April 22, 2020
By: Sonja Sajic
I am a Pharmacist-turned Physician Assistant student at the University of Toronto. As a pharmacist, too many times, I heard my patients complain about how long they had to wait to see their doctor or specialist, and how rushed they felt when they finally got into the clinic. Like so many others, my patients were members of an underserviced city in crisis. Many of my sickest patients also struggled with addiction, mental illness, homelessness, and violence. Their doctors were overworked and beating their heads against a system that didn’t support the sickest people in the community. While very well intentioned, these doctors are only human, and even with longer hours and rapid-access clinics, the needs of the community were overwhelming.
As a pharmacist, I felt powerless to help the many people and doctors who were victims of a broken system. I knew that although many of my patients who had been prescribed pain medication really needed it, they were selling their meds on the street, just to pay for another night at the hotel, or for another warm meal. I knew that many other patients bought illegal drugs, because they couldn’t cope with the burdens of their daily lives. Many of these patients wanted to get help, but wait-lists for counselling, detox programs, and mental health clinics were too long, and they were lost in the system. I desperately wanted to help them, and for me, helping them meant helping their doctors find better ways to meet their needs. And so, I left the comfort of a 16-year career in Pharmacy to become a Physician Assistant.
As a physician assistant student, I am learning about how to diagnose and treat common illnesses as an extension of our already overworked physicians. We learn about symptoms and medications, lab tests and anatomy. But more importantly, we learn about how our approach to the health of society must extend beyond recognizing and treating illness to include the social factors that leads our patients, and all of us, down the path towards poor health. You might be surprised to learn that the biggest determinant of poor health isn’t a poor diet, it’s a low income.
When you think of “poverty”, perhaps you think of words like “poorly dressed”, “lazy”, “beggar”, “dirty”, “crazy”. You’re not alone. This is the image we have come to associate with “poverty”. The reality is much harder to believe for those of us living in a developed country like Canada. But, according to a 2016 Statistics Canada report, for over 20% of Canadian families and more than 25% of single seniors, mostly women, poverty is all they know.
We often hear about the “unsustainability” of the healthcare system in Canada. But what we don’t hear enough of, is how our system of caring for our basic needs is unsustainable, and worse yet, it’s making us sick. We know that the best way to minimize the costs to our “unsustainable” healthcare system, is not to get sick. It sounds so simple. But the fact is, our society is already sick. And our approach to caring for our sick is just making them sicker. Low-income puts anyone of us at risk for developing diabetes, heart disease, cancer, mental illness, toxic stress, accidents and trauma, and a whole host of other chronic diseases. However, doctors can’t see into their patients’ minds any better than they can see into the future. Unless they find the time to ask the tough questions about their patient’s income, they won’t really be able to make them well. It’s like putting a band-aid on a bullet wound. So “hire more doctors!”, you might be saying. The number of doctors graduating from medical programs in Canada is simply not enough to meet the demands of an aging, growing population. Even if more students were accepted to medical school, the training time is a minimum of 7 years to become a Family Physician. Even longer to specialize. Enter, the Physician Assistant. Trained in the medical model, Physician Assistants cost ¼ the amount the government pays to a single physician. A single physician can supervise multiple Physician Assistants. By working together to extend the care that physicians provide, Physician Assistants can take the time to ask the tough questions about all the factors that our making our patients sick. Simple questions like, “do you ever struggle to make ends meet” can have a significant impact on how doctors manage their patient’s health. Adding physician assistants to a medical practice gives doctors the time to see their patient’s whole health: body, mind, spirit, and yes… financial burdens.
As it is now, our “healthcare” system is really a “sickcare” system. We provide care when our citizens are already sick. Of course, a system that waits until patients are already sick, can’t possibly be sustainable. The population is growing, and at the same time, it’s getting older. Our level of unemployment and poverty are on the rise, and poor, unemployed, socially isolated, people make for very sick people. Sick people demand more of our healthcare system, and approaching health as solely physical, is short sighted. Only by addressing the factors that contribute to sickness, can we hope to create a sustainable healthcare system. A healthier society means a more sustainable healthcare system for all.
Speak to your MPP today to demand support for your health by adding Physician Assistants to every healthcare team.