On Tuesday, Feb. 14th, 2012, an article appeared in the Ottawa Citizen: "Waiting for a Health-Care Crisis".  In the article, the authors challenge Canadians to muster the confidence to tackle the looming health care issues now, instead of waiting until a crisis strikes.  The article quoted several essays published by the Macdonald-Laurier Institute.  One in particular, by Professor Janice MacKinnon offered her frank comments:

        "the problem cannot be addressed without fundamentally changing our health care system and its funding."  She suggests diverting

         services away from traditional hospitals, which in her words are "expensive, heavily unionized, and therefore difficult to manage

         efficiently."  She believes private clinics, focusing on specialty care, can deliver better services at a lower cost.

         She also wants patients diverted from expensive and crowded emergency rooms and other costly facilities to primary health clinics. "                            

These, and other of her comments are meant to offer " a model for how Canadians and their governments can and should be debating health care reform today".

Other suggestions revolved around how things should be paid for.  It is emerging that the old system where most Canadians pay nothing out of pocket for publicly insured health-care services would have to change. Considering my experience, this comes as no surprise.

But more of this issue upcoming.

Pierre Dupont  is a welcome addition to our practice.  Here, in his own words, he introduces himself:

I received the degree of Doctor of Podiatric Medicine (D.P.M.) from the Quebec University in 2010, knowing that I still had much more to learn... My ultimate objective was to serve, to the very best of my ability, a community deeply in need of high-end podiatric services. In order to achieve this goal, I knew the best way was to join the most reputable, team oriented, progressive & successful podiatric private practice I could identify in Canada. By joining Feetdocs in August 2011, I have not only put my shoes in the practice of my dreams; I am also privileged to work side by side with a solid Master willing to share his 30+ years of experience derived from a very dynamic & busy private practice.

I am thrilled to be part of a practice offering its clientele a real solution – the laser treatment - for fungal nail infections, a problem I had studied with a special attention since I had been personally affected by this condition for the last five years…

Since my involvement with Feetdocs, I have actively participated in the introduction of revolutionary and optimal treatment protocols for Morton’s neuroma, foot ulcerations & plantar warts.

I am particularly proud & excited to be part of the first podiatric practice in Ottawa to offer the HyproCure Internal Orthotic Device as an alternative to the conservative External Orthotic Device. For thousands of patients suffering from the numerous ailments of misaligned feet, their TaloTarsal Dislocation Syndrome results in many ailments, such as heel pain, ball of the foot ailments, repetitive ankle sprains, chronic tendinopathies & neuropathies, knee & hip joints stress, lower & upper back pain.

Has the Ontario Medical Association given me a ringing endorsement of my practice model?

The OMA argues that "as the province looks for ways to curb health spending, clinics are a viable option because they can deliver many of the services currently offered in hospitals at higher value and lower costs".

Dr. Stewart Kennedy, the OMA president notes that "there are lots of procedures that do not need to be done in the more expensive infrastructure of a hospital"

In 1973, when I first began to practise podiatric medicine in Ontario, I was prevented from performing many of the procedures that I was trained and qualified to perform within an existing healthcare facility - hospitals included.

As a result, I and other progressive doctors of podiatric medicine were forced to develop techniques and surgeries to be delivered within our own private ambulatory surgical facilities.  These procedures have been solving foot pain for years outside of hospital settings.  Although OHIP helps pay a small portion of patients' podiatry costs on a per visit basis, no such coverage is available for surgical procedures in our private setting.  Study after study has shown that ours is a cost effective model, but, ironically OHIP and public funding will only pay for services provided in the most expensive settings - the hospital.

I doubt very much that the OMA had me in mind when they made the case for my delivery model since they represent Ontarios 26,000 doctors.  But, isn't it time that we be included in discussions regarding new, innovative and effective models for improving the delvery of health care to Ontario residents?

I recently received a bulletin from the College of Chiropodists of Ontario with current news affecting our profession.

Of particular interest was an article entitled "Ontario Labour Mobility Act-Strengthening the Economy by Opening Provincial Borders to Workers".  The article states:

        Under the Agreement on Internal Trade (AIT), certified workers in professions and skilled trades will be able to move freely, to work where opportunities exist or where they choose to live in Canada.  Therefore, if a chiropodist or podiatrist is a member in good standing in another regulated Canadian province, they may come into Ontario and will be required to write the Jurisprudence exam.  This legislation supports the right of all Canadians to live and work where they want in Canada.

The Ontario Labour Act applies to over 80 regulatory authorities and 300 occupations.  Amendments to the RHPA, require the College to incorporate the principles of labour mobility into our Registration Regulation.  The deadline for doing so was originally December 15, 2010.  However, this deadline was extended to June 2011.

However, a podiatrist, DPM (doctor of podiatric medicine) who is licenced to to practice in Alberta, Quebec or B.C, may not be licenced as a podiatrist  in Ontario.  He/She must register as a chiropodist, which means that many procedures one is qualified to perform in those provinces, cannot be performed here.  I refer to the taking of X-Rays, performing bone surgery (bunions, hammer toes etc.), communicating a diagnosis as well as other rights and privileges afforded only to podiatrist registants.

I must be missing something, because our college governing board seems to think that registering a podiatrist as a chiropodist is some form of equivalency, and in the best interests of Ontarians' foot health needs.

We need podiatrists, registered as podiatrists!

On Friday September 23, 2011, Amir Attaran, the Canada Reasearch Chair in Law , Population Health and Global Development Policy in the Faculties of Law and Medicine of the University of Ottawa, wrote an article in the Ottawa Citizen titled "Still Waiting for better Care".  In it, he says that the McGuinty government has failed to meet its most basic goals for improving the health system, but wonders if the other parties can do better. He states that "no party has developed an adult discussion on health care, and that is a shame because it makes choosing between parties hard".

That certainly is at the heart of my voting dilemma as I try to gauge who will best take care of the health care mess and in particular foot health.

Several weeks ago a patient who has been working for the re-election of Bob Chiarelli suggested I write to Bob since she was certain that he would see the importance of improving foot health.  I have a great deal of respect for Bob, having worked with him to raise funds for the Ottawa Regional Cancer Foundation while he was mayor.  Reluctantly, since Dalton McGuinty had not responded to me when I attempted to gather his attention, I did write to Bob, explaining the plight of podiatry in Ontario.  I did receive a reply telling me that my letter had been forwarded to the member in my riding, Madelaine Meilleur.  I received a letter from Ms Meilleur's office saying that my concerns were forwarded to the Ministry of Health who notified me that there are procedures in place and the matter of foot health would be dealt with somewhere in the future. Does that mean that the Ministry of Health has taken the lead?

 So much for being able to raise the level of consciousness of the government and the MPP's in my immediate area. One would hope that our elected officials, especially during an election campaign would show some concern.

The above is no surprise to me, but it still leaves me the question of who can best provide a clear vision and guidance when it comes to health care in Ontario.  Where do the Conservatives stand?  Tthey and the NDP were instrumental in creating the situation we find ourselves in today (see previous blogs). I am unaware of their position now, or if they actually have one. 

Does anyone really care to fix the problem?