The herd mentality is why you can't find a doctor

Suppose I told you Canada had too many doctors. You'd think we urgently needed at least one more psychiatrist, right? Well, we might as well get our heads shrunk if we're not going to use them a bit more on crucial public policy questions, including health. This melancholy reflection was prompted by a bit of spring cleaning. Things are just as dismal under the couch (or, if not, credit my wife). But I finally got around to my computer. And amid the dust bunnies on my hard drive, I found the horrible, dried-up husk of the conventional wisdom on health care: We have too many doctors in our cities.

Don't laugh so hard it hurts, now that a million people in Ontario already don't have family doctors and, nationwide, one in five doctors is between 55 and 64 and another 11 per cent are over 65. But the front page of the Nov. 2, 1996 Globe and Mail said "large urban areas" were "oversupplied with doctors" and specifically identified "Toronto, Ottawa, London and Kingston."

The Toronto Star that same day said parts of Ontario had "too many doctors" having referred to "over-serviced regions" on Oct. 27 and "over-serviced areas, like Metro" on the 26th.

What, other than organic brain disease, could have led to this conclusion? Well, the Star explained it all in a sage editorial on Oct. 30, 1996: "It is generally accepted that there are too many doctors in Metro and other large urban centres in Ontario, while there are too few practising in the North. But unlike other services ... there's almost no chance that the interplay of supply and demand for physicians will produce the desired exodus from the south to the north. That's because a doctor is not just a supplier or producer of medical services. He or she is also an agent of the consumer, with the power to generate demand. As a result, doctors in the south can protect their incomes by 'over-servicing' patients who are not required to pay for the treatment they receive. Under the current fee-for-service system, the provincial government's only role is to just keep paying the doctors' bills. But as the ultimate purchaser of doctors' services, Queen's Park should have the power to match its payments to more objective criteria of actual need."

As Kenny Stabler might say, "Easy to call, hard to run." Getting power is easy. It's using it wisely that's difficult. Abolish market prices and it's not at all clear where you're even going to look for "objective criteria" to help you reconcile the competing demands of quality and price. Yet on Oct. 31st, 1996, the Globe said "the only real gain" the Ontario government had made in three weeks' bargaining with MDs was "the power to keep doctors from setting up shop in over-crowded areas and to get them to where they are needed."

So for the last nine years, Queen's Park has been able to drive doctors away from Ottawa on purpose as well as by mistake. Feel better now?

I understand why people who once thought "over-serviced areas" was a groovy phrase now hide it in the back of the cupboard with the bellbottoms and leg warmers. (Of course some papers are under new management since then, including this one). But isn't it a bit worrying that something so totally lunatic could have become the conventional wisdom?

Remember: every trendy blunder does lasting harm without impairing the credibility of our chattering classes.

Back in 1992, the feds and every single provincial government agreed to cut medical school enrolment by 10 per cent to combat the national infestation of doctors. Now I think they're all saying group practices are the thing that will for sure prove socialism works in health care and if not you die.

Uh, leave out that last bit. Why alarm the patients?

The herd of independent minds escaped disgrace despite babbling about too many doctors a decade ago because everyone was doing it. And conformity keeps them safe today. It's like when a bunch of zebra all get moving in roughly the same direction, jostling and twitching so the stripes form a dazzling, blinding pattern in which no individual stands out. You end up standing in a dusty, empty field wondering where everybody went.

Just as you probably will if you go looking for a family doctor today. It all makes me very anxious. But I don't need a psychiatrist. Though I would like more doctors generally, along with more free-market economists and more free thinkers. If, that is, we're going to shrink our waiting lists, not our heads.

[First published in the Ottawa Citizen]

ColumnsJohn Robson