A deep, moral obligation’; Doctors showed ‘strength and stamina’ during COVID, OMA head says
Posted: May 3, 2023
(May 2, 2023)
By: Jeffrey Ougler, Sault Star
It’s probably unprecedented that the public has seen so many doctors up close and personal.
Since the pandemic reared its head more than three years ago, the mainstream media have banked heavily on expert commentary from those on health-care front lines. And, in turn, those in the trenches have relied on reliable information providers to get the proper message out. Toronto infectious disease specialist Dr. Isaac Bogoch is likely now as well-known to many as the familiar faces and voices posing questions. And, closer to home, Sault Area Hospital infection control specialist Dr. Lucas Castellani, who in more normal times would carry out the bulk of his work behind the scenes, has been tapped by the Sault Star more than once to lend his expertise to stories. Dr. Rose Zacharias has also been among those for whom microphones, digital recorders and cameras, have become very familiar.
Ontario Medical Association’s president has fielded her share of media questions over the past year that she has headed up the membership organization that represents political, clinical and economic interests of Ontario physicians.
These have been strange times and, unlike so many of her predecessors whose duty it was to mostly ring the alarm bell over such chronic problems as underfunded public health care and physician shortages, Zacharias also had to weigh in during a most turbulent time when doctors were not only dealing with the unknowns of the pandemic, but contending with those forces totally opposed to what they were doing, whether it be the anti-vax crowd, those who considered COVID a hoax or many who utterly scoffed at any COVID-related restrictions. Perhaps all three rolled into one.
“I think it was often times disappointing to see the level of harassment and negative commentary on social media, speaking out against public health experts and health-care providers who want only to do right by our patients,” Zacharias told the Sault Star in a phone interview. “As a profession, we will not tolerate harassment of any kind and we, ourselves, abide by a certain code of conduct.”
Doctors, she said, are scientists who rely on data and evidence to inform decisions.
“And we expect that from our patients, from our communities … and it is a deep, moral obligation to care for anyone and everyone in our publicly funded health-care system who reaches out for health care.”
Even those who vocally and, in some cases, violently opposed them.
“That’s a concrete example how we don’t turn anyone away no matter what someone believes, no matter how someone has behaved. And I’m extremely proud of that ethic in our profession,” Zacharias said. “I do think that also saw us through the trying times of the pandemic.”
As she wraps up her term this week, the veteran Orillia, Ont., MD reflects on this most challenging time in health care and the battle she and her colleagues waged to keep Ontarians safe and sound.
“I’m incredibly proud of my physician colleagues for the strength and stamina and compassion and intelligence that was applied to their everyday work,” she said, adding what “sustains me professionally” in her OMA role is “really bringing a message forward of truth and of trust of a deep conviction to care, and also advocating for health-care system changes so that we can continue to deliver high-quality health care to everyone in Ontario.” Public health experts were also essential, she said, as they ruddered a vaccination campaign that was “impressive and, indeed, provided protection.”
Zacharias, 50, an ER physician and hospitalist at Waypoint Centre for Mental Health and who administers to an “incredibly vulnerable” portion of the population, saw firsthand what happened in her facility prior to widespread vaccinations when COVID-19 outbreaks occurred. Subsequent outbreaks after mass vaccinations yielded no deaths.
“It speaks to the protection the vaccine afforded us and the public’s uptake of it. I’m so glad to be at a very different place now,” she said. Indeed. But so many health-care challenges remain in the wake of the pandemic’s darkest days. Physician shortages, overburdened facilities and mental health and addictions issues, continue to plague this overburdened system.
Zacharias cites co-ordinated, team-based, community-embedded care as what doctors report they want, “but are yet far from realizing.”
“It’s relevant when we speak of mental health and addictions care, when we speak of long-term home and community care,” she said. “Our hospitals are overwhelmed, our emergency departments have occasionally closed because they were beyond capacity. Because it’s really an upside-down experience of the type of care that people need. We want to bring care to where people are currently, and our system doesn’t have that degree of care inside communities.”
Replacing retiring Ontario physicians – many, Zacharias said, are heading to the door branding burnout – will be a major challenge, especially filling family medicine roles, as specialization appears more the popular choice among recent medical school grads.
“We ask doctors what the problem is … They point to administrative burden,” Zacharias said, adding some 75 per cent of OMA member report they are operating at a level of burnout.
“We want doctors to be doctors so as to be equipped in their power to cut away from their documentation responsibilities, their administrative duties and do clinical care. That’s really the joy in our experience of medicine, to practise clinical medicine, to build relationships with patients, make diagnostic decisions and treatment recommendations.
“So, decreasing the administrative burden is key and then we can be, I think, equipped, empowered and able to manage the health-care needs that will exist inside of our aging population. Until we make some changes within the system, that type of quality care will be under threat.”
The Canadian Medical Association’s 2021 National Physician Health Survey, which grabbed no shortage of headlines here and elsewhere, saw MDs speak openly about burnout, exhaustion, moral distress and, not surprisingly, a growing exodus from the profession.
So why would a bright, motivated undergraduate choose medicine now? Zacharias says for the same reasons she did, recalling being “ecstatic” the day she learned she was chosen for the incoming Mc-Master University medical school Class of 1999.
“I still believe that those reasons around which I was excited still exist,” she said. “An opportunity to study academically, to apply oneself clinically and to come alongside people at their most vulnerable points in life, pursuing health and their well-being, but often struggling with poor health and disease. And coming alongside in an intelligent and compassionate way to help make people better is still a high calling that many people do aspire to.”
Zacharias said enthusiasm she sees on the part of students, interns and residents, buoys her.
“There is an excitement and there is a joy of the optimistic hope of a medical career,” she added.
“We, who are in the profession, and all levels of government and all the health-care system stakeholders, have a responsibility to come together and co-ordinate positive change within the system for exactly the people who we want to retain and recruit into medicine.”
Ontario medical school faculty are designing programs to educate students and equip them “as best they can” for a future in the health sector, Zacharias said.
“It makes me very hopeful because we still do have a lot of very bright people who want to enter the medical profession and it’s what makes me hopeful for this profession and even for the healthcare system because of the people we will see inside of it,” she added.
Northern Ontario has its own unique set of challenges in the doctor recruitment department. Northern Ontario School of Medicine, officials have told the Sault Star over the years, has been instrumental in stemming some of the need in this vast geographic space. But the jury is out as to how effective it’s been helping the hinterland.
Speaking to the Sault Star in 2018 as vice-president clinical with North East Local Health Integration Network, Dr. Paul Preston said NOSM had been “good” but not “complete” in fulfilling the role for which it was designed. The North Bay doctor said the problem often stems from the fact graduates will remain in the North but settle in larger centres.
“They’ve tended to not go to the most difficult spots,” Preston said at the time. “They may come to the Sault, but that’s very different than practising in Hornepayne. Guess where the docs are short? Hornepayne.”
Zacharias said she is heartened by NOSM’s rural generalist pathway program, designed specifically to train rural generalists.
“It’s so important to train in the area we know we have a need to populate with physicians,” she added. “So, really excited about how it is being approached by our faculties of medical education.”
NOSM numbers show that as of June 2021, Northern Ontario required 325 physicians, with an increase in the need for family doctors and rural generalists.
Of those, the region required 135 family physicians (97 of those in rural communities), 166.5 specialists in a variety of disciplines and 18.5 hospitalists and emergency medicine physicians.
Zacharias shares the belief that mandating NOSM students to practise in severely underserviced areas for a period as a graduation requirement would not work.
“There’s this whole thing always with carrot or stick in order to motivate people,” Dr. Janet McLeod, a retired Algoma physician and NOSM Outreach Pilot Project lead, told the Sault Star earlier. “The stick does not work. Making people come to practise in an area where they don’t want to be … I’m not sure you’d want to see that person as your family doctor.”
Zacharias agrees. “And I would say more so than mandating a return of service, really getting out ahead of a medical learner’s experience and making it the most positive that it can be inside of a community where physicians are needed, is the best way to go about it,” she said.
OMA is working with the College of Physicians and Surgeons of Ontario, as well as with the province, to expedite the licensing of internationally trained physicians.
“I think there is some movement there … I think there could be probably more,” Zacharias said. “So, we are committed to seeing that immediate solution through because, for those international medical graduates who are here and want to enter the medical profession, we need to reduce the barriers in order for them to do so.”
Mental health and addictions care is “complex,” Zacharias said, adding a team-based approach is needed.
Many in need reach out to primary care physicians, but many family doctors’offices are inadequately resourced, she said.
“Neither are emergency departments the ideal place to come for a mental health crisis,” Zacharias added.
“I think it speaks to the social determinants of health that we need to be supporting better (solutions to) homelessness, food insecurity, lack of social supports.”
Some efforts to stem the crisis locally – data show Sault Ste. Marie shoulders a higher-than-average overdose and fatality rate from the opioid addictions epidemic – include a 20-bed residential withdrawal management site slated to open by late summer and a live-in youth treatment program unveiled in mid-April.
Zacharias said these determinants of health must be “robustly” supported inside communities, adding people have been coming forward more readily with depression, anxiety, substance abuse and pandemic-fueled isolation woes.
“These really difficult, challenging ways of coping have really taxed the system with the need for mental health and addictions supports. We need investments there, for sure,” she said.
A coalition of health experts has vowed to defend Ontario’s public health-care system from further privatization, after the province confirmed in mid-April “all options are on the table” to deal with ongoing staff shortages.
The Ontario Health Coalition, which represents more than 500 organizations, announced it was speaking with lawyers and having emergency meetings with unions and health-care groups to shield public hospitals from any privatization efforts led by the Ford government.
Zacharias said every medically necessary service “needs” to be funded by OHIP.
“We would never want anyone to able to jump the queue by paying out of pocket for any procedure or surgery,” she said. “We know that equity is a value and the type of health care we deliver needs to be in compliance with the Canada Health Act.
“This is where we’ve been very loud and clear in our position on how we deliver health care in Ontario.”
OMA celebrated Doctors’Day Monday. A flag-raising took place late afternoon at Ronald A. Irwin Civic Centre.
Do Zacharias and her colleagues feel the love? “We appreciate the gratitude and trust that we experience from our patients,” she said. “And it’s really because we have that relationship with our patients that we feel confident to advocate for the changes that are needed in the health-care system.
“And wanting to continue to do right by our patients, we need some changes because our health-care system is incredibly strained, and we’ve all experienced the stress of a three-year pandemic.
“But we do believe that our patients appreciate the work that we do and we’re very grateful for that.”
Would Zacharias recommend her OMA role? You bet your life.
She said the “privilege and the responsibly” has been a personal and professional game-changer.
“I was an emergency department doctor, showing up at the hospital and working my shifts that seemed somewhat repetitive,” she said. “And it didn’t seem as though I was making much of a difference anymore and I was feeling a bit burnt out and my career was not very fulfilling. And I wanted to have a seat at the table of change and to effect change.
“And now that I’ve been able to do that, it’s been extremely rewarding, albeit not easy.”
Large-scale, complex system changes don’t happen overnight. Nor do cures for all of the system’s woes, Zacharias said.
“But I’ve been really encouraged by other leaders that I have met that are very committed to similar positive changes,” she added. “And it’s been inspiring, and I would say this year’s made me come alive inside as a doctor and I’ve been very grateful for that.”