EDITOR:
While those proposing the creation of a medical school at UPEI to address a real health-care access problem are well meaning, the idea itself is fraught.
First, it is very expensive. Second, graduates of this school cannot be obliged to stay on the Island under the charter, so there is no guarantee the perennial access problem will be solved. Third, I fear some of the appeal of this idea is status-based (as in: “We have our own medical school”). Last, other, less costly and more comprehensive and enduring solutions to health-care access problems have been successful elsewhere.
I would hope these approaches would be explored before undertaking the large cost of creating a medical school. The health-care access approach I refer to is a population health model based on the internationally recognized determinants of health. The clinical or doctor approach is one of the determinants for sure, but it is not the only one. Focussing resources only on the clinical, where health is implicitly defined as the absence of disease, ignores other factors that directly bear on health outcomes.
Income, education, community functioning and integration, gender and ethnicity, are the principal determinants, none of which is addressed in the medical model of care. The patient or health customer load on family physicians could be greatly reduced by adopting population health models of care that produce better health outcomes at lower unit cost than the medical model.
Instead of having a family doctor, Islanders would be clients of a health practice with direct access to a nurse practitioner, an OT, a dietician, a health educator and a health-system navigator and a social worker — all sharing a practice space. The practice medical doctor would act as a key consultant to the practice. As a trial or pilot project, this practice could be located in a rural under-enrolled school and function as a health hub for the entire community.
In time, savings from this care model could be directed to recruiting medical specialists where there is a real shortage on the Island. This is no overnight fix for the current health access problems but there is a better and more cost effective way of addressing the full range of health needs of Islanders than creating a medical school here.
It’s worth a look!
Darragh Mogan is a retired senior executive with the federal government specializing in health and social service policy living in Charlottetown
