Watch out! The big guns are aimed at private practice

There's more trouble coming. The federal government in its infinite wisdom has decided to fix private practice in the same way it "fixed" the hospital system. By consolidation as a cost cutting measure. Michael Decter, the chairman of the National Health Council, is in the vanguard of this initiative -- and it's not going

to be pretty. To see just how ugly it may become, one need look no farther than the hospital system in Ontario where Mr Decter once ruled as deputy minister of health. The "successful" model of what's to come closed smaller "inefficient" centres and centralized care in larger hospitals. Once accomplished, it was far easier for the government to tighten the purse strings and get costs under "control." The results were swift and predictable, patients had to travel farther to receive hospital care and, once they got to their "regional health centres" they found they were short of staff, short of beds, and short of equipment. The quality of care spiraled downward. From the government's point of view, the plan was a huge success -- it's achieved what it set out to do: reduce costs.

The quality of care declined? Really? You don't say! It reminds me of one of my father's favourite old jokes. In it, a pet food company spends millions to develop a new dog food that they believe is as nutritious as existing foods yet costs considerably less to produce. The new product is launched with an extravagant advertising campaign. And it utterly fails. The president calls all the VPs and researchers into his office and demands to be told why. After a long silence, a small voice from a junior researcher at the back of the room pipes up, "The dogs don't like it." The people are no fonder of the healthcare system than the dogs were of their new food.

The only shining light in the current government lead fiasco is private practice -- particularly general and family practice. Bad as the system was outside a doctor's office, and as impossible as it's become for overloaded, stressed out practitioners, once the patient arrived for a consultation they were relieved to find their doctor as compassionate and interested in their well-being as ever. The federal government is now on a course that could end all that. The idea is to shut down as many solo and small group practices as they can and to consolidate them in larger "more efficient" units. Big box, Walmart-style medicine in coming town and the results are entirely predictable. Need another example? ATMs replacing local bank branches. Smaller practices will be forced out of their old community locations and into remote new facilities with cost cutting as the overriding priority. Patients will have to travel farther to get care and once they arrive they'll be greeted by just what the government planned for them: Assembly line medicine.

You don't want it. Your patients don't want it. And unless there's a concerted effort to stop it, including strike action, it's exactly what we're going to get.
David Elkins