Steve- So, John, now you told me that you were a physician, and I guess that's another field that has changed over the years because of the nature of the medical system. Well on the one hand, we have the aging of society, we have new technology, and then we have how we organize medicine in this country, so I guess you went through a lot of change in your career.
John- Yes, I did. Very significant, as a matter of fact. Today we were remarking that it would be nice to be back in practice because the general practitioners got a 20% raise in the next very short order, so that would be kind of neat to see that. But, I mean my going back in my own training, I was fortunate enough to do all my training here at-in British Columbia and practice in, initially, in a small community in Northern B.C. I, at the time I felt like I was giving back, I guess, just immediately after being trained. I felt that you almost owed this, but it was a unique experience having to go up there, but at the same time, it took a very short order for me to realize that medicine was not the be all to end all.
I had placed medicine the very number one thing in my life at that time, and because I did that, I then realized that afterwards, golly, you know, I can practice medicine with one hand in my pocket, one foot in the air, and half my brain turned off, and it's not that difficult. And it was only after that point in time that I put medicine, I guess in a better priority in life and left the north because people up there, well they loved the service. There wasn't the appreciation of the total amount of work you were doing and you were absolutely deluged with work in the north. Steve- And, of course that would have been a few years ago that you started up there, and did we have the same medical system as we have today, or was it different then? Or, what sort of changes have you seen in how we organize medicine in this country, and the kind of service the doctors are able to offer, what people can expect, you know, what their attitudes toward the medical profession? What about those kinds of, sort of, institutional changes over the years?
John- Well, the institutional changes were, again, very dramatic up north as well, because I went to a community where I was the first physician ever to serve that community. And it's a community of over 3500 people, which is quite significant. And then, going from there, I, went back to university and took a master's in business administration and subsequently went into medical administration and worked on the institutional side, and it was really being on the institutional side where I saw the difference and the changes that have occurred in medicine over the last, say, 30 or 40 years. I mean, hospital budgets, you know, in four or five years would literally double because of the capital, intensive capital requirements, of the phenomenal things that we are able to do in medicine now.
So, there-and the difficulties we're seeing in medicine now, though and, we, a lot of us predicted this over 20 years ago, are the manpower situation. And the manpower situation in family practice, I mean we're short 3500 family doctors across the country. We've got 100,000 in and around Surrey who do not have a family physician. So that makes their ability to find a simple solution to what could be a simple medical problem, often a nightmare because they could end up in the emergency department. They could spend 6, 7 hours in an emergency department where as that problem could have been dealt with very clearly in an office setting. And, of course, that just clogs up our emergency departments.
Our hospital in Surrey, busiest emergency department in the country right now, with over 100,000 patients visiting there on a yearly basis. I would say probably 40,000 of those patients do not even need to be there at all. They could be easily treated elsewhere. Cost to our system in doing that? Huge. Just huge.
Steve- Well, I certainly remember growing up in Montreal we had a family doctor and he used to visit us. I don't feel I have a family doctor now, because I can't get in to see him. And when I do get in to see him, it's like he's got a stop watch out, you know, he wants to process me through there as quickly as he possibly can. So that as a user of medical services, you have the impression that it's not as good as it used to be. On the other hand, I've had senior members of my family who have had very serious situations and of course, once you get them into the hospital, then they're very well looked after, and of course you don't have to pay for it. So there's, you know pluses and minuses, but this shortage of family doctors, how do, how can that get resolved? John- Well, that in itself is a very difficult problem because you have to go back to what's happened to our medical schools. Our provinces, through the federal government, have agreed and they've doubled the size of our medical schools in almost every province across the country, so theoretically that should double the number of physicians. However, and it's a problem that's not spoken about too often, the percentage of women going into medicine has dramatically increased. When I graduated back in 1969, we had 10% women. Now it's 60% women in a class. And then, if you look at the total hours a woman spends in practice, which is half that of a man, then, we've doubled the size of the class and yet we've accomplished nothing because of the number of hours that are being worked. Steve- But, here again, I mean obviously we can't, sort of, limit the number of women that choose to study medicine. We can charge them more. Maybe that's what we should do. We should charge . and of course you want them to make babies, so what is the solution, just to, to increase again the size of our medical faculties at the universities?
John- No, I don't think so. I think the solution is going to come in a private/public mix, and is going to be a change in focus and how things are practiced. Perhaps you're going to see nurses or nurse practitioner-type people who have different levels of skills and they're going to be your front line. What we would call now a family physician, and they're going to be able to work together with family physicians and yet see maybe 70% of what a family physician would see comfortably and write prescriptions, and do a lot of things that are now being done by, or attempted to be done by, the family physician. Steve- I mean, certainly, not being in the medical, you know sector, but as a user, and from what I read, you do get the impression that we have a rather inflexible system, and that other places in the world have a somewhat more flexible approach. I saw a program, I sometimes watch on television in French, and they were saying that 50% of the people who immigrate to Quebec from France go back. And the main reason they go back is the medical system. And that in France, there's no waiting period, but it's a 50% private delivery, 50% public delivery. They have user fees which we don't have. And, one of our learners actually, we had a learner on our Linguist system who was a nurse from France. And they, there, just the way she described it, everything was much more flexible. She and her partner were nurses. They would be contacted by the hospital when someone was ready to leave; they would pick up the slack, so they, she in effect, was a private operator. And I just, one got the impression that they weren't hung up at all about ideology there, whereas we, I think, have a strong dose of ideology in our approach to solving our medical problems. Add a little bit of a, you know, political question there, but . John- Well, if I go back 35 years, I had the fortune to spend 6 weeks at Cornel University in the United States, and it was a multinational conference, or get-together. It involved spending 6 weeks there. We had representatives from 36 countries, and we were actually evaluating health-care systems around the world. At the end of the 6-week time period, a vote was taken amongst the whole group, because we had international speakers come talking to us on all different kinds of subjects in healthcare. Canada was rated number one back then.
Steve- Excuse me, what year was this?
John- This would be about 35 years ago, so we're talking, 1975. Extremely, I mean, and it wasn't even close. Nobody was a close second. But what has happened since then, the cost of providing, you know, medical services, vis-a-vis the interventional equipment and diagnostic equipment has just forced other countries to change. They have been more flexible. They have made the changes. And as a result, they've catapulted over us in the provision of general services. I have to say, however, if we look at the acute emergency, the really intensive medical care services that are provided, we're second to none again. Steve- Well certainly my personal experience has been that once you, once, like my father, for example, had a, in order to get in to have his heart condition treated, he basically had to collapse in a shopping mall. But once they got him into the hospital, he was very well looked after. But, on the other hand, I have had other experiences in my family where, you know waiting for diagnostic services and being shunted around actually probably caused a brother-in-law to not get the service or, you know, the attention that he needed. So that-yeah, I think there's pluses and minuses, obviously, in our medical system, and hopefully we can find flexible solutions. So you then stayed on the, in the administrative side of health care for most of your career then after that change?
John- No, not totally, I spent 16 years doing that. I thought I was in there for the long haul, but then left and went back to family practice. When I went back to family practice, and I guess I was in the forefront of providing services from a walk-in clinic basis, where a patient could be guaranteed to be seen if he walked into a clinic. And, this was unheard of in British Columbia at the time.
You would phone up your family doctor. Say you'd been up all night with your child with an ear infection. You'd phone up the family doctor and say you'd like to get in, and you might get an appointment that afternoon. Often it was the next day. And of course, what I was doing was providing the service right away, so between 9 and 11 every morning I would see maybe 15 or 20 moms, provide them the medical service that they needed to get on with their lives, and I can tell you, you know, they were coming back to see me. You provided a service and-it really taught physicians that medicine was a service industry. Because prior to that time, physicians, because they were in need and demand, and were busy enough, they really dictated the terms of providing the service.
Steve- Okay, thank you very much. We'll move on, then, to the financial sector, with Frank, who is sitting beside you. I'll just move along here.
