Are you familiar with the ancient Greek tragedy 'Antigone'? Antigone was a young woman torn between a choice: she could obey the state and leave her brothers to rot in the battle field or she could obey the gods to bury her brothers resulting in the likelihood of her execution. Antigone was faced with a no win situation; either way she lost. By the end of the story Antigone buried her brothers and then was sealed in a cave and left to die.
Last Thursday I received an email from the physicians requesting a meeting to discuss financial assistance to cover their overhead/operating expenses. I quickly realized that there were going to be no winners as Council considered a response. If we payed the costs then the Town would be spending money outside of our legislative jurisdiction further stretching our tight financial situation and neglecting our legislated obligations. If we don't pay the costs then we risk angering and alienating the doctors resulting in their leaving Kindersley. In this scenario there are no winners. I feel terrible about the spot the doctors have been put in and how unfair it is to those of us living in Kindersley.
In considering a response I talked with Mayors across the province to learn how they have responded to such requests. There was a wide variety of ways in which municipalities addressed the issue of operating expenses:
- Some communities, like Rosetown, built their Clinic and are now managing development while charging the physicians rent.
- Other communities such as Nipawin, have a P3 model, where a developer is building a new clinic and the Town is leasing the building and then the Town is leasing the facility to the physicians at less than cost.
- Another response is like Shaunavon and Humboldt who contribute no monies to the operations of their Clinics.
Prompting this idea was the competition that municipalities are forced into to recruit and retain physicians. This 'divide and conquer' tactic, whether intentional or unintentional, is unsustainable and unstable. Municipalities can't continue cannibalizing each other to recruit and retain physicians. The end result is neglecting water, sewage, solid waste, roads, parks, recreation, culture and more that you expect the Town to provide.
The problem is that if everyone is playing a game you have to play by the rules to: understand success and what winning means, sustain the game to its natural end, and provide stability by preventing cheating. The same applies to physician recruitment and retention. We have to ask: what does it mean to have success recruiting and retaining physicians? What do we do to make it sustainable? How do we keep our, and our municipal neighbours, healthcare services stable? However, there are no rules so everyone operates according to what they think is best.
This line of thinking led to the decision to ask my mayoral colleagues to discuss some of these issues as a group. The physicians are talking with one another and comparing notes. As a result they seem to be asking for the same incentives from their respective communities. From a municipal perspective this is unsustainable: we have to spend more and more to recruit and retain our physicians. This is unstable because physicians may choose to go where they think they can earn more and municipalities are spending money on health for which we don't have sufficient resources.
The only norm in speaking with my mayoral colleagues is that physician turnover rate is high. I would say that in rural urban communities retention is a failure. In one community I spoke with they have lost 50% of their physicians in the last 5 years even after meeting the requests of the physicians.
The madness has to stop. It is unreasonable, or insane, to keep doing the same thing expecting different results. That is why we are going ahead with the SK Mayor's Health Summit and the Kindersley Health Services Needs Assessment.
The need for the Kindersley Health Services Needs Assessment is because of our local situation. There seems to be no agreement by the three primary stakeholders: Ministry of Health, Heartland Health Region, and our local stakeholders, particularly the Foundation and physicians, on what the real need is for health services in Kindersley. Engaging an independent health consultant is a means to developing trust among the stakeholders so a foundation can be built for future health services development. Here are the objectives of the study:
Ø Complete an
assessment of current and anticipated demand for primary care, acute care and
long term care services in the service area;
Ø Identify
strengths, weaknesses and major issues relating to access to health care
services, including the attraction and retention of family physicians within
the region;
Ø Engage
physicians, other health care providers, the public, the Foundation and other
key stakeholders in identifying health services issues to be addressed and
potential solutions;
Ø Identify creative
options and approaches to organizing the delivery of health care and physician services,
which may improve access and enhance quality; and
Ø Evaluate options
and recommend specific approaches and strategies within the context of the
legislative and policy frameworks of Saskatchewan Health and the Province.
This study was requested by the Town at the SUMA Convention during our meeting with the Minster of Health and the Minister of Rural Health. The province has committed funds and a senior adviser to oversee the project. The senior adviser is also overseeing a very similar project in Lloydminster. Will this study fix all of our problems and challenges? No. Is it a start? Yes. As I have said we can't keep doing the same thing expecting different results and pointing fingers at one another when things don't change.
To stop the circle of madness present in our health care we have taken two steps which are looking at mid and long term solutions. How about the immediate request by the physicians? We can't afford it. Their request was for over $400,000 per annum. To cover this cost the mil rate would go up more than 1.5 mils. However, should the study indicate that Town assistance is needed, and should the Mayors at the Summit agree that municipal money should be given, then Council has to fully consider any request for assistance the physicians bring before us.
Another step taken is to invite our Health Authority representative Mark Stockford to address Council on a quarterly basis. The purpose of the invitation is to ensure Council is kept abreast of the issues and challenges and understand how Heartland is addressing the them. The first such presentation is expected to be March 24th.
Another step taken is to invite our Health Authority representative Mark Stockford to address Council on a quarterly basis. The purpose of the invitation is to ensure Council is kept abreast of the issues and challenges and understand how Heartland is addressing the them. The first such presentation is expected to be March 24th.
I can't promise that our steps will lead to solutions; but I am confident that doing nothing or doing the same thing will not solve it either. I feel terrible about the difficulty the doctors are experiencing. However, the Ministry of Health and Heartland Health Authority have the legislative and ethical jurisdiction and responsibility to address the immediate needs of the physicians. However, we are committed to working with our healthcare partners to ensure Kindersley has sustainable and stable healthcare services.
Finally, the Town can not accept responsibility for the decisions and choices made by other organizations over whom we have no legislative mandate.
