Dr. Merrilee Fullerton on Healthcare

Preventive care and the early diagnosis and treatment of medical conditions causes increased governmental costs in the long run...patients survive long enough to develop other disorders and the requirement for long term care facilities...the least expensive method is have non preventive 'care', late diagnosis and delayed treatment...dead people don't cost the state anything.

Interestingly I spoke today to a patient who is involved with the packing of the boxes that might arrive at my office door one day...as far as I can tell they don't contain Tamiflu/Relenza...no orders have come to ship them out as yet.

It is gathered that during the SARS episode the boxes to be sent out were packed in inaccessible places....this time around there are racks etc., for easy access...when the word comes down from high.

I still want Tamiflu for my colleagues, my staff and our loved ones...two cases of Swine flu reported in our vicinity today...my staff members are getting nervous.

I'm not expecting any boxes any time soon.
April 30, 2009 | Andris

**************************************

'I still want Tamiflu for my colleagues, my staff and our loved ones...' -Andris

I do realize realist's thread relates to the cancer wait time issue but Andris's post prompts a thought lightly related.

I too want Tamiflu at the ready for all my loved ones but have no opportunity to realize this not being a physician or pharmacist. Most of us of course are not.

The strategic deployment of antiviral drugs is geared to efficacious treatment of patients and to maintain essential public services (including all health care staff).

The human impulse of individual doctors to provide Tamiflu to loved ones by dipping into the strategic public supply is understandable and will occur. This amounts to loved ones being placed at the front of the line to a publicly owned resource does it not?

This scenario having come to pass will clearly demonstrate how advantaged access to limited health care services (outside of crisis situations) would play out should wholesale privatization of the HC system come into play that is not built and regulated around principles assuring the overall public good and fairness is served.

The public will simply not support such an outcome so why promote it?
April 30, 2009 | hedgehog

***************************************
something strange going on here...in Canada the patients with influenza A H1N1 seem to be doing ok...there must be some complicating factor with the cases in Mexico.

Why are some people just getting minor illnesses not much different from other kinds of respiratory viruses and recovering just fine while others (few others) are dying.

I suggest that co-morbidities might be at fault and any other kind of influenza would be just as likely to cause severe illness or death in these kinds of patients.

I'm not convinced that this is the pandemic that we have been fearing so much.

However, in my house we will be making sure we get proper sleep, eat healthy, wash hands, keep hands away from face in general and avoid exposure to people who appear ill.

Now, maybe I'll change my tune when Influenza A H1N1 boogeyman comes knocking at my door but I'm not convinced that Tamiflu is the cure.

Realist

Realist thanks for relenting and allowing the unruly mob to vent about the swine flu!

If one examines today's MOHLTC Guidance for Ambulatory Care Patients with Suspected H1N1 under the patient care section it suggests the following:

1. Plexiglass barrier be kept between office intake staff and suspected cases.
2. All suspected cases be asked to use alcohol hand sanitizer on entry to clinic.
3. All suspected cases be given a N95 mask or if not available a surgical mask.
4. In between cases the room should be wiped down with an approved sanitizer known to kill the influenza virus.


We had a meeting today and decided against calling the contractor to install a plexiglass barrier, however we did decide to implement the other recommendations at our expense. My question is which groups of physicians are having these expensive supplies provided by the province and which are having to foot the bill on their own. Are some swine more equal than others? ;)

On Monday I went out and purchased $800 of N95 masks for staff and we are using the surgical masks supplied to us post-SARS (they should have been N95) to put on any patients with influenza-like illness (ILI).

Today in order to have hand sanitizer available to the patients we purchased 5 one litre bottles and also two gallons of Cavicide spray for sanitizing the ILI room and reception surfaces. Another $120 out of our pocket.

We have started to see an uptick in the high school population here of ILI and we await nasal swabs to confirm whether this is seasonal influenza A or the swine flu. My hunch is we are already seeing person to person spread in contacts of the original cases who returned from Mexico after Easter.

How did it spread so quickly one asks? By sick people roaming about the city as happened in this case.
http://www.torontosun.com/news/columnists/michele_mandel/2009/04/30/9299471-sun.html

It was this type of laissez-faire attitude which got the city into trouble during the SARS crisis and that was a hospital based epidemic. Now lets see how fast this will spread with a community-based flu epidemic.

The most likely reason for the difference in mortality rates between Mexico, and the USA and Canada is simply the temporal relationship between the two epidemics. In all likelihood this has been circulating for a few months in Mexico and has time to infect large swaths of the general population.

These epidemics follow very predictable patterns as shown here in the 1918 pandemic. Canada and the USA are very early on the left arm of the curve whereas Mexico has likely now passed over the peak. Here in the GTA in a month's time when we are seeing the peak number of cases there will be much more serious disease as those yet to be determined high risk groups become infected. At this point in time we really don't know what the demographics are for these high risk groups but this will become more apparent over the next two weeks as more cases are detected and analyzed.

Of course there could be other factors in Mexico increasing the case-fatality rate such as poverty, overcrowding, pollution, and a lack of access to antiviral drugs and advanced ICU care.

Give this a month to circulate in the GTA and then one can compare our case-fatality rate to the Mexico City situation.

http://upload.wikimedia.org/wikipedia/commons/thumb/e/e2/Spanish_flu_death_chart.png/787px-Spanish_flu_death_chart.png

Notice the 8 week time frame from the beginning of the epidemic to the time it burned itself out in each city.

Should a family member or friend end up being hospitalized for swine flu choose your hospital carefully. Those hand washing rates are all over the map.
http://thestar.blogs.com/maps/2009/04/maps-patient-safety-in-hospitals.html

R:

Overall, the handling of the "swine flu" pandemic in Ontario has gone well. In a sense, the media desire to promote a "story" despite good communication from the MOHLTC about "no story" is interesting to watch.

As for publiuc goodness and fairness, the one issue that all have agreed on is:

1. the first nature of all within the MOHLTC to serve themselves first.

and 2. The continued desire and committment of each individual in the "public" to serve themselves first without regard to "public" interest. The great advantage of the poltical nature of our system is that it allows the appropriate routes played through political routes to always supplant and override "public" good. The great beauty of the current system is the complete disregard of individual opportunity to override the poltical system of power redistribution. those whom now know how to use the "political" route now always get they way. The backroom politicals ALWAYS will succeed.

The plan is good.

My office doesn't function without its staff...my staff have families...we have two suspected cases of wine flu in our vicinity...patients are presenting with upper respiratory symptoms...we have a glass partitioning betwixt the office staff and patients...in order to communicate the sliding windows in the partitioning has to be slid open...the patient coughs...our staff worry...when they worry, I worry...my staff need the Tamiflu prophylactic far more than any big wigs in the MOHLTC or the political hierarchy...we have designated one room for URI patients too sit in...a matter of luck in that one of our colleagues retired, otherwise we'd have no room....we have worked out our own strategy, no thanks to the MOHLTC/Political hierarchy...if we get away with it, it will be thanks to our thinking on our feet rather any governmental intervention.

"One learns something suspending a cat by the tail that can not be learned in any other way"...certainly not by reading the literature or going through memos...we learned something with SARS, that we are all alone...the government/MOHLTC is absolutely useless and unhelpful...we imagined that following SARS that they would have had all their ducks in a line...they don't.

So, if a real pandemic hits, they had better start looking at matters from the perspective of those in the front line trenches otherwise everything will fall apart...if my office staff don't turn up one morning because of the feelings of vulnerability...my office grinds to a halt and Myself and my colleague might as well go home..he has a farm in the country and could easily sit matters out there.

BTW I stockpiled Tamiflu in anticipation of the governments incompetence and indifference...a governmental supply of Tamiflu to keep our office functioning would have been appreciated...but I don't expect it.

If we survive it will be despite the government not because of it.

My hopes are that this flu virus will fade out....and it likely will over the summer only to possibly reactivate itself in the autumn in a more vigorous form when the faeces really hit the fan with few ICU beds and fewer respirators in addition to a demoralized medical profession and their medical staff.

"Wine flu"...my subconscious betrays me.

I spoke with a Sunnybrook ED doc yesterday who said they are still seeing a significant number of flu cases presenting as "rule out H1H1 flu", but so far they are returning as seasonal A and B. This is a good sign that the H1N1 flu may not be spreading outside of those who contracted the disease in Mexico.

Hopefully this week a clearer picture will emerge as to which direction the Canadian and USA epidemic will go. Our weather will work against further spread of the virus as it prefers cold weather with low absolute humidity whereas those in the southern hemisphere may see a worsening of the situation heading into fall and winter.

Swine Flu:

As things wind down, some positives:

Claerly things were better controlled than with SARS. SARS placed Ontario at the bottom of public health services in North America. Certainly lessons have been learned.Not perfect but one would venture at least a solid "B" in performance. Still to many chiefs as all want their moment in the sun, but communication was relatively good.

The negative may be the cost - now would be a good momemt for the accountabilty bit - how much resource went into the swine flu "watching" and "preparing"?

"as things wind down" - mfo

Must have missed the fat lady singing. Surely the overture. Hominid-Suidae transmission means the reservoir lives with us, figuratively.

I also think it too early to call this 'scare' ended. We now have reports out of Alberta of a case involving human H1N1 infection of swine. Has this one finished morphing? How does anyone know this is the case?

The WHO definition of a level 6 pandemic status differs from level 5,as I understand it, when person-to-person infection occurs in separate regions of the world vs simply within regional nations. Level 6 criteria has been met if this criteria is in fact the case. Why no level 6 WHO declaration? I think we can all guess the reason and it starts with $.

This particular flu virus was reported to the CDC and WHO first by a private U.S corporation named Veratect on April 16. Not by government agencies.

Should this flu have proven to be more of a killer (or a future one) and run its 8 week course through each region the result would be horrendous mortality numbers. My concern is that while SARS lessons are reflected in some national responses, I am far from convinced that nearly enough co-ordination and planning is in place to defend against the inevitable killer virus pandemic in our futures.

I hope my anxiety can be dismissed by someone.

Mfo I'd agree did we miss the Fat Lady singing or the bear market bounce? There really isn't enough information yet to say that we are out of the woods in Canada let alone the rest of the world. Now that we have seen the virus re-enter the pig population this will give another reservoir for further mutations down the road.

In the Globe article this morning the CDC spokeswoman was saying this is not the typical flu with regards to demographics in that there was a propensity to infect young people.

We are only one week into this epidemic in Canada so there likely will be more surprises to come. Trying to predict what this virus will do next is probably akin to asking the Bank of Canada's Carney where he thinks the Canadian economy will be in 3 months time.

As for the cost of the new monitoring it appears there are 707 new employees which includes 600 laboratory staff. I suspect this is money well spent given the fact during the SARS epidemic public health was tracking cases with 3M Post It notes and seemed to only have handful of competent people.
http://www.thestar.com/article/628216

Hedgehog I would concur with your assessment particularly with respect to the impact of raising the alert level to a six. In the past we have heard rumours of a change coming followed by an upgrade and in fact this morning the rumours have started.

It might be more useful in the future to actually have several indices reported for a pandemic much like we do for cancer staging with tumour, nodes, and metastasis reported in order to better determine treatment and prognosis.

The current WHO pandemic alert system only looks at geographic spread but tells us nothing about disease's morbidity or case-fatality rates. Given the relative low case-fatality rate to date outside of Mexico one might include this metric in the pandemic alert in order to allow the media to better gauge its reporting level and the public its anxiety level.

This particular pandemic might have a score on geographic spread of 6 but on mortality rate to date globally a 1 or 2 on a six point scale. (G6M2). For the 1918 flu at its peak the rating would have been G6M6. One could also incorporate a treatment option index as well into the score.

In the end it is clear we are all still learning from this H1N1 outbreak and mistakes will be made along the way. Hopefully we will learn from those mistakes in order that when the mortality risk rises substantially we will be properly prepared. In the meantime lets keep our eye on the ball as this pandemic unfolds in real-time.

This outbreak could simply be the opening overture as occurred in the Post WWI pandemic...mild in the spring...seemingly vanishing in the summer only to return with a vengeance in the autumn.

Can't think of anything that the government has done, having supposedly "learned from SARS", to take credit for the seeming passivity of this Swine flu...the ordinary flu season is still with us although it seems to be on its last legs...and there is another variety skulking in the background.

Before anyone starts to celebrate we should await for this autumn...hopefully this Swine flu virus won't have changed, gone through a mutation, that would allow it to erupt in a province without adequate facilities and respirators.

"An Alberta girl has been hospitalized with severe swine influenza A H1N1 symptoms, the province's chief medical officer of health said today."

http://www.theglobeandmail.com/servlet/story/RTGAM.20090504.wflustaffmain0504/BNStory/International/home


As to why influenza seems to have a propensity to worsen in the winter it is the absolute concentration of moisture in the air rather than the relative humidity which is important.

http://www.sciencedaily.com/releases/2009/02/090209205148.htm

The lack of any excess capacity in our hospitals is going to bite hard if and when this virus or another spreads in Ontario in true pandemic fashion.

Difficult choices will need to be made when we are down to our last ventillator.

We will not be able to offer ICU care to patients over 75 ? 65 ? 55 so good luck if your older than this.

Unfortunately this is not a joke.

Thanks to all for keeping the dialogue going in my absence.

I believe you are right ERDOC. We don't have even the teeniest bit of wiggle room.

If a family member were to fall ill and be unable to access care here in Canada, would I be able to go South of the border to pay for care or would I be denied access at the border? Would the US capacity be stretched as well? Probably.

In our community pandemic planning exercise last fall the medical group kept telling all the other groups (emergency services, large industries, businesses, and the county that a major pandemic would be entirely "self care" after the first ten days or so since our hospital, although it seems to have enough staff to put out bulletins saying "we are on top of it" every day, does not have any excess capacity at all. People would die, we said, and not only of the flu. They all seemed surprised.

Swine flu:

Clearly it will continued to be watched but we're through the panic.

Things learned:

1. SARS was a diaster waiting to happen. Despite numerous warning from a lot of good people (including the Chief Medical Officer in place before SARS hit) central refused to beef up things. Central can't deal with advanced core planning for health. It likes the "hot" items that get go press ($100 milion for new genomic work, etc) but doesn't have the means or skill set to properly fund core service.
2. Central over responded to the SARS diaster. Now we are "overfunded" in public health surviellence (no, we won't reduce it) but we are looking for things to give to public health to monitor.
3. We have no excess capacity in core services and it will stay that way until after we need them. we can't figure out how to build needed redundacy into the sytem. each time we try and resources are allocated - if not spent they get suffled off to other underfunded areas.

The plan is good - the politics will continue - Ontario Health Care Lite - love it or leave.

Gee whillikers, mfO.

Sounds like the MOHLTC is prepared to adopt the 'nothing like a good population cull" approach to solving a lot of problems causing excess capacity (i.e., ER wait times, ALC crises, long-term care home wait lists, and more).

Kinda harsh, no?

ELB:

"population cull" is a little to harsh.

It is preferred to refer to this policy of head in sand as "population realignment to available rationed resources".

Steering the good ship Ontario Health Care Lite we now have Capt. Doris Day. Hair blowing in the wind, spinning the rudderless wheel and singing the theme - Que sera sera.

I love that line MFO "Population realignment to available rationed resources"...it sounds so 'reasonable' that the general population might just accept it not realizing the implications for themselves and their loved ones.

George Orwell once stated that "Some ideas are so preposterous that only an intellectual could believe them"...one suspects that there are a few pointy heads 'up there' who really believe that the culling [sorry 'realignment'] is quite rational.

In the early 1990's Dr. King at that time on the board of Unicef if I recall suggested that we not use oral rehydration therapy on children under 5 if the resources did not exist in the community to support these children into adulthood. As expected he was vilified given his high profile position, but in the end his paper "Health is a Sustainable State" continues to be hotly debated to this day.

While his focus was on the demographic trap in the developing world it appears we are heading for a demographic trap in the developed world where we will not have the resources to support a huge and growing elderly population. If this is truly the case Dr. King might argue that we should not offer the influenza vaccine to the elderly as this will only deplete our limited resources further and place an unfair burden on the younger members of society who will be asked to support the unsustainable health system.

http://www.popline.org/docs/0918/063017.html
http://www.answers.com/topic/sustainable-health

'... not offer the influenza vaccine to the elderly as this will only deplete our limited resources..'
-Canary

Thankfully we are not dealing with this dilemma at present and we could improve planning based on this and other outings. The issue of course goes well beyond who gets/doesn't get limited life saving medical resources during acute shortages in the face of an epidemic.

We live in a world with such diminished environmental integrity that it is not unreasonable to assert that hundreds of millions of people now surviving with limited food or fresh water will see access completely disappear. The world will have to decide how what remains is distributed. The ethical debate will be Dr. King's on steroids.

Hug your loved ones and thank your maker for the Great Lakes and northern latitudes we have the good fortune to occupy....for now.

By the way, I think Canary's fine tuning suggestion re: WHO pandemic status levels is a fine one.

'... not offer the influenza vaccine to the elderly as this will only deplete our limited resources..'


Hmm, let's see if understand this. If I decline to treat my dog for an illness I will be charged with animal cruelty......

"When it comes to home, auto and life insurance, most Canadians are adequately covered. We hope that nothing ever happens, but quietly pay our premiums to give us what the insurance companies advertise as "peace of mind." When something does happen - a car crash, a break-in or a basement flood - we expect quick action and advice from our insurer.

The same analogy can be made with public health, the often invisible component of the health-care system. Its role is to prevent diseases and injuries from happening or to lessen their impact through early detection and treatment. In fact, when public health is successful, nothing happens, and therefore there is no news to report. You will never see a headline citing how many people dined in a clean restaurant, avoided an injury or did not contract a sexually transmitted disease."

http://www.theglobeandmail.com/servlet/story/RTGAM.20090505.wcohealth06/BNStory/specialComment/home

There are two health care systems...the one that most of us function in and the other, the Public health care system...it is the latter that should be the primary responsibility of governments and not the former.

The Public health system is a shadow of what it should be....from Walkerton's water contamination...to Maple Leaf's Listeria contamination...to SARS...to any pandemic...to immigrants entering Canada with a variety of diseases...but despite the various governments having proven to being inept....it didn't stop them from applying their innate ineptness to the rest of the health care system.

The government should go back to its knitting...focus on Public health....and if they did wondrously in that area they might have the right to make suggestions in the other health care arena, which they've managed to screw up royally.

Turnaround time on the nasal swabs is now at 7 business days and not the advertised 5 days. The nine to ten day lag time in order to rule out cases makes knowing what is going on in the community much more difficult.

We are fortunate in that all of these recent flu-like illnesses predominantly in the teen population are mild and have only required five to seven days at home in order to recover.

http://www.healthzone.ca/health/article/630602


"Ontario was required to address the interests of the public at large rather than focus on the particular interests of the plaintiff or other individuals in her situation."

EKlimek it is the quote below which only serves to illustrate that the province doesn't give a damn about health care workers. If and when the big flu arrives it will be look after one's family first and foremost.

It appears there is a duty of care to protect police officers from flying bullets and fire fighters from smoke inhalation, but when it comes to health care workers they are expendible and can be sent to the front line with only a surgical mask as we saw in SARS and again in this outbreak which fortunately has been mild.

When the big one arrives my office will remain locked with a large sign saying to seek urgent health care at your nearest MPP's office.


"While the Ontario government is obligated to protect the public at large from the spread of communicable diseases such as SARS, it does not owe any "duty of care" to individual residents who contract such an illness, the court said.

This is equally true for nurses and other health care workers, said Justice Robert Sharpe, who wrote the series of decisions on behalf of the unanimous three-member court.

"Nurses were, by virtue of their profession, in the eyes of the SARS storm, but they had no higher claim to have their health protected by Ontario than any other resident of the province," he said."

http://www.theglobeandmail.com/servlet/story/RTGAM.20090507.wsarsappeal0507/BNStory/National/home

One can not successfully sue the Crown.

The ultimate weakness in Health is "true accountability" is absent in monarchy run systems. Central can impose action, paid from with serfs money, but , in the end, isn't directly accountable.

http://www.freerepublic.com/focus/f-news/900134/posts

thought you might appreciate this twitter link for CDC:

http://twitter.com/cdcemergency

Realist your thoughts on pre-existing co-morbidities in order to explain the excess of Mexican deaths appears to be on the right track given there is no genetic difference between the Canadian and Mexican H1N1 virus.

The other factor was the virus in Mexico had at least four to six weeks to circulate in the general community before measures were taken to curtail its spread. As more Mexicans were infected the odds of infecting those with chronic disease increased.

Let's hope the one case in a Princess Margaret Hospital worker remains that way as cancer patients would be the type of patient in which the virus could cause significant disease.

It is interesting to note the one quarter of patients who had vomiting and diarrhea which may increase the risk of spread if washrooms are not kept adequately sanitized. We made need to take a closer look at the uptick in gastro cases we have seen in the office over last ten days.

http://www.google.com/hostednews/ap/article/ALeqM5gD1ZJvhHO6wfvF42FQf6V4E9eISgD981MJA02

Good point Canary .....yes...washrooms....uggghhhh.
I must admit I see more people using hand-sanitizer in public places than I ever used to....in TO last weekend and one little automatic dispenser at the Eaton's Center entrance seemed to be kept busy but one wonders if a few people using it while thousands walk buy makes any difference. Perhaps a good reminder though.

We keep hand sanitizer on wall mounted units in the hallways of our clinic and although originally intended for our staff, I now see patients using it on their way in our out....smart patients!

http://www.cbc.ca/canada/edmonton/story/2009/05/07/edmonton-swine-flu-death.html

"true accountability"- mfo

So let's agree for the moment that that the Ontario HC system is not held to such accountability.

Can you indicate a nation with a HC that is?

This court ruling may not be the final ruling on this subject of course. Again assuming for the moment that it is, it does essentially support the view that individuals have both obligation and right to protect themselves in any reasonable manner they deem warranted.

That is, if doctors, nurses, social workers, cleaners or anyone else working in a public setting during a contagion event wants to done mask, smock or anything else, the employer should not see themselves in a position to insist they do not for fear it send the wrong message to the public.

Quite the conundrum.

The health care providor now has no choice but to resign or go AWOL. Otherwise the individual is conscripted into acting in an manner that exposes them to an known avoidable risk but disregarded by the state in favour of societ's benefit

In my opinion the action should be recognized and valued beyond their hourly salary.

If, during a war situation, the government and its generals proclaimed that they owed "no duty of care" for their troops in the trenches...that if they were maimed or died in the line of duty neither they nor their loved ones would be cared for...they should not be surprised if none of the troops emerged from the trenches on the command to advance on the enemy...they should not also be surprised if the troops did emerge from the trenches that they would be advancing on the government and its officer corps with fixed bayonets....one is reminded of the Russian troops on the Eastern Front in WWI turning on the effete and indifferent Russian aristocracy which had sent them to battle poorly armed, poorly equipped with imbecilic leadership.

The signal has been given by the powers that be that those in the medical profession front lines are on their own...the recent judgement will be digested...and when the bugles are sounded the powers that be will find the trenches empty.

"The time to dig a well is before a drought"...it is a concept alien to the political bureaucratic class.

http://www.ona.org/node/1335

“The message to front-line registered nurses is that government is not accountable for their safety or their lives,” says Haslam-Stroud. “The government is not required to pass laws that provide RNs with safe working conditions, safe equipment and they don’t have to take any responsibility to keep us safe. It’s an outrageous and deplorable situation.”

http://www.theglobeandmail.com/servlet/story/RTGAM.20090508.wflu0508/BNStory/International/home

http://www.cbc.ca/canada/story/2009/05/08/edmonton-swine-flu-death.html

It is not often that I get to agree with Andris outright. His last post gives me an opportunity to do so.

I just cannot imagine we have heard the last word on this one.

HH

Motivated health care providors will, and should, seek further action on this decision. Those motivated few are the very ones who will give their best in a crisis. They have every reason to ensure their loved ones are cared for, if it costs them their lives.

We should all be much more concerned if none seek further action or the government fails to come forth spontaneously with new legislation to meet this challenge.

Because it means, none will be there when the heavy lifting starts. Good luck with SARS - Version 2.0

http://www.google.com/hostednews/ap/article/ALeqM5hZVkRqV2uZVim0TRk5R1ZBfovTCAD982VKS80

Thanks Canary!

And Happy Mother's Day to all the mothers and the children who are remembering their mothers!

Have a happy day.

Greetings from Central

Clearly the most inactive period we've had in central for years. We are locked down from spending so all committees are inactive, basically treading water.

All is safe and secure because Ministry funding is assured until 2011 so all in all secure with income and benfits but it's hard to sit and watch.

Has been some staff movement - the arguemenst that were surfacing that perhaps other options exist are gone - we are too entrenched and will remain fix with central is right and central will pay for all approved services. We deeply enjoy the power, but also the public loves free health care. They can't help but love it more than 80% of the population beenfit from the current system because of the revenue reditribution system, and the 5% that are "hurt" by lack of acre and fragmented into small enough groups that they have no political voice.

Still lots of special interest groups from health approaching MOHLTC with plans to improve the system as long as the new money is directed through the special interest groups. The conflict of interest in the system is overwhelming but we seem to survive, thank goodness for tax revenues.

Folks,

I am surprised (gobsmacked, really) at the absence of chatter on this blog regarding the Minister's/Ministry's unilateral decision to suspend the registration of graduating family physicians into primary care care practices.

Government representatives say that they want to go over some issues with the Ontario Medical Association that are largely technical and related to funding. The review will take about a month to complete.

With all due respect to her Majesty, this is a bunch of Purple-assed Royal bullshit. I for one fully expect the results of the review to be completed no sooner than September 2009. No inside info...just my gut.

This will cause many (if not all) family physicians in Ontario to seriously reconsider this former "have" province as a location to set up practice. Frankly, I expect President Obama to stretch his welcoming arms across our friendly porous border and snap up many who are facing loan repayments at the very beginning of their clinical careers.

How sad that this untimely and counter intuitive action will defeat the aims of the Ontario government and signal that the province is actually closed for (health care) business.

Please ... for our system's sake I hope that someone is able to prove me wrong.