Episode Transcript
Rupesh Patel (00:05.201)
Hey, Rosalie, great to have you today. So pleased for you to be on this podcast. I'm really excited to talk about this topic of Canada's health crisis and the challenges that people ought to know about. But I wonder if we can just get to know you a little bit better, but welcome to our podcast and looking forward to the conversation today.
Rosalie Wyonch (00:23.086)
thanks. Thanks for having me. And yeah, I guess just to tell you a little bit about myself. I'm the Associate Director of Research at a place called the C.D. Howe Institute, which is a think an economic think tank that's based in Toronto. And we have the mission of raising the living standards of Canadians through economically sound public policy. We are also a charity in the same way that universities are charities. So really, my job is to do policy research.
and try and talk to Canadians, policymakers, and anybody that might be able to make change to try and make it happen.
Rupesh Patel (00:59.943)
When people think about think tanks, I wonder if they're thinking, well, this person kind of like on the right of a think tank or are they more from the left or like, how would you describe the world of think tanks, I guess, and sort of where does maybe CDHow sort of fit in it, I suppose.
Rosalie Wyonch (01:14.934)
Well, I mean...
Ask anything tank and they'll tell you that they're nonpartisan and and we are as well. But I truly think that we tend to land pretty much in the center. But the thing about the CD Howe Institute is the Institute itself doesn't take positions on policy, all the authors have editorial freedom and everything goes through peer review. So that means that depending on the issue and depending on the project, we might land anywhere along the political spectrum and
Really it's all just about good policy and what makes the most sense for Canadians.
Rupesh Patel (01:52.893)
Okay, that's cool. and what are the things that you like to write about typically or like to focus and research on?
Rosalie Wyonch (01:58.422)
Well, I've been leading the healthcare policy program there since 2018. well, to put it lightly, that's been probably more than a full-time job for the last five years or so. But I also run our small and medium-sized business growth working group and have done some research on how AI and automation is going to affect our economy.
Rupesh Patel (02:22.491)
Hmm.
Rosalie Wyonch (02:24.492)
Back in the day, I did some stuff on the Netflix taxes and just really how are we going to do that taxes for our digital economy. But, you know, I don't want to get too into taxes or I'll make your audiences eyes glaze over, but I was a tax nerd back in the day. But yeah, lots of topics, but mostly health care.
Rupesh Patel (02:38.589)
Okay.
Rupesh Patel (02:45.531)
Are you an economist by trade or what's your background?
Rosalie Wyonch (02:49.152)
Yes, I've got two degrees in economics. And well, I guess one is in math, and then one is in economics. So I'm a data nerd. I've always been a nerd.
Rupesh Patel (03:01.457)
Yeah, yeah. And where did you go to school?
Rosalie Wyonch (03:04.91)
Oh, I went to you Waterloo, probably the the nerdiest place to go for math. And and it's I still live in the city. I mean, I moved out for a while and came back but I like the vibe in Waterloo. I know.
Rupesh Patel (03:20.913)
We should have had your pink tie, right? I'm a Waterloo grad too, so I know what that is. I didn't, I say kinesiology, so I was in the cool part of the campus, but you guys had the pink tie showing over that building, I remember that.
Rosalie Wyonch (03:36.428)
Yeah, well, mean, I started in physics, so Waterloo can challenge just about anybody on just about anything.
Rupesh Patel (03:46.752)
So you graduated there, did you know that you wanted to kind get into this think tank space or like how did you eventually make your way to CDHow?
Rosalie Wyonch (03:55.467)
honestly, I was a bit of a cliche. I,
I knew I wanted to do policy. was never really into banking or finance. And when you're leaving school, that's pretty much what econ grads think is government or bank. There's actually a lot more out there than that. For anyone that might study economics, we can work just about anywhere. We've got our fingers in every pie. Seeing as I do healthcare, I didn't know that was an option when I was in school. But I got a co-op with the Ontario government at the Ministry of Finance in the economic policy branch. And, you know, I thought this is
Rupesh Patel (04:24.421)
Hmm. Hmm.
Rosalie Wyonch (04:30.094)
my co-op, I've got access to the internal postings, I'll get my permanent job. Awesome, this is gonna be my career. And about two weeks into that job, I wasn't so sure.
I'll just say the government is too bureaucratic an environment for me, I think. And they really want you to go really deep on one specific issue. And I'm more of a let's look across areas and pull things together type person. So I talked to my professors, I sort of had a bit of a career existential crisis. Have I just spent seven years studying? What the heck am I going to do? I still want to do policy, but I hate government.
Rupesh Patel (04:47.851)
Mm. Mm-hmm.
Rupesh Patel (05:10.653)
Mm-hmm.
Rosalie Wyonch (05:13.934)
Ah, oh no, what am I gonna do? And so then I just happened to be really lucky. I was targeting think tanks, maybe a consultancy that did policy work. And someone who might not even be aware I exist, but I've been following him in his career steps unintentionally, Craig Alexander.
with the Institute and that left quite a large hole to fill. And I just happened to be working on a project with the Ontario government at the time, which was exactly what they were looking for. And my bosses will tell you this, I did okay in the interviews. But then in that last question, when they say, do you have anything else to share? I pulled out a slide deck that I had presented that morning.
Rupesh Patel (05:57.693)
Yeah.
Rosalie Wyonch (06:07.338)
And apparently after I left, after I just sort of ran them through my slide deck about like, so this is why automation isn't as scary as people think it is. Apparently they sat there and they were like, hmm.
Well, were gonna hire the other person for the job we had, but then they made a job for me. so I got to be a bit of a Freakonomics economist and I was super lucky at the beginning of my career to get that exposure and cover a lot of ground. And then I guess, sort of the same thing, there was a spot that opened in healthcare and I didn't know too much about it at the time, but I knew it was important and that I was looking for a new challenge and...
Rupesh Patel (06:32.988)
Yeah.
Rosalie Wyonch (06:49.762)
Then two years after that, the pandemic hit. So it's basically been an adventure since I started. But I'll fully admit I didn't have a clear idea of where I was going when I started.
Rupesh Patel (06:51.911)
Hmph.
Rupesh Patel (07:01.917)
Yeah, yeah. That name, Craig Alexander, he was a foreign minister, right? Or is this a different person?
Rosalie Wyonch (07:10.112)
He was he was chief economist at TD for a lot or he was no sorry chief economist at Deloitte. And he also works I think at finance and maybe stats can't it was one of those he worked a lot of places and he was a pretty big deal. Like he he took up space wherever he was working. I don't know offhand where he is but I'm sure he's out there making waves he always was.
Rupesh Patel (07:14.14)
Okay.
Rupesh Patel (07:33.051)
Okay, no, this is a completely different person. I know the last name is Alexander and I feel bad because I met this person, but he was a former minister in the Harper government and he was the former ambassador to Afghanistan. Chris Alexander, sorry. Anyways, completely different name, but yeah. Yeah. Yeah, it's true for sure. So on the healthcare side, what about that field that
Rosalie Wyonch (07:49.74)
It's okay. Neither of them were named William, and then we would have really been in trouble.
Rupesh Patel (08:01.883)
gets you kind of juiced up and that you just love sort of diving into it and kind of making a career out of it right now.
Rosalie Wyonch (08:09.292)
Well, I probably should say something about how I really wanted to help people, but if I'm being completely honest, it's that I like a challenge or a puzzle, like a complicated puzzle. And that's sort of what draws me to policy because it's human, it impacts our lives, but at the end of the day, it's procedural.
Rupesh Patel (08:16.795)
Yeah. Yeah. Yeah. Yeah.
Rosalie Wyonch (08:34.198)
you have to translate the real human results you want into something that is, let's face it, a bit bureaucratic, a set of rules, a process. And so how can we connect those two things so that we actually get what we want at the end? And healthcare is probably the best area to do that kind of work, particularly as an economist, because I'm quite sure that
Rupesh Patel (08:43.005)
Mm-hmm.
Rosalie Wyonch (09:01.48)
every single healthcare policy question exhibits every single economic market failure. So it's it's probably where the most challenging policy puzzles lie. And I can't say that after years, I know exactly what to do or how to fix it. But it's certainly it's, it's a puzzle that's going to take a while to work out. And that keeps me interested.
Rupesh Patel (09:26.813)
Mm-hmm. Yeah. Yeah. So we're focused today on some of the biggest challenges that we see in 2025 for, to address Canada's health crisis. And I know folks are probably interested in hearing your thoughts on that. Maybe the first place I want to start is Trump is on everyone's minds. And I've, on this podcast, I've talked about Trump and his impact on Canada through the terrorists. And there's been a lot of conversation around that, but haven't really focused on.
whether Trump would have any effect on Canada's healthcare crisis. He just said recently, I think the other day on the virtual, his virtual speech at the Davos forum about how Canadians could benefit from American healthcare or that we would love their healthcare system. Something to that effect, which I'm sure most Canadians kind of cringed. Although, I mean, there might be, I think some Canadians also do access American healthcare and they see there's some benefits there. But anyways,
That kind of perked my ears up and then I knew we were having this conversation. So anything from there maybe that we can start off that you see as sort of a big challenge that Canadians ought to care about with this new president.
Rosalie Wyonch (10:37.71)
Well, I'd say there's two major things that could disrupt our medical supply chains, particularly our drug supply. And it's sort of depending on which way policy goes, it could be one or the other. It's pretty unlikely to be both. If it was both, I haven't actually thought about how that would all play out. But
Actually, the last time Trump was president, he, the FDA created new regulations that would allow state Medicaid programs to import bulk wholesale purchases from Canadian, like from Canadian drug manufacturers. And just given the sheer size of the U S the fact that their prices are about three times as high, and the size of their population, it's.
Rupesh Patel (11:30.983)
Mm-hmm.
Rosalie Wyonch (11:36.524)
There's a pretty good incentive to sell.
drugs to the US market instead of the Canadian market if you have that choice. And that was a policy that Biden actually continued and is only now becoming real with in the state of Florida. So we still don't know how big of an impact that policy could have on our drug supplies. Health Canada has taken some actions to protect critical supplies. This isn't something that's going to just disrupt everything right away.
Rupesh Patel (11:43.997)
Mm-hmm.
Rupesh Patel (11:48.625)
Mm-hmm.
Rupesh Patel (12:08.701)
Mm-hmm.
Rosalie Wyonch (12:09.232)
has been a slow process, but to me it's potentially a threat, but also potentially a huge economic opportunity because we could actually potentially expand our domestic manufacturing of medicines immensely and then, you know, be selling those drugs to the US and global market, which could actually really help with our long-term resiliency in the event of say another pandemic, epidemic situation.
Rupesh Patel (12:38.077)
Mm-hmm.
Rosalie Wyonch (12:38.99)
and so that's one that could potentially be a threat just due to the sheer size, but we have, I think it's more of an opportunity than a threat and it's likely to continue because it dates back to the last Trump presidency and Biden didn't cancel it. I found an issue that they agreed on. Can you imagine? and it's
Rupesh Patel (13:00.835)
Mm-hmm. Well, they agreed on the Chinese tariffs, too. There are a few of them. But yeah, was few and far between for sure. Yeah Yeah
Rosalie Wyonch (13:05.262)
Yeah, there are a few. The other thing that he could do and was on the table last time he was president is something called external reference pricing. It's something that Canada does to control our drug supply, but I don't want to get into the technicality of it too much, but what ends up happening is...
Essentially, to determine what the price of a drug should be or what the maximum price in Canada can be, we look at a whole bunch of other countries and what's the price there. And based on an average of those prices, that is where we put our ceiling. The US has no such regulations. But the thing is that if they were to put those in,
Rupesh Patel (13:48.125)
Hmm.
Rosalie Wyonch (13:53.538)
The only way to not have a reference price in Canada is for a drug company to just not launch the drug in Canada. If they don't sell the drug in Canada, then there's no comparison price. And so if the US with approximately triple the price decides to reference Canada, the natural market effect would be that we...
have much more delayed access just so that the companies can protect their profits in the US. And so the US has this ability to just put this negative externality, to use the jargon, onto Canada. And Canada has essentially no recourse of any kind. But...
it would probably do a lot for Americans and their drug prices and that's probably one of their biggest issues. And really the US is unique there. So there's likely something coming on drug pricing and I just hope it's not external referencing because there's almost nothing we could do about that and it would mean that we probably won't get new innovative medicines.
Rupesh Patel (14:46.204)
Yeah.
Rosalie Wyonch (14:57.886)
for at least a year or two longer. I don't know the timeline, but it would delay medicine launches in Canada. And that does make me worry about sort of the future of our, are we going to get the new cancer treatments or are we stuck with what's 10 years old? And then, sorry.
Rupesh Patel (15:15.375)
I was going say on that one, on the reference pricing, can you just give maybe, even if you had to make up an example, can you just give an example that people maybe could relate to?
Rosalie Wyonch (15:24.686)
Well, I guess maybe I'd just sort of explain it as like, so say it's $3 in Germany, $2 in France, and you know, in Canada, someone complains that it's being sold for $10. Our regulator can then go look at the prices in other countries and determine.
Rupesh Patel (15:39.709)
Mm-hmm.
Rosalie Wyonch (15:45.804)
Like, no, you are ripping Canadians off. This is much higher than the average. So you must pay this fine equivalent to that extra. it's part of, we're a bit unique in how we run our external reference pricing as an actual regulation. Most countries do it as just part of negotiating their universal healthcare. It's not a hard line. It's more like, this is the, this is.
the governments will do a comparison. They sort of are like, this is the price we're willing to pay. And drug companies will either say, yes, we'll sell it at that price, or maybe we don't, we aren't gonna access your market. And the US doesn't do that so much. But actually, there's one detail that I should say. I'm, it's one of those, because it's a technical point, I'm not 100 % sure if it's a signal or just,
Rupesh Patel (16:25.245)
Mm-hmm.
Rosalie Wyonch (16:42.954)
sort of caught in the crossfire and the craziness of the first couple days. Trump did stop some, he did reject a Medicaid policy that lowered drug prices for Medicaid beneficiaries. And that was actually a specific external referencing, but it was only within the US market. And so that actually to me, if,
Rupesh Patel (17:06.941)
Hmm.
Rosalie Wyonch (17:11.636)
If that was sort of intentional and like really an intentional policy move and not just sort of caught in the crossfires, then that makes me less worried about this external referencing idea. But it's also one of those, was that just collateral damage, not a policy signal? It's hard to say.
Rupesh Patel (17:29.629)
Okay, and then the other question I had is, would you know what some of those drugs are that we often are now shipping to the US? Like what are those common drug categories or what is that typically looking like right now?
Rosalie Wyonch (17:43.47)
Well, I mean, in some cases, this is just normal. Lots of medical manufacturing can't just serve a domestic market. To be profitable, it has to be volume. So a lot of Canada's medical manufacturing goes to the United States. There's stuff that goes the other way across the border as well. think a big example, a good example, actually, I'll pull from the pandemic because everybody remembers this, the N95 masks.
Rupesh Patel (18:12.049)
Yep. Yep.
Rosalie Wyonch (18:13.358)
Trump wanted to stop the export of those 3M masks. Well, in BC there is one pulp plant that makes the paper pulp that goes into all of the N95 masks that are approved in Europe and North America.
So it only took a couple of days and a couple of back and forth calls before that trade flow reopened because it's okay, you won't send us masks. Okay, we won't send you the inputs to make the masks and then nobody has masks. Nobody likes this. So what are we going to do? And then now we have a 3M plant in Ontario, which is not only supplying the Canadian market, but also the US market. So this is
Rupesh Patel (18:45.319)
Yep,
Rupesh Patel (18:59.238)
Mm-hmm.
Rosalie Wyonch (19:01.356)
You know, these sorts of dynamics are natural.
But I think that one is a particular one where it shows that you do need a certain amount of critical manufacturing capacity or control of critical inputs to help make these these trade issues. You know, it takes the heat down when when you nobody wants to go tit for tat and make everything worse, especially when it's critical. But if it's not critical, they can keep going for a while.
Rupesh Patel (19:32.228)
Yeah. I wonder where, where Trump goes now then on, especially on... Yeah, go ahead.
Rosalie Wyonch (19:36.43)
And actually I've got one more. This isn't Trump related. It's just us related and Just because I think it's super interesting As I said the the manufacturers health Canada can say No, you're not authorized to export But there is a channel through which Americans can get Canadian drugs and that is online pharmacies And so
Rupesh Patel (19:40.551)
Yep. Yep. Yep.
Rupesh Patel (20:00.295)
Okay.
Rosalie Wyonch (20:06.254)
Basically, any American can get a Canadian pharmacist can fill their prescriptions and send it across the border as long as that prescription is co-signed by a Canadian doctor. And so I'm going to use the example of Ozempic because it's, let's face it, it's called it. And so back last year, there was a really
Rupesh Patel (20:16.989)
Hmm
Rupesh Patel (20:25.117)
It's mainstream, everyone knows about it.
Rosalie Wyonch (20:33.45)
large increase in usage from the beat like the BC drug plan noticed that there was a big spike in ozempic going across the border and so they they just changed the rule and and it was like that you had to physically go collect it in person and that basically stopped Americans ordering from pharmacies but that what I thought was interesting is one
Rupesh Patel (20:55.741)
Mm-hmm.
Rosalie Wyonch (20:59.788)
doctor who was licensed in Nova Scotia and living in Texas was co-signing prescriptions for Americans to then order from a BC pharmacy. When BC shut the loophole, like basically shut this specific thing down, sales of ozempic in the province dropped 92%.
Rupesh Patel (21:20.303)
Okay.
Rosalie Wyonch (21:22.2)
There was not a shortage of ozempic at the time, so no type 2 diabetes patients were threatened by this or anything at the time, but just to show what one doctor and-
Rupesh Patel (21:25.947)
Yep, yep.
Rosalie Wyonch (21:34.51)
sort of the popularity of one drug, 92 % of sales in BC were likely going to Americans. And so this is a super interesting sort of cross border dynamic. And it's actually a concern for both Health Canada and the FDA, because how does the person ordering online know that that's in fact a Canadian pharmacy?
Rupesh Patel (21:41.447)
That's wild.
Rupesh Patel (21:56.914)
Mm-hmm.
Rosalie Wyonch (21:57.452)
that it's in fact licensed, that these are actually real drugs that they're getting. And so there are a lot of not real or not, well, they're real in a sense, but not legal licensed Canadian pharmacies that are online, essentially with a .ca. But who says that that's coming from Canada?
Rupesh Patel (22:18.973)
Mm-hmm.
Rosalie Wyonch (22:23.586)
They might also route the packages through Canada if that makes it more legitimate. But this is basically a huge opening for illicit drugs, counterfeit drugs, and a regulatory concern for Health Canada and the FDA. And really it was just this one sort of blip last June, I think, kind of alerted everyone to how big of an issue this was. Because previously we just sort of thought it's snowbirds, like Canadian snowbirds go to Florida.
Rupesh Patel (22:28.285)
Mm-hmm.
Rosalie Wyonch (22:53.502)
to get their prescriptions through their Canadian pharmacy, that's fine. And, you know, people that go across the border from the US should be able to get their prescriptions filled. This seemed normal. I don't know if anyone knew how disruptive it could actually be.
Rupesh Patel (22:56.433)
Right. Yeah.
Rupesh Patel (23:10.375)
Do you know if this is also maybe contributing to Trump's concerns around, yeah, there could just be, it's contributing to their fentanyl crisis or if some of those drugs are around painkillers or maybe.
Rosalie Wyonch (23:22.882)
I mean, certainly, I think it could be, but it's also, in that case, there's a lot of illicit. And so it's sort of, don't know enough to know exactly what those channels are or where it's coming from, but at least sort of in a gray market sense, like if someone in the US at least has a real prescription, they can, you know, then they could absolutely get real opioids and,
Rupesh Patel (23:35.303)
Yep. Yep.
Rosalie Wyonch (23:52.726)
whatnot from a real Canadian pharmacy, meaning that since there's actually a real legal totally in the open way to do that, there's a lot of black market activity possibility underneath that, even going so far as offering fake prescriptions to appear real. know, so I think there's
Rupesh Patel (23:54.813)
Mm-hmm.
Rupesh Patel (24:10.205)
Mm-hmm. Mm-hmm.
Rosalie Wyonch (24:15.15)
No one's really sure how big it is because, well, it's criminal or black market and they don't exactly send you spreadsheets, unfortunately. Believe me, I've tried. That was actually my first research project was illegal weed, but it was, it was hard to get inventory numbers from people on that one. So I think this, this goes in a similar category.
Rupesh Patel (24:25.415)
Yeah. Yeah.
Rupesh Patel (24:33.853)
I bet. Yeah. Yeah. The other thing you said though, was that, um, with these prescriptions, they gotta be co-signed with the doctor. I was like, Hey, how does, how does that work? And then, but then you said, yeah, there was this one physician licensed in Nova Scotia, working out of Texas. Like that's yeah.
Rosalie Wyonch (24:51.778)
Yeah, just do a virtual appointment, talk to the person, or just they just get the script and co-sign it. It depends on how, you know, if they're getting paid and they're not actually treating patients. Like, I mean, it's their liability. If there's a physician that's willing to do that, it's going to be on them if it goes wrong. But I would also point out at least that, you know, malpractice insurance
isn't actually
In a lot of ways, it's backstopped by provincial tax dollars. So doctors themselves don't necessarily shoulder all of their risk. And so, well, there's a lot of technical other ideas I have back there, but truthfully, it's just all you need is one physician or one provider that's willing to do this. And considering that these aren't Canadian patients, the risk is relatively low.
Rupesh Patel (25:29.117)
Hmm.
Rosalie Wyonch (25:52.716)
I mean, the average Canadian probably doesn't know how to make a formal complaint about a physician. And also, when someone's drugs for an off-label use through a quasi-legal channel, I don't think they're likely to make official complaints.
Rupesh Patel (25:53.746)
Yeah.
Rupesh Patel (26:07.291)
Yeah, that would have been a lucrative gig I imagine for that Nova Scotia physician for sure.
Rosalie Wyonch (26:12.95)
Yeah, I think his license was suspended, but I would also point out that BC is likely one of the only provinces that has data systems that are sufficient to even have noticed that this spike was happening. So their one mistake was targeting Americans that were going to order from BC pharmacies. If it was any other province, we might never have known that that was happening until there was a shortage.
Rupesh Patel (26:24.957)
Okay.
Rupesh Patel (26:37.585)
Yeah. So the other thing that's on my mind though, related to that is if Americans are now accessing virtual primary care from Canada, is that sort of competing with Canadians needs in the lack of access of primary care here? Do you think that there's a problem there? Like I know you said, it's in this case, we were able to track it to this Nova Scotia physician, but do we know if it's a more wider problem where we're now competing with Americans to access primary care in some ways?
Rosalie Wyonch (27:06.326)
in that I wouldn't, I would say I don't, I don't know, but I would doubt it. I would doubt that it's significant enough to really make a difference just because of the sheer size of our primary primary care access challenges and the fact that that was only one physician. So there might be a few, but
that physician was living in Texas, were they close to retirement? Were they going to be seeing patients anyway, they were living in Texas, the chances that they were going to actually be treating Canadian patients are near zero. So particularly in that case, I'd say no, that's not taking any labor out of the Canadian market. But I do think that there are
maybe there's maybe been a fragmentation of the different ways that people can access primary care and there's fewer physicians doing the traditional in clinic full-time work and they can all kind of supplement by doing additional virtual care through a couple of platforms and so this isn't necessarily a problem
Rupesh Patel (28:06.141)
Mm-hmm.
Rosalie Wyonch (28:19.39)
because it gives physicians more flexibility over the way they work, different ways to earn income, gives people different channels to access them. All of that is good. The problem is when we don't have enough supply, that it's where the those effects land, right? If we had, if we had enough providers, all these different channels and all these different activities would be totally fine. They'd actually be good, right? But when it's
when it's uncertain how people are going to access primary care, that's when it becomes a challenge. So I'd say my example is that previously primary care providers kind of worked in their offices and that's like, that's just how they worked. And during the pandemic, there was this explosion of virtual care. They can also do
Rupesh Patel (29:08.861)
Mm-hmm.
Rosalie Wyonch (29:16.546)
You know, you can do some virtual consults that you do yourself. If you're licensed in another province, if a physician is licensed in two different provinces, they can work in the public system in one, and work in a private system in the other. And, you know, so it gives people more flexibility, it gives them the ability to treat different types of patients. But I think part of the issue becomes when you need to pay a fee, or the people that want
Rupesh Patel (29:27.282)
Mm-hmm.
Rosalie Wyonch (29:46.208)
an in-person doctor at a physical clinic can't get one. And we do have that problem. So I guess looking at it from the doctor's perspective, all this flexibility is good. gives them a lot of different ways to do things. And for a lot of people that have gained access to virtual care through their employer provided health insurance, or might be paying for it out of pocket themselves, it's convenient for them. But
Rupesh Patel (29:48.209)
Mm-hmm.
Yep. Yep. Yep. Yep.
Rosalie Wyonch (30:15.064)
For the people that don't have access to those channels, they end up going to urgent care, going to emergency rooms, or just not having continuity in their care. And sort of that's really where the concern is, is for the people that end up going to the ER that shouldn't really be there and that they'd get better treatment if they had a doctor.
Rupesh Patel (30:37.981)
Okay. So you're, walking into the second challenge, which is the lack of access to primary care. think that's one of your big ones. Is that right?
Rosalie Wyonch (30:44.916)
Yeah, it really, is. Mostly, like, partly because it's such a big problem. About 19 % of Canadians don't have a regular primary care provider. And another 29 % have difficulty seeing the one they have. And I'm currently in that category of I have been playing telephone tag with my doctor trying to get a basic like, I need you to sign this referral form. That's all I need.
Rupesh Patel (31:11.517)
Yep. Yep.
Rosalie Wyonch (31:13.516)
It's been three weeks of back and forth telephone calls and I still don't have an appointment. So this, it's clear, like it's a challenge. And this, it has all of these domino effects to the system. Like I already mentioned how people will end up at emergency rooms. Well, it's not exactly like there's extra capacity in our hospitals and that's a more expensive place to be. And you're less likely to get good primary, like good primary care there.
Rupesh Patel (31:28.359)
Mm-hmm.
Rupesh Patel (31:39.357)
quality care, yep.
Rosalie Wyonch (31:41.294)
because that's not what they're designed for. They're designed for emergencies. And so you end up waiting for a really long time. And just it's not efficient for anybody. It's not efficient for government spending. People don't want to be waiting there. It's not what we want. But also, if you need specialist care in a lot of provinces, primary care physicians are the gatekeepers. You need a referral to be able to get that appointment. And so
Rupesh Patel (31:56.145)
Mm-hmm.
Rupesh Patel (32:06.429)
Mm-hmm. Mm-hmm.
Rosalie Wyonch (32:10.196)
if you know, even if you know what kind of specialist you need to see, you need to find access to a primary care doctor to even be able to get on the list to get a phone call for an appointment. And so really, I think that this lack of access to primary care is probably if we could fix that thing, that would take the pressure off the hospitals and give them a lot more capacity. It would.
you know, give better chronic disease management for seniors would probably take some pressure off of our long-term care system. And so I really just see this and it's that basic care. Like it's what most people need. If you don't have a chronic condition, you don't need a specialist. You don't need the ER. You might just need a prescription renewal or got an infection and need just some...
Rupesh Patel (32:43.772)
Mm-hmm.
Rosalie Wyonch (33:03.638)
lab tests and some antibiotics. That's what a lot of Canadians actually need. And if they don't get it, then whatever their condition is can become severe enough to need hospital care. And in that case, nobody wins. So really, I just see them as since they're the first contact with the health care system. If half of Canadians don't have that first contact point,
Rupesh Patel (33:17.533)
Totally.
Rosalie Wyonch (33:28.78)
then we really just don't know how many people are lost in the system who might actually need care or might just be totally fine and they go to a walk-in clinic when they need their one little thing, like one little thing a year. But if we aren't doing screenings, physicals, we aren't catching things until they're severe and that's not good for people's quality of life or our healthcare spending.
Rupesh Patel (33:51.485)
Yeah, I agree. Huge, challenge. then that's just like, just to get people access to a physician, let alone like there's no choice there either, right? It's like, if you can even get somebody to listen to you and you have that first point of access, doesn't mean you might like that doctor that you're working with either. So it's not like you can really pick and choose who you want. The first place is just to even get that physician to work with you or to get that access. So definitely, definitely a big challenge.
There is some traction, some promises that folks are probably realizing where they're inviting other practitioners to provide primary care access. What are your thoughts about that? so maybe that's the first question. And I also want to talk about, I think there's this overall thought that we have a doctor shortage entirely. So be curious about whether you feel like there is an issue there. So whichever one you want to tackle first.
Rosalie Wyonch (34:46.53)
Well, I think to me they're related and you've opened up a pretty big rabbit hole. Whether you know it or not, that was a pretty big question. And so I guess I'd say, yes, lots of provinces are...
and have expanded the scope of nurse practitioners, of pharmacists, of a whole bunch of different practitioners to be able to do different aspects of primary care. So for pharmacists, it might be injections and diagnosis of a couple minor conditions or being able to prescribe for, yeah, I guess more minor simple things that you probably don't need to see a doctor for anymore. And
So those scopes of practice have expanded. Great. Nurses can provide this care so people can access them, No, it didn't actually. They're not covered on the provincial insurance plan just because they're now able to give this care. There's a separate. your provincial insurance plan include that? And so in some provinces, yes, it did. And in the territories, they've been delivering public primary care for for years, many years.
Rupesh Patel (35:49.319)
Mm-hmm.
Rosalie Wyonch (36:00.362)
But I'll just use the example of Ontario because it's where I live. Here there have been news stories about nurse practitioner led primary care clinics that are entirely private and I guess for-profit and people being quite upset about that and how can that be possible? Well, they aren't actually allowed to like they are allowed within their scope
Rupesh Patel (36:03.086)
Mm-hmm. Mm-hmm.
Rosalie Wyonch (36:27.692)
But in that form of working, they can't bill the provincial government for that primary care. So how are these nurse practitioners supposed to work then? It's like they've been given nearly full scope, but to be able to bill the province, need to...
Rupesh Patel (36:32.731)
Mm-hmm.
Rosalie Wyonch (36:45.452)
work with a physician. And in a lot of cases, we have family physicians that have nurse practitioners delivering care, but for an added fee, because it's not part of the insurance system. So basically, because it's not part of the insurance system in Ontario right now, they're free to charge for it. So it's opened up this sort of separate avenue of access, but it is, in a lot of cases, not free.
Rupesh Patel (37:09.085)
Mm-hmm.
Rosalie Wyonch (37:10.222)
And so I'll just say this is your audience might not know, but the health minister did something a little over like about two weeks ago now where he
Rupesh Patel (37:21.917)
Mm-hmm.
Rosalie Wyonch (37:24.172)
put out what's called an interpretation letter. That's essentially the federal government saying, this is how we are going to interpret the Canada Health Act moving forward. Provinces, here's your notice of how we will be interpreting it. it's kind of a big deal because there have only been a couple of these since the Canada Health Act was written.
though there'll be some political fights about it, I'm sure, it essentially could form the new policy. And what's part of that is essentially that the federal health minister has said that where nurse practitioners are, they have primary care within their scope of practice.
that it was considered medically necessary. They are practitioners of this care and it should be part of medically necessary provincial healthcare plans. Now, that's potentially very good because it means it really frees up the nurse practitioners to provide primary care. And there's a lot more of them than there are physicians. It's also slightly...
Rupesh Patel (38:29.629)
Mm-hmm.
Rosalie Wyonch (38:37.032)
easier to train them. Like there's not quite as many restrictions on the number of nurses compared to the number of doctors with their very set number of residency slots. It's a more flexible labor pool and there's plenty of evidence that says that they're capable of giving the care.
Rupesh Patel (38:40.016)
Mm-hmm. Mm-hmm.
Rosalie Wyonch (38:55.788)
to that level, only in sort of the most complicated cases do you actually sort of need it to elevate above their abilities in primary care. Now there are a million primary care doctors that would yell at me for that and tell me that, you know, for the continuity or the, you know, I would say early detection or maybe the doctor might see something that the patient wouldn't bring up or wouldn't
complain about but the doctor might ask the right question because they they're sort of thinking of that more advanced care pathway and that is absolutely a possibility but let's face it for I've got a sprained ankle or I think I've got a throat infection which is the bulk of of things
Rupesh Patel (39:32.007)
Mm-hmm.
Rosalie Wyonch (39:43.522)
that you can absolutely go to a nurse practitioner or a pharmacist might be able to help you out. So really it's all about levels of care and making sure people can practice to the limit of their scope. So this could be great. It could really expand the number of primary care providers in the country. The only question is who is going to pay for that? know, the provinces haven't done it voluntarily already and we have this primary care crisis. That makes me think it's expensive.
Rupesh Patel (40:09.915)
Mm-hmm.
Rosalie Wyonch (40:13.486)
expensive. If 50 % of people don't have access to primary care, that also means that it's not coming out of the government's spending on health care. So actually solving the primary care crisis is, will be expensive for the government simply because there's so many people that will need these appointments and the practitioners will bill for them.
Rupesh Patel (40:35.645)
I imagine though nurse practitioners, their rates would probably be lower, I would think, than a GP, for instance. Would that be fair to say?
Rosalie Wyonch (40:46.382)
That's quite likely. But it's hard to say because equal pay for equal work. Who's to say it's not equal work if it's the same procedure? And so I'd say those, the interpretation letter has put the provinces on notice that this is something the federal government wants to do. And they've given them till next year, I guess June 2026 to make that change.
Rupesh Patel (40:56.349)
Mm-hmm.
Rupesh Patel (41:13.767)
Mm-hmm.
Rosalie Wyonch (41:14.382)
So I guess we'll see in the next year how it develops whether the provinces move to automatically move to doing this or whether they want to have a fight with the federal government over the funding for it, which I think is the most likely or whether they're all just in a holding pattern wait and see because if there's a federal election, the next health minister could tear up that interpretation letter or they could say, no, I like it. We're leaving it like it was its existing policy deal with it.
Rupesh Patel (41:27.677)
Probably, yeah.
Rupesh Patel (41:34.48)
Exactly.
Rosalie Wyonch (41:44.288)
So it will really depend on what happens in the next little while. I guess since it's within their scope, nurse practitioners have the scope to provide this. Canadians don't have access to primary care. The fact that it's kind of stuck in an insurance problem is a bit frustrating to me because we could really get better care.
Rupesh Patel (41:57.479)
Mm-hmm.
Rupesh Patel (42:07.207)
For sure.
Rosalie Wyonch (42:10.574)
better access to care by incorporating this and also by not incorporating it, you're essentially allowing a completely separate primary care system to develop. And the longer you let that develop, the less they'll be able to change it. So I guess it's, think, broadly speaking, I think it's a bold move by the federal health minister. It will definitely lead to a fight with the provinces, but it might actually make a significant difference.
And so that's just, it's bold of him and I wish him luck, but also how are we going to pay for it and is it actually going to become reality is still a bit up in the air.
Rupesh Patel (42:46.471)
Mm-hmm.
Rupesh Patel (42:51.101)
I think you're probably channeling the feelings of folks who are listening who are probably like, okay, yeah, there's this pool of talent that could potentially help the primary care access issue and we're getting caught in this sort of funding thing. Like who cares, right? Like that's probably what the average person is thinking, right? Like healthcare and the economy are usually the top priorities, whether it's a federal election or a provincial election and people want to make sure that there's funding towards healthcare. And I think the...
Probably the mainstream thought is that we have a shortage of workers. so like that's whether that's true or not, that's probably where most people's heads are at. And they probably say, okay, well, here's somebody who can fill the gap. Let's work on solving that. So it'll be interesting to see that fight that comes back from the provinces, which I would agree it's probably going to come because they're probably going to say, hey, you're going to have to pay for this if this is what you want.
Rosalie Wyonch (43:44.62)
Yeah, and I, you said, and I just want to make a point on the shortage of workers.
just because of the time of year, chances are we're going to see a spike in news stories about the shortage of workers. Partly that's because of seasonal flu. So both like both care providers get sick and people get sick. And, this is sort of a normal seasonal thing that happens. kind of like when, you know, you see a bunch of articles about the housing market changing around June for the summer. Like this is sort of a cyclical pattern. But what stands out to me is whether or not we
Rupesh Patel (44:13.543)
Mm-hmm.
Rosalie Wyonch (44:19.468)
currently have the right number of workers, nurses, personal support workers, and even up to physicians. We have people that want to work or were fully trained but then leave the profession.
Rupesh Patel (44:33.767)
Mm-hmm.
Rosalie Wyonch (44:36.192)
retention, like making the job more attractive and addressing burnout is a big issue. We have people that have their medical training, but they need a residency slot before they can be licensed to practice.
Rupesh Patel (44:40.637)
Mm-hmm.
Rosalie Wyonch (44:51.244)
we have fewer residency slots than we have applications by a mile. So if it truly was a labor shortage issue, then the government can control the inflow. They don't necessarily control the outflow. when you have, well, a lot of physicians are aging with the rest of our society. And so it's one of those things where in a specific location, there may be a shortage, but nationwide,
Rupesh Patel (45:03.41)
Hmm.
Rosalie Wyonch (45:22.07)
I see a shortage of physicians, but that's only because of the way we've set up primary care. If we move forward with this nurse practitioner idea, and I think we should, it's less clear that there's a shortage. There's actually, just because there's a lot of vacancies doesn't mean that there...
they're strictly necessary. You know what I mean? Like it's one of those, you can always put a job posting up, but do you actually need that person? Or is there another way that you could save that labor by maybe implementing a system that saves your existing people time? Like if people are doing data entry, if you can automate that, you've freed up labor. So I think I would really push for, if we're going to talk about labor shortages, it's not about getting more bodies. It's about how we can make
the job better for the practitioners that we have.
Rupesh Patel (46:18.173)
Okay, so there's definitely a nuance there because you see a lot of the provincial governments looking to fill those vacancies by going to the Philippines to fill nurse shortages. So am I hearing that you're not sensing through the numbers that there is actually like we do have the people here in Canada. It's just maybe the way we are filling those spots or managing their time or it's more of a
management administrative thing or maybe help people understand where the challenge is.
Rosalie Wyonch (46:47.33)
Well, yeah, I'd say all of that, absolutely. Like, skilled immigration of healthcare providers is great. We should absolutely do that. I guess what I'm saying is you're not going to recruit your way out of this problem. Because if...
Rupesh Patel (47:02.191)
Okay.
Rosalie Wyonch (47:05.47)
nurses leave the profession at a faster and faster rate. You can recruit at a faster and faster rate, but you're never going to actually change how many nurses like how many are actually providing care. So really, I guess there's maybe the point is, there's lots of focus on the inflow. I think that it would be better if we focus on the outflow.
Rupesh Patel (47:29.883)
And what do mean by that, the outflow in this? Okay. Okay.
Rosalie Wyonch (47:30.068)
and like as in people leaving the profession or the burnout where it's like if we can essentially I'm thinking if we can use technology or redesign the way we provide care in ways that can make practitioners less stressed out, free up some of their time, take away like boring administrative tasks, then that frees up time for direct patient care immediately.
Rupesh Patel (47:56.637)
Mm-hmm.
Rosalie Wyonch (47:57.28)
And it makes the practitioners happier, so they'll probably stay in the profession that much longer or provide that much more care. You know, it's just to me...
we see, like you can actually see over time a declining number of hours that physicians are putting into direct patient care. So you can keep adding physicians all you want, but if all the physicians are spending less time with patients, it's always gonna be a downward trend. You see what I mean? Where it's like, if we can actually just address why the hours per worker are declining.
Rupesh Patel (48:27.057)
Mm-hmm. Mm-hmm.
Rosalie Wyonch (48:34.75)
Or if we can take some of the hours that are spent on tasks nobody likes?
then we can really free up time. And that's a lot quicker than, you know, an immigration process where someone then needs to be trained and licensed, like just sort of, we should absolutely be recruiting skilled immigrants. But that's still a process of like four, five, six years before they're actually able to then provide care. Whereas if we free up physicians' time, well, the thousands of physicians that are already working, if we could save all of them one hour of time,
Rupesh Patel (49:11.229)
Mm-hmm.
Rosalie Wyonch (49:12.04)
That's the equivalent to a couple more patients per doctor. It's the equivalent to many more hours. So that's really it is I think we can add bodies all day, but if the job gets worse or people can't spend time with patients, then that's really where the problem is.
Rupesh Patel (49:13.703)
Three or four patients perhaps. Yeah, Yeah, yeah. Yeah.
Rupesh Patel (49:37.169)
Yeah, because you're to see these physicians or these practitioners potentially leaving their field due to burnout or maybe not feeling satisfied with the job or whatever it might be. Yeah.
Rosalie Wyonch (49:48.14)
Yeah, and I think it's or it's just simply that they have to spend too much of their time on fillings and admin tasks. And if we could take away some of that frustrating time wasting, then then everybody would be happier.
Rupesh Patel (49:53.853)
Paperworker. Yep. Yep.
Rupesh Patel (50:03.365)
Is there a shining example of any of the provinces who you feel are getting or understanding maybe that and are taking some action into making maybe the lives of practitioners a little bit easier so that they can take on more patience or?
Rosalie Wyonch (50:16.652)
Well, I'd say that there's definitely leaders in the healthcare system that are fully aware of these problems because a lot of the leaders in the healthcare system are in fact physicians or they were physicians at one point. And so I think they're aware, but I also would say that it's not something that's directly within government control, right? Physicians are independent business people. They're essentially independent contractors.
Rupesh Patel (50:26.791)
Right, right, right.
Rupesh Patel (50:40.477)
Mm-hmm.
Rosalie Wyonch (50:43.18)
So I think part of the issue is that they actually are responsible for figure out how you're going to work. And some younger physicians really want a more traditional employment style relationship. so there's different, be it private entities, hospitals, municipalities, doesn't really like lots of different sectors.
Rupesh Patel (50:49.714)
Hmm.
Rosalie Wyonch (51:06.57)
segments of notice this is a pattern. And so what some municipalities are doing is they'll build state of the art primary care clinic, just trying to get doctors to come and work in their rural community or hospitals are doing outpatient clinics.
Rupesh Patel (51:09.053)
Mm-hmm.
Rupesh Patel (51:18.065)
Mm-hmm.
Rosalie Wyonch (51:26.178)
to help manage their chronic patients so they aren't waiting in emergency room beds. And, you know, where are all those patients coming from? Well, if all those patients are over there, well, let's go build a clinic and put one of this, like try and get a specialist in that community. But at the end of the day, the physicians choose where they work, just like anybody else, they choose where they live. And so there's different challenges. You know, the downtown,
Rupesh Patel (51:42.077)
Mm-hmm.
Rosalie Wyonch (51:55.086)
Toronto state of the art hospitals with all the top of the line tools, the cool clinical research trials, the research that's just ongoing. They don't have any trouble recruiting specialists. It's rural Ontario out in the boonies or you know, there's...
Rupesh Patel (52:06.333)
Mm-hmm.
Mm-hmm.
Rosalie Wyonch (52:13.64)
one cardiologist in this region, but there's, you know, people might have to travel six hours to get to them just because they're the only one within this huge area. So for me, the rural and remote is a bigger challenge, but.
Yeah, I'd say there's lots of different strategies where people are almost like, what can we do for you to get you to come work here? So it might be buildings, might be billing systems, might be admin or just straight up, we'll pay your medical school debt. If you work two years in this rural community, we'll give you this many thousands of bonus per year. So there's everything from financial to practical to just selling how beautiful your town is.
Rupesh Patel (52:41.618)
Mm-hmm.
Rupesh Patel (52:52.453)
Right, yeah, yeah. Okay, let's walk into the third challenge, and you've already spoken a little bit about that. Because of the lack of access to primary care, it's putting pressure on hospitals, and people are naturally going to those places. The quality of care might not be as great. They're not set up for primary care, like primary care practice. It is more expensive. So maybe just help people understand why that is a big challenge on the hospital side.
Rosalie Wyonch (53:21.666)
Yeah, well, guess the hospitals are, well, they've been, they were the vanguard for COVID, right? Like they took the brunt of the damage, but so they were basically running over capacity the whole time. And then meanwhile, we stopped a lot of
Rupesh Patel (53:29.863)
Mm-hmm. Mm-hmm.
Rosalie Wyonch (53:43.796)
non-urgent procedures or people didn't have access. So then, you know, some conditions got worse. so once COVID was kind of over, I would point out that we there's a significant amount of our ICU beds that are still occupied by COVID patients. Like this is now a permanent capacity issue where we have a significant percentage of ICU beds are COVID. So that right there takes a
Rupesh Patel (54:02.769)
Mm-hmm.
Rosalie Wyonch (54:13.68)
what their capacity was before. You add on to that the burnout, the stress that everyone's been under, as well as people haven't had access to the system, so there's a bit of pent up demand, as well as health conditions could be a little bit worse. All of that is the perfect storm that our hospitals had to deal with. so right at the moment where they need to...
sort of go into overdrive and could potentially redesign systems or address some of the issues that that we that were highlighted during the pandemic. Okay, that's great, but there's no money. Your entire staff is burnt out and tired. And all of your patients are extra sick, grumpy, frustrated. And that's kind of the situation. so
Rupesh Patel (54:55.718)
Mm-hmm.
Rosalie Wyonch (55:04.67)
hospitals are dealing with this and they're dealing with it as well as they can but the majority of hospitals in Ontario are in a deficit position so like they're not keeping up and I fully believe that they're innovating as much as they can to try and try and handle this capacity but we've seen ER closures like like I said the hospital can do what it what it wants to recruit but if there's nobody to work a Sunday midnight shift
Rupesh Patel (55:23.623)
Mm-hmm.
Rosalie Wyonch (55:35.06)
the ER can't be open. And so when people don't have access to primary care and then in their community the ER shuts down.
Rupesh Patel (55:36.594)
Mm-hmm.
Rosalie Wyonch (55:46.382)
actually, where do you go? Where do you turn to? And if the nearest ER is hours away, that really is, in a practical sense, leaving large areas of our country with no access to care.
Rupesh Patel (55:47.921)
Where do you turn to? Yeah.
Rupesh Patel (56:00.637)
Mm-hmm.
Rosalie Wyonch (56:03.138)
people that, you know, they're gonna give birth, but they're hours away from the nearest hospital, are told to move close to their due date. Most, you've seen the housing market, you know what rents are like. A lot of people, particularly in a Northern rural community, aren't gonna have the ability to take a month off work around their due date to go live near a hospital, like,
Rupesh Patel (56:17.789)
Mm-hmm.
Rosalie Wyonch (56:31.436)
shouldn't the care be available to them where they live? And you know, in some cases, it's too remote, or or what have you or you know, some travel is reasonable. We have a huge country. This is just a fact. We have to fly some patients to the high tech city center wards.
Rupesh Patel (56:43.911)
Mm-hmm.
Rosalie Wyonch (56:52.588)
But when we don't have basic emergency care, maternity care, or primary care in areas of the country, that is a huge, huge problem. And essentially it's just as these dominoes kind of keep stacking up or this pressure keeps stacking up, eventually even the demand sort of at the well-resourced high-tech hospitals will hit a limit because when the ERs are dealing with basic primary care,
Rupesh Patel (56:56.487)
Mm-hmm.
Rosalie Wyonch (57:19.136)
they never really have that capacity to then fix the higher order problems. And so this is just the issue with hospital capacity to me is that a lot of the dominoes have fallen and all of that weight is on the hospital. But we can't just pump money into the hospital system to keep propping up that negative outcome, right? Like that's not the outcome that the government or patients want, but the hospitals are under strain. So it's how can we create
Rupesh Patel (57:23.868)
Yeah.
Rosalie Wyonch (57:49.254)
space for them to maybe take a breath, look at the chaos of the last five years and see what they can do without, see what they can do better. Can we refresh these systems or innovate a little bit on these processes to free up people's time?
increased capacity, but they don't have the headspace to do that. Like if you're a hospital CEO that's trying to make sure the ER doesn't close, you don't have time to think about how you're going to strategically improve processes. Like it's something that everybody wants to get to, but there is a space or money for it at the moment, but it's exactly what we need. And instead, what we might get is just more demand on them, but not much
Rupesh Patel (58:22.333)
Mm-hmm.
Rosalie Wyonch (58:34.654)
supportive system change, maybe I'll say is because they Yeah, they they've got a like the analogy they always have is we're trying to fix a 747 in flight But you know when you're getting to a point where you're worried the engines gonna fall off or the tail is gonna rip like Okay, it's time to land now and take a minute. Make sure the plane's good to fly but
but there's no ability to land the plane or take that breather without, you know, the ER shutting down and people not having access for periods of time or what have you. So it's, I guess it's, I bring it up not to say I have solutions, but that to make people aware of the challenge and that it's not necessarily on the hospitals to deal with all of this. It's actually that what I see as the problem is
Rupesh Patel (59:24.433)
Mm-hmm.
Rosalie Wyonch (59:28.074)
all the other areas of the system, like places they could send people to, like home care, rehab, or, you know, people that wouldn't show up if they had primary care. That's really the cause of their challenge. They have other challenges as well, but until we relieve that pressure on them and stop sort of just making the buck stop at the hospital, they won't be able to do that. They're just kind of being asked to do more and more and more.
Rupesh Patel (59:54.072)
100%. Yep. Yep. Do we have data to show that because of the lack of primary care access, how much actual pressure is being put on the hospitals? Like how many more patients people, uh, the hospitals are getting. And, then you talked about the COVID piece and I think people are naturally even more so wanting to go to hospitals. Like there's been before COVID, would say like there's
I think maybe people are trying to understand, people are getting that, okay, we can't go to hospitals as much anymore, but I wonder if COVID really shifted that a little bit. But yeah, do we have any data to show whether, there is actual, because of the primary care challenge, there is a lot more pressure post-COVID especially on hospitals to take on some of these primary care cases.
Rosalie Wyonch (01:00:39.394)
Well, I'd say the primary care access challenge has gotten worse, but it certainly existed before COVID. Like lot of these challenges existed before COVID. It's not like hospitals didn't have nursing shortages anywhere in the country before COVID.
Rupesh Patel (01:00:48.579)
Mm-hmm. Mm-hmm. Mm-hmm. Yep.
Rosalie Wyonch (01:00:53.142)
It's really just that COVID increased, like COVID takes their takes hospital capacity. It also delayed treatment. So really we have this hopefully short term, but really increased demand for health care. And we're still working through that backlog in some ways. And so I think that's partly it's that I don't know that this pressure will last forever. But if we don't
fix some of the things, the pressure will continue to build. was really just COVID was the pressure that really blew up the bubble.
Rupesh Patel (01:01:24.369)
Mm-hmm.
Rosalie Wyonch (01:01:29.67)
And so there is data. I don't have the number just handy off the top of my head. But in surveys, Canadians will there are there's a good chunk of Canadians that will say, respond to survey questions about did you go to the ER for something that could have been handled elsewhere? Or did you go to the ER because you didn't have other access or things like that? And I would
Rupesh Patel (01:01:50.407)
Mm-hmm.
Rosalie Wyonch (01:01:56.842)
say that there's there's some data there's quite a bit of data that shows that there are specific high flyer high flyer populations and a lot of that would be seniors that have chronic conditions.
Rupesh Patel (01:02:12.871)
Mm-hmm.
Rosalie Wyonch (01:02:13.558)
that will go to the hospital, be monitored for a couple of days, but there's not a ton they might be able to do for them, and then they get sent back to the long-term care home or their home. And they're regularly in hospital to monitor their condition. That's something that could be done at a clinic, not a hospital. But if they don't have access, that is pretty big drain on resources. And I would also say that hospitals deal with
When there's increased sort of social societal problems, the hospitals also have to deal with that. So we also have data on increased emergency room use by
people that are of no fixed address. That's how they're coded. We don't know if they're actually homeless or not, but they definitely, they were coded in as no fixed address. And so I think there's sort of different segments that are higher need. And so in some cases, a targeted solution can be helpful. So it's like, if we could do chronic disease management for seniors better, that would be pretty significant.
Rupesh Patel (01:02:56.923)
Mm-hmm, mm-hmm, mm-hmm.
Rupesh Patel (01:03:22.769)
Mm-hmm.
Rosalie Wyonch (01:03:23.724)
pressure reliever. Same with if we had alternative services for the unhoused to either access care or addiction treatment services or mental health care services, then they wouldn't be showing up at the ER. And so it's where the big demand bubbles are is sort of where you can implement targeted solutions. And I think those would be the two that I would pick is the sort of the substance and
abuse and mental health issues, particularly for the unhoused population, but let's face it, everybody. And chronic disease management for seniors would probably be if I could pick two groups, but obviously I'm not a hospital CEO, their data might show different ones. Those are the ones that I see in the public data.
Rupesh Patel (01:04:08.509)
So something different, Yeah, yeah, yeah. To think that we were gonna, I think before we joined, said probably gonna spend like 40, 45 minutes on this topic. I probably was a bit ambitious to do that, but it's honestly, it's been a privilege just to speak with you. And I think folks are probably getting a huge benefit from hearing your thoughts on all three of these challenges. So I just appreciate your time Rosalie for sharing all your insights and.
I would love to have you back at another time to see how maybe we progress on these things or if there's new emerging challenges, maybe we do this again next year or something. But thanks so much for making time for me and for our audience and look forward to a future conversation.
Rosalie Wyonch (01:04:50.912)
Anytime, hope it helps. mean, lot of the time, economists and, let's face it, health discussions these days can be doom and gloom, but I really, like, the problems are real, but they're solvable. They are. And I really just think that it's trying to see the forest for the trees, you know?
And we can get lost in these esoteric policy discussions or things just fall through the cracks like the issue of scope of practice versus insurance. And so I hope all of that technicality can help you help your audience help you think about the healthcare system maybe a little bit differently because I'd say, you know, we have this universal public system that everybody believes in. But in reality, it's a lot more complicated.
Rupesh Patel (01:05:33.415)
Mm-hmm.
Rosalie Wyonch (01:05:43.712)
and so the more I can do to make that understandable or clarify it for anybody even if it's confusing at first like I had to dive down that rabbit hole and the more we know about our system the more we can actually demand the outcomes we want as the population this is our healthcare we pay for it the more we understand the more we can actually ask for what we want and then get it
Rupesh Patel (01:05:44.957)
totally.
Rupesh Patel (01:06:10.578)
I love it.
Rosalie Wyonch (01:06:10.97)
So happy to be here anytime and I hope everybody learns something.
Rupesh Patel (01:06:15.389)
Thanks, Rosalie. All right, well, we'll catch up at another time. Thanks so much again. Okay.
