Health-care crisis: conspiracy theory or patriarchy at work

Doug Ford, get your white, male-privileged paws off our health-care system.

Canada’s universal public health-care system, so long a symbol of our national identity and source of international pride, is being dismantled before our eyes.

We can no longer discount conspiracy theories that the Ford government is calculatedly starving Ontario’s public health system as a means of clearing the path for more privatized services.

Exhausted and frustrated nurses are leaving the public health-care system in droves Recruitment efforts are falling far short of need. Staffing shortages are leading to unprecedented waitlists, closed emergency rooms, and a staggering shortage of family physicians, who are scaling back unmanageable workloads or retiring in large numbers. To date, 2.2 million patients across Ontario have no family doctors. That includes 32,000 in my city of Kingston.

Ford’s many stealth moves toward undermining Ontario’s healthcare have only escalated since the onset of the Covid pandemic. He has subscribed to a type of ‘disaster capitalism’. Amid a crisis, governments and corporations take greedy advantage of the urgent need for immediate solutions. Ford’s latest move to introduce private clinics in what he is selling as an attempt to deal with unwieldly patient wait times is a prime example.

Ford’s government has passed Bill 60 to allow more private delivery of healthcare, including publicly funded surgeries and procedure. This approach would once have been widely condemned as another step toward a two-tier system where patients of means can jump the queue and access services out of reach to others: it’s now being shrugged off by many as a reasonable solution. But the unintended consequences – or at least unacknowledged consequences – of setting up a parallel system will seriously undermine the underfunded public system as it is forced to compete with the private system for nurses, doctors, and other frontline workers. Indeed, many nurses are already turning to private agencies where the pay and pace is much more to their liking.

And who can blame them.

Throughout the pandemic, nurses worked exhausting shifts, at a time of severe staff shortages, and at risk to their own health and that of their families. In return, Ford slapped them with Bill 124, capping their wages at one per cent. The law targeted nurses and teachers, leaving male-dominated professions like police and firefighters untouched. Briefly celebrated as angels and heroes during the peak of the pandemic crisis, nurses soon learned their real worth in Ford’s eyes. (The court recently struck down Ford’s tight-fisted, sexist approach).   

This blatant and unapologetic undervaluing of women’s work in a field that is still over 90 per cent female was a shocking unveiling of patriarchy in action and a harsh reminder that progress is often illusion. Gender discrimination is baked into the system. The pie is still being sliced up the way it has always been. Female doctors in Ontario earn 34 per cent less on average than male physicians in 35 specialties, including those dominated by female doctors, such as obstetrics and gynecology, reports the Globe and Mail.

You won’t see many female names amongst the highest paid members of the system. Only eight per cent of Ontario’s top billing MDs are women. The glass ceiling remains firmly intact, even though woman now outstrip men in graduations from medical school and nearly 60 per cent of doctors under 35 in Ontario are now women.

For decades, male-dominated surgeon and physician lobbyists have blocked nurses, nurse practitioners and midwives from applying their full expertise and skill set to the care of patients. The Ontario government has long ignored a call from nurse practitioners for a funding model that enables them to play a bigger role in primary care. 

Governments, like those of Premier Doug Ford, who embody strutting male smugness and ignorance, put no value on many essential skills traditionally viewed as female. In healthcare, these include communication skills, patient-centered teamwork, diversity of skill sets, compassion and empathy, and community outreach.  A recent study found that AI’s newest rave ChatGPT has demonstrated a better ‘bedside manner’ than some doctors. 

Ontario spending on public healthcare has for years been lower than that of the other provinces. Ontario also has the lowest hospital funding, fewest hospital beds and fewest nurses, notes the Canadian Centre for Policy Alternatives. 

The mounting crisis has given new impetus to ongoing calls for a major overhaul of the health-care system. A new Taking Back Health Care report by an expert panel led by Queen’s Dean of Medicine Dr. Jane Philpott calls on provincial and federal governments to create a more accessible health-care system with a team-based approach.

Commissioned by Canada’s Public Health Forum and released four months ago, the report notes that “coordinated care includes doctors but is not exclusively about doctors…There simply needs to be more choice and access points to primary-care services.”

Health-care academics and educators are diplomatic in how they articulate the problem. The don’t use the word patriarchy. But it’s not difficult to read between the lines. Dr. Rosemary Wilson, a nurse practitioner and Associate Director of Graduate Programs in Queen’s School of Nursing, says it’s time to redefine the problem from being a shortage of family physicians to a shortage of primary care providers. “There is enough work for all of us, for family physicians, for nurse practitioners, and for physician assistants. And registered nurses should be able to play a bigger role in primary care. Then we would be able to deal with some of the problems we are now facing.”