Divide and conquer

Bruce P. Squires, MD, PhD
Editor-in-chief

Canadian Medical Association Journal 1996; 154: 623

Perhaps the most ominous reality that government, the medical profession and the public has had to face is that there will never be enough money to fund all the health care we would like. Even if Canada were by some miracle to leap forward into a decade of unprecedented growth, health care would demand an inexorably growing part of the economic pie, and ultimately we would again smash headlong into the economic stone wall.

Demand that exceeds supply creates tensions. Facing ponderous debt, provincial governments predictably, albeit sometimes irrationally, attempt to limit the activities of what they see to be the main perpetrator of health care spending, the medical profession. In pressing the profession, governments have exposed medicine's internal fissures and threaten to destroy organized medicine as we now know it.

Already governments have attempted to control where physicians practise, which has the unfortunate effect of alienating young physicians, especially when their older, established colleagues may not be seen to stand up for the rights of the young. If the profession cannot support all of its members it will disintegrate into warring factions.

As well, economic pressures have prompted some governments to consider courting family practitioners and specialists separately. Those being courted may greet their suitor's advances warmly, with the misguided belief that separate arrangements will make their group more powerful. But such a division can only lead to the two colleges squabbling over the relative size of their portions of the pie.

Never before in organized medicine has it been so important for the various segments to remain united; some very difficult and painful decisions must be made. If they are made individually by groups with vested interests, the entire profession and the health care of Canadians will suffer.

| CMAJ March 1, 1996 (vol 154, no 5) |