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Jim Wiedrick, an ER physician in Nelson BC shares ideas and interviews timely guests involved in healthcare in BC's southeast corner
Canada's healthcare system is at the core of all of our everyday lives, and it's kinda sad to see how sick the system itself has become. My mission is all about finding some solutions and charting new paths. I'm Jim Wiedrick. Every day, I am transforming health care in Southeast BC. My work is as an emergency room physician at the Kootenay Lake Hospital in Nelson in the West Kootenays.
Jim Wiedrick:Over my life, I've experienced healthcare systems across the country and throughout the world. I've been in Alberta, the Northwest Territories, Ontario, Equatorial Africa, and many sites across British Columbia. I've worked as a family practitioner covering cradle to grave needs. I've served as a locum. I've attended hundreds of deliveries and given thousands of hours of anesthetics.
Jim Wiedrick:I've even done some admin work serving five years as my community hospital's chief of staff. ER is now my work focus, and the journey continues. I can really say that I have lived and worked in the trenches of health care. Now, in 2024, it's estimated that five million or more Canadians don't have access to primary care. Wait times have gone way up in our emergency room and many others.
Jim Wiedrick:Surgery takes longer to access. More and more folks are experiencing local emergency room closures or scheduling realignments as sometimes it gets, fancy spoken. And now politicians might quote to you that spending per capita on health is up at least 50% in the last twenty years, even after adjustment for inflation. But the key question is, did your health care get better or more accessible? The system is kind of straining and groaning under all of the new realities, our post pandemic issues, and the wide spectrum of new technologies and options that are out there as our world continues to evolve.
Jim Wiedrick:Well, you know, when we pause and go, where have we been and how did we get to where we are right now? We can say, all right, in Canada, our guiding legislation is the Canada Health Act. Now that goes back to 1984, and it now feels a bit outdated. The fact is the system has truly evolved, and today's medicine is nothing like what was practiced or even thought about forty years ago. So take a moment with me and take stock.
Jim Wiedrick:What's the point of the Canada Health Act? What were the key pillars that were brought in? Well, the federal Liberal government of the day was looking to smooth out health care provision, province to province. Health, ultimately in Canada's governance, is a provincial jurisdiction, but over the decades it should be noted that it was supposed to be that the Federal Government was going to provide 50% of the funding. Now that isn't true anymore, it's down around 30 to 35% in terms of how much federal funds actually contribute to the care that your province is able to provide.
Jim Wiedrick:And here in BC, there is a shaky kind of agreement between the provincial government and the federal government, but sometimes the federal government is inserting new concepts. They've talked about dental plans and they've talked about pharmacare, but they did that all without provincial consultation. So you can see that things are just a little bit on the topsy-turvy side. It's kind of important to note that as a family of four, average family with regular income, we're contributing somewhere in the neighborhood of 10 to $15,000 in tax money every year that then is going to the health system. I mean, it's always true, There is no such thing as a free lunch, and I do bristle when I hear sometimes people say free health care.
Jim Wiedrick:Well, it's not free health care. It's publicly administered health care that comes from the tax dollar. Whether that dollar is provincial or federal, somehow that great big system has to draw on a pool of money from somewhere. So going back to how the federal government thinks about things, they're still trying to influence provinces by dictating comprehensive, portable, universal, accessible, and publicly ministered healthcare. Now those were the five principles of the Canada Health Act, comprehensive, portable, universal, accessible, and publicly administered.
Jim Wiedrick:Okay. But you know what? It's not enough. We really need a redesign of the federal Canada Health Act, and I say we need at least two more pillars. Number one, patient centered and number two, timely.
Jim Wiedrick:So let me explain. In this context, the phrase patient centered means that the dollars flow and follow patience, they don't just sit and wait in program design. So maybe you've heard of a federal or a provincial government initiative that created a new program. Oftentimes, there's a big funding allocation that's gone into that, but then there becomes problems with service provision. You know, a good example in British Columbia is the urgent primary care center model that the provincial government has tried to make fly over the last five to ten years.
Jim Wiedrick:It's not done well. If you really scrutinize that the amount of dollars that have been allocated and addressed to that is nowhere in good relation to the amount of patients that are truly being served or getting benefit from it. And so if you have a stand alone program and it's being funded but it doesn't have incentive to make sure that patients get what they need from it, we're missing the boat. Another example might be the creation of a surgical program, but then one that for some various reasons just can't get people scheduled for surgery. We've still spent the big dollars on that, but people aren't getting the services they need.
Jim Wiedrick:So what does the word 'timely' that I've proposed as my second additional pillar mean? Well, timely reminds us that access to a waiting list is not access to health care. Commentators from other countries are sometimes blown away by what we as Canadians accept as reasonable health care standards. Since when does waiting two years to get into a chronic pain clinic or waiting nine to twelve months for a hip replacement count as deliverance of health care. Well, just not true.
Jim Wiedrick:And here is something I never hear talked about. In all of the discussion around these kind of weights or these allocations of funds, and we can see that it's just not working to highest efficiency in our system, the other thing is that practitioners themselves, so that could be doctors, that could be nurses, that could be auxiliary health care professionals, they're kind of getting numb, I think, to the system's problems. And there's not the same level of engagement that I remember from five, ten, or fifteen years ago. If we don't look at revolutionizing our system, then this kind of phenomena means that the system is gonna continue to get worse. There isn't real opportunity for it to get better.
Jim Wiedrick:Part of the issue surrounding provider accessibility is that doctors and nurses are just choosing to work with us. People these days are recognizing the perhaps mistakes of the previous generation of providers that went before us, and they're not willing to extend themselves or sacrifice their own well-being just in the sake of service provision beyond what maybe would be seen as a healthy level. So I'm on record via my website writings at jimweidrick.ca and via social media posts that I favor a big rethink, and I think we need to transition our our health care system design into the kind of frameworks that exist in Australia and Scandinavian countries. They have hybrid models with both public and private delivery options. We need a kind of shakeup in order to truly incentivize some reforms.
Jim Wiedrick:There are so many administrative and bureaucratic levels in our healthcare system stasis. And so in this case, stasis just means stuck in the mud and there's no real ability to adapt quickly or be nimble. If we are looking for improvements, we have to accept this truth, just pouring more money into the system that we have isn't gonna get us a better service delivery when the system that we have is truly not geared to the highest level of efficiencies. And here's another unspoken truth. We live and have been living in what is an effective two tier system.
Jim Wiedrick:Now for most of my adult life, people are like, oh, two tier. We can't have that in Canada. But listen, here's the truth. People access private health care options all over the place, whether they go to The United States, whether they go to international destinations, or even whether closer to home, they find an auxiliary care provider. I know not everybody can afford these options, but it's become commonplace, And it's just kind of bogus for folks who engage in debates on how to make the health care system better to suggest that any kind of concept where we start proposing changes and incentives to create new reforms, those folks then stop and start scaremongering, or they start talking doom and gloom about two tier kind of statements.
Jim Wiedrick:That's so yesterday. We don't need to, quote, talk about bringing American style health care to Canada. Hey, it doesn't really work in The United States, so we don't need that kind of greed or dysfunction here, but there are plenty of countries where the ideas in place with parallel systems are truly working. Hey, I don't have all the answers. I am just saying, let's start having an open mind.
Jim Wiedrick:This current big bureaucratic, everything flows down from the Provincial Ministry of Health and it has to flow through big bureaucratic regional health authorities is not working anymore, and it's getting deeper and deeper in the rut. Imagine a great big tractor in a whole bunch of mud, and we haven't been able to get the tractor out of the mud. Well, spinning the wheels harder isn't likely to work. So what's the scene today in Southeastern British Columbia? In this part of our world, our health care system is designed around two regional centers.
Jim Wiedrick:So that's Cranbrook in the East and Trail in the West. Patients flow from Fernie and Invermere and Creston into Granbrook. Patients flow from Caslo, Grand Forks, Caslegar, Nelson, and if they need a higher level of care, that's where you go to trail. We are all a part of the larger scene then of interior health, and ultimately decisions flow up to or from Kelowna. It's not always to great satisfaction, is it?
Jim Wiedrick:We have to be honest about that. And so in Southeastern BC, what are a list of the big issues? Well, two ones that I had at the top of my list were transportation for patients and mental health care provision. So now dropping at the same time as this episode, I've got two podcasts on these topics. I've got a great conversation with Lisa Keach, and we are talking about the high acuity response team and how they function in our system.
Jim Wiedrick:And I've also got a fascinating conversation with Jerry Taft, and he's written a vulnerable memoir about his journey through the healthcare system and his understanding of the provision of mental healthcare. You know, there's so many other hot topics on the list. I'm always in the process of feeding more conversations, and I'm gonna be grabbing guests to talk to each and every one of those other categories too. Hey. I truly wanna hear your ideas.
Jim Wiedrick:That's why I'm doing this project. That's why I've got a mission to, quote, find, collaborate, and truly transform into practice the best ideas out there. If you've got responses to things I've said in this, if you've got your own original ideas, or if you wanna collaborate with me on a video podcast, shoot me an email, connect@jimwadrick.ca. I'm definitely here for bold new ideas. I'm here to brainstorm, and I wanna learn from the folks that are out there, either on the front lines of provision or actually receiving the care and have come across ways to make improvements.
Jim Wiedrick:Thanks for listening, and thanks for gearing up to help me transform health care in Southeastern BC.