Ontario nurses are outraged by a Canadian Medical Association proposal that would allow doctors to choose the public or private sphere of health care.

The Registered Nurses of Ontario (RNAO) sees it as a cash grab.

A highly-specialized medical team that devotes itself to one specific health problem can be a good way of reducing surgery backlogs, says the RNAO.
(CBC)

"We believe that this is a strategy for the Canadian Medical Association and those doctors that follow that type of vision to increase their income at the expense of the public system and at the expense of longer wait times in the public system," Doris Grinspun, executive director of the RNAO, told CBC News.

She believes a private-public partnership will increase cherry picking among physicians, leading them to opt for simpler medical treatments in the private system and defer more complicated ones to the public system, increasing the cost on the public side and lengthening wait times.

The CMA released a policy paper Monday outlining a strategy for decreasing wait times and improving patient access. The paper — titled Medicare plus: toward a sustainable publicly funded health care system in Canada — calls for a greater choice in medical procedures for patients and physicians, and suggests doctors be allowed to make the public or private choice.

'When things start to improve, you can no longer sell the idea of a for-profit or parallel system.'— Doris Grinspun, Registered Nurses of Ontario

Grinspun said there have been numerous studies documenting the cost burden a private system can create.

"[The CMA is] ignoring or choosing to ignore the extensive research that exists when doctors work in both systems. The private gets better but the public does not," she said. 

These days, patients are waiting less time for medical procedures and the health-care system in Canada is actually getting better, said Grinspun. She believes it's this improvement that is driving the CMA's push for private health care.

"When things start to improve, you can no longer sell the idea of a for-profit or parallel system."

As for the Ipsos Reid study released by the CMA, which finds that 62 per cent of Canadians support the Medicare plus plan, Grinspun is skeptical.

"The public will respond to the way the question is posed."

A focused approach

To increase the number of doctors and alleviate long waits for surgeries, the RNAO suggests increasing the number of nurse practitioners, who can conduct physicals, prescribe medications and assist in minor surgeries.

It also encourages the creation of more specialized medical practices where a team of doctors, nurses, and other specialists work in one not-for-profit clinic devoted to one health area, such as cataract surgery.

"The more you work on a specific procedure, the faster you get at it," said Grinspun. "If you put management processes that get patients in and out, without cancelling surgeries, with proper supports in communities, there will be less of a burden on hospitals."

As for the CMA's proposal that codes of conduct be developed to oversee physician's practices as they straddle public and private health care, Grinspun said it's an idea that doesn't work.

"You're moving to the U.S. system, where they need to police insurance companies, doctors and everybody else."

The RNAO is urging Prime Minister Stephen Harper to issue a statement on the government's position of the CMA paper. It also wants the public-private health-care debate to become an issue in the next election.