Corbella: Frustrated Doctors ‘Hindered,’ Not Helped by too Many Managers

Commentary, Healthcare & Welfare, Frontier Centre

‘They justify their existence by dreaming up new processes and systems that have nothing to do with patient care but that significantly adds to our workload’


Judging from the amount of mail I received from front-line health-care workers following my weekend column, the consensus is that there are too many bureaucrats in provincial health-care systems and not enough doctors and nurses.

It’s safe to say that front-line health-care workers across Canada feel overmanaged and under-supported, but I’ll focus on Alberta doctors, all of whom asked to remain anonymous for fear of repercussions.

“They hinder us more than help us,” said one Alberta surgeon from Edmonton.

“My colleagues and I try to figure out what exactly our ‘bosses’ do all day except nitpick away on stuff that doesn’t matter. We’re saving lives and they’re running around . . . creating procedures that do little but bog us down with paperwork that no one ever reads, except maybe them, since occasionally I’ve been corrected on the words I’ve used,” said a physician at Foothills Hospital.

“They justify their existence by dreaming up new processes and systems that have nothing to do with patient care but that significantly adds to our workload,” wrote another doctor who works in an Edmonton hospital.

One surgeon from a Calgary hospital said that for every five doctors in his hospital there is one manager, a figure I am awaiting to confirm through AHS communications.

“I don’t need managing,” wrote the specialist. “I’ve been doing this for decades. What I need, what we need, is more beds, more surgery time, less red tape, more support. We’re all exhausted not because of our work — I love what I do and I could do it for 12 to 18 hours a day and regularly do. That’s not what exhausts me, what exhausts me are the battles I have to wage on behalf of our patients.”

As pointed out in my last column, when Canada’s health-care system (which is ranked as one of the worst universal systems in the developed world) is compared to Germany’s (ranked at or near the top in the world), there’s one striking difference: Canada has 10 times as many health-care administrators as Germany, even though Germany has twice the population of Canada.

Canada has one health-care administrator for every 1,415 citizens. Germany: one health-care administrator for every 15,545. Even accounting for Canada’s vast land mass and that each province and territory runs its own system, the discrepancy doesn’t make sense.

That information is compiled in a compelling and very readable new book: Patients at Risk: Exposing Canada’s Health-care Crisis, by Susan D. Martinuk.

“Five million Canadians cannot find a family doctor to manage their care, almost 40 per cent of our doctors will be over the age of 55 and closing in on retirement within three to five years, and while the number of physicians may currently be increasing, it still remains well below that of other developed countries,” writes Martinuk, a health researcher and writer.

The book, which includes numerous gut-wrenching stories of tragic health-care failures that leave the reader with equal measures of sadness and anger, is also chock-a-block with statistics from numerous sources.

According to 2017 Statistics Canada information, 15.3 per cent of Canadians don’t have a family physician.

“These same statistics indicated that Ontario patients had better access to physicians than the national average — even though 1.45 million Ontarians do not have a doctor.

“Quebec appears to be in the worst shape for numbers of doctors as 25.6 per cent of its population (12 or older) were without a regular physician in 2018. In B.C., Saskatchewan and Alberta, that same number is more than 18 per cent.”

According to data compiled by the Commonwealth Fund’s International Health Comparisons survey (2017), Canada ranked 13th out of 17 countries when looking at the number of physicians per 1,000 population.

“It credited Canada with 2.7 physicians per thousand, still far below other OECD countries such as Norway (4.7) and five other European nations that each registered higher than four doctors per thousand,” writes Martinuk.

Considering that Canada has such an enormous land mass compared to many of the other countries studied — Switzerland (4.3 physicians per thousand), Sweden (4.1), Italy (3.99) and France (3.2) — only makes these numbers worse.

Not having a family doctor means that many Canadians do not have access to specialists, either, since you need to be seen by a family doctor to get a referral.

One of the stories in the book that illustrates that point is of Ralph Coughlin of Prince Edward Island, who has been waiting for a kidney transplant since early 2018. “But he may miss out on the opportunity for a new lease on life because he does not have a family doctor,” says Martinuk.

“The transplant team in Halifax quite reasonably requires recipients to have a family doctor to provide ongoing care and followup after the procedure.” After visiting seven clinics, Coughlin was told to put his name on a provincial patient registry, which he did, only to find out that it has a two- to three-year wait.

“Access to specialists is most often determined by factors such as time from referral to a consultation appointment, or time from referral to treatment. According to the latest statistics from the Commonwealth Fund, Canada is last in each category,” writes Martinuk.

Canada ranked worst out of the countries studied that had data available when it comes to the percentage of patients who waited two months or more for a specialist appointment (30 per cent in Canada but just three per cent in Germany) and worst again when it comes to the percentage of Canadians (18 per cent) who waited four months or more for elective surgery compared to best in class Germany (0 per cent).

“It’s appalling to know that, compared to others, our system is one of the worst in the world, but it is even worse to know that we spend more money on our health-care system than almost every other country,” says Martinuk.

Meanwhile, AHS is investigating the death of an unidentified person in Red Deer on the weekend, who went to emergency and was never treated as wait times spiked to 14 hours at the hospital’s emergency room.

This will likely be blamed on the stress that COVID-19 is causing in our hospitals, but these kinds of stories happened long before COVID ever came along. Martinuk’s book is full of them.

“We do, however,” she said, “have 10 times as many administrators.”


Licia Corbella is a recently retired Postmedia columnist from Calgary. Appeared originally in Calgary Herald, January 26,2022.

Related items

See Policy on Frontier discussion session with Susan Martinuk and David Leis, March 24, 2022 (1 hour), click here.

Order the book, Patients at Risk: Exposing Canada’s Health-care Crisis, by Susan D. Martinuk.