Here in beautiful North Vancouver Island we have a problem. The Vancouver Island Health Authority (VIHA) wants to spend money on us for a new regional hospital. The problem we have is that most people are in favour as long as it remains in their own community.
Initially, VIHA paid a consulting firm to meet with stakeholders and find the best location for this brand new hospital. The solution arrived at was to place the hospital halfway between the two communities of Comox and Campbell River. VIHA looked at her new baby proudly, but found that no one would admit to being the father. And that was a problem, because the municipalities of the north are responsible for footing 40% of the cost. If they don't agree, VIHA doesn't get a hospital. More importantly, neither do the people who live here.
So, the municipalities decided that the best thing to do was to have the doctors decide. They appointed two doctors each from the Comox Valley and Campbell River to come up with an answer. Not surprisingly, they couldn't agree. None of them wanted to move.
We now have two well dug in camps. One insists that VIHA refurbish the old hospitals in the Comox Valley and Campbell River. The other insists that a regional hospital is required to save health care in the north.
I would probably support the first group (enhanced status quo) if we were delivering great care to our population. The facts however suggest otherwise. Surgical call is split between the two hospitals. We end up transferring patients to the other community's hospital if we don't have an appropriate surgeon on call. Sometimes, we'll have an orthopaedic surgeon on in one hospital and a general surgeon on in the other. This doesn't work well for trauma patients who may need both types of surgeon to get them out of trouble.
The other problem has to do with critical mass. We don't have the numbers of physicians in each specialty to sustain the call schedule. We are facing a manpower crisis when the baby boomer docs retire. Thirty percent of internists, 38% of orthopaedic surgeons and 33% of general surgeons in this province have been out of medical school thirty years or more. The docs coming to replace them will not be willing to work on call every other day.
There is also the economic problem to consider. Hospitals pay their workers well. Campbell River in particular relies on its hospital as an employer. It is losing its pulp mill, having previously lost a sawmill. Municipal politicians aren't likely to agree to losing another major employer.
All of this is by way of setting the scene. What can be done to get out of the impasse and to deliver the care that the residents of the north deserve. Well, at one level, we may be going about the problem backwards. It would make more sense to ask the physicians and nurses in these two communities, in consultation with VIHA to talk about what services we should be able to deliver here. Then VIHA should go with its planning staff to the municipalities to discuss how we could do that. The physicians should not be part of that discussion.
If I were the Czar, we would have a single hospital with two campuses, one in each community. One campus would be responsible for inpatient care and would house all on-call services. The other would be a state of the art ambulatory care centre providing teaching clinics for the medical school, day surgery, endoscopy and diagnostic facilities. It would be win-win for all communities. Too bad I'm not the Czar.
