits for service at our coveted provincial cardiac and cancer centres, are not improving.

The unnecessary and medically incorrect focus on inpatient beds and emergency rooms is robbing and diverting important funding from where it's actually needed to make our patients better.

Our inability to adjust our resources to better meet population needs gives us little flexibility to redistribute the dollars and human resources to community services, the New Brunswick Heart Centre surgical waitlist and other tertiary or expensive services.

On the primary care level, most residents are all too familiar with spending several hours in emergency rooms waiting to be seen by a doctor when few or no other options exist. Resources must be moved proactively into the community to improve access, and to relieve emergency room congestion.

The proposed plan of Horizon Health Network is to "squeeze the middle of the barrel" which means moving dollars and human resources from secondary care, traditionally done in hospitals, to tertiary care such as cancer care, the New Brunswick Heart Centre, joint replacement and surgical wait lists.

In addition, resources would be moved to preventive health care services to improve access to community-based primary health care, limiting the need for patients to sit in an emergency room for these services.

Changes to delivery of care must not happen in rural hospitals alone. They must be made in our larger hospital facilities as well as in our primary care centres. It is important that we act now. That means everyone involved in the health care system must be willing to face the facts and make the tough choices.

This is not just a dollars issue; it is a quality of care and patient safety issue. The inability to access care and our prolonged wait lists pose a significant risk. The longer we delay, the more difficult it will be to maintain the quality of care and the methods of care that the people of New Brunswick want and deserve.

I invite my medical colleagues to continue the dialogue. 

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