Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 





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Improving Hospital and Emergency Room Capacity

Of all the telltale signs of mismanagement in Ontario’s health sector by the Provincial Governments of Dalton McGuinty and Kathleen Wynne, perhaps the most glaring is the current, sorry state of Ontario’s hospital and emergency rooms. 

“Gridlock” and “Overcapacity” are terms being used on a regular basis to describe the ongoing overcrowding of hospitals and emergency departments in Ontario. Overcrowding no longer occurs just in a flu season. Hospitals in eastern Ontario are over 100% capacity for most of the year. This lack of capacity has resulted in compromised ability to provide access to care for our most vulnerable citizens at their time of need.

The root of the problem is at the top. Instead of improving access to hospital care to serve our growing population and aging seniors, the Ontario Liberal government chooses to push care to the community and mercilessly underfund those very community health services.

Budget restrictions of the last decade, along with the lack of accessible hospital beds and relative shortage of affordable long term care options, have combined to result in gridlocked hospitals and emergency departments. Today, patients are at risk and it is commonplace to have cancellations of needed elective procedures, longer waits for specialist care, and a myriad of strain and negative health effects on patients and their families.


Liberals’ Frozen Budgets Create Chaos

The last five years of austerity funding for Ontario hospitals have been particularly harsh. From 2012-2015, funding for hospital operational costs were frozen. In 2016, hospitals received a 1% increase. Hospital budgets have fallen in real dollars when inflation is considered despite a growing and aging population that requires more services not fewer. It is estimated that hospitals require a 2% increase just to meet inflation, another 2% increase to address aging and population growth, and roughly 1% increase to address higher demand. (I will not broach the subject of the rising hydro and energy costs hospitals must budget for over and above other rising costs.)

The recent Ontario budget included $518 million allocated for hospital operating costs (roughly a 3% increase while the Ontario Hospital Association was asking for more than 5%). The Liberals have called this announcement a “booster shot” but it fails to come anywhere close to addressing the effects of the lack of funding over the past decade. The “boost” would be more aptly referenced in terms of the Wynne Liberals’ re-election efforts.

To address hospital and emergency department overcrowding and their negative effects on patient care, the government must budget responsibly rather than using a stranglehold on patient services in attempts to make up for the billions of tax dollars it has misspent on the eHealth spending scandal, the ORNGE fiasco, a bulging health management bureaucracy, and the one billion dollars a month it is spending on debt servicing charges. This money could have gone a long way to solving the overcapacity problems in Ontario hospitals and emergency departments.


There is Lack of Hospital Beds

Evidence shows that minor medical issues do not contribute significantly to ER overcrowding—it is the lack of beds that causes delays in the emergency department. The lack of bed capacity both in the hospital and in the long-term care community limits the ability of the hospital to deal with admissions and important treatment of our most ill patients. If incoming patients who need admission cannot access a hospital bed, the wait times build in the emergency department delaying care and causing waits that can extend from many hours into days. On average, one patient “warehoused” in the ER denies access to approximately four patients per hour to the emergency department.

A surprising fact about how low the last decade of mismanagement has taken our health care system is that Ontario has among the fewest number of hospital beds of countries in the developed world with 2.3 beds per 1,000 people--- ranking close to the bottom behind Turkey.

As part of the 2017 budget, Ontario Liberals are proposing to spend an additional $9 Billion to support the construction of new hospital projects across the province. Older hospitals are being replaced but building new hospitals with fewer hospital beds is not a solution to improving access to care especially when care in the community continues to lag.

Ontario’s growing population and increasing numbers of seniors will need more hospital beds despite the push toward care in the community. The ER overcrowding issue is beyond the point of being managed by doing more with less. Governments must restore additional bed capacity.


Alternate Level of Care Patients with No Place to Go

Outside of the hospital, community supports and long term care options also have potential to improve capacity issues within hospitals and emergency departments.

Long term care access is critical to restoring acute care bed capacity within hospitals and to improving waits in emergency departments. Roughly 15% of all hospital beds are occupied by patients who would be better served in a setting outside of hospital.

To avoid hospital gridlock, patients who cannot return home because of cognitive or physical limitations, so-called “Alternate Level of Care” patients, must have timely and respectful transition to more appropriate care. Early in 2017 there were over 3,000 ALC patients waiting in acute care hospital beds. It is estimated that about a third of ALC patients are waiting for a long-term care home. Even for home care in Eastern Ontario alone, there are approximately 3,000 people on a waiting list.

Addressing the home care and long term care needs of seniors including ALC patients is critical to improving capacity of Ontario’s hospitals both rural and urban. For more thoughts on this, please read my previous health priorities article A Way Forward with Accessible Long term Care in Ontario.

Here is something more to think about when considering the need to fund community health services versus hospitals. Over these past years, investments in primary care transformation to community managed services have not resulted in reduced numbers of patients visiting the ER. Statistics show that visits to Ontario hospital emergency departments rose more than 5% between 2012 and 2016. Patient visits are up and the patients are sicker. So, I suggest what the Liberals have failed to properly address is that our aging population means not only more chronic disease but also more acute events such as falls and infection.


If Ontario’s health care system were a patient, it would be whisked immediately to the ER

After a decade of mismanagement under McGuinty and Wynne, the Liberal legacy is: cuts to nurses and front line care personnel, ERs empty because hospitals cannot afford to run them, elective surgeries cancelled because of lack of ER beds, sick and elderly having to endure warehousing on gurneys in hospital hallways. These commonplace signs in Ontario’s hospitals are unacceptable. Our provincial government and health minister must do better at managing the health sector - starting with Ontario’s hospitals and emergency rooms.





Reader Comments (134)

Niagara has individuals capable of multitasking.


Chief of Staff
May 11, 2017 | Unregistered Commentereklimek
No you misunderstood. The OMA sends a disc to the MOH with the names of the docs who haven't voluntarily sent in their dues by April 1. The MOH then deducts the dues from two consecutive RAs in May and June and sends the OMA the money. That's how Rand (via the OMA Dues Act) works in this case. Don't send the MOH the names, and the dues don't get collected. Hence the OMA becomes a voluntary organization once again, just like they were for 18 months in 1997-98.
May 11, 2017 | Unregistered CommenterStephen Skyvington
The OMA will send in its list. It needs the money. If the OMA didn't send the list in, no one would pay. NO ONE. The new players WILL NOT change things.
May 11, 2017 | Unregistered CommenterMovingforwardOntario

If the public ever found out the conflict of interest issues, they would be shocked.

Most,if not all the consultants used by the MOHLTC, have "outside" interests.

No one at central cares.
May 11, 2017 | Unregistered CommenterMovingforwardOntario
"No one at central cares"

A sad reflection on the moral vacuum at the Ministry, if true. Given the suspicion you have raised about pending civilian service raises buried in the budget, now would be time for a full account of the income streams not documented in the "sunshine" list.

A government unable to reduce the debt while allowing the apparatchik to line their pockets sounds like a precursor to a change in government. Without such change it will not be exposed. However, perhaps I am naive. Perhaps every government evolves into a self serving monster?
May 12, 2017 | Unregistered Commentereklimek
But perhaps debt is not an Issue?

Maybe central is right, and wealth redistribution is more important than debt reduction.
May 12, 2017 | Unregistered CommenterMovingforwardOntario
Clues from the British National Health Service mothership about as to how matters are likely going to unfold in Ontario.

Daily Mail " we need another 5,000 doctors" in eight FP posts left empty,

Some medical offices have given up trying to recruit more FP's and are hiring pharmacists or ' therapists' to take appointments as well....some offices have closed altogether with the patient load transferred to neighbouring practices that have become overloaded and over crowded.

Rising numbers of FPs are retiring in their 50's , moving overseas,going part time or retiring altogether....increasing the pressure on those remaining.

150 FPs are leaving each month.

Interestingly, thanks to increased obesity British ambulances built to carry patients up to 28 stones ( 364 pounds/ 165 .1 K) have been reenfoced to transport those at 70 stones( 980 pounds /444.5 K).
May 12, 2017 | Unregistered CommenterAndris
British NHS has just suffered a cyber attack, ransom demanded.

One more benefit of EMR etc.
May 12, 2017 | Unregistered CommenterAndris
Is this the fund raising arm of a state's cyberespionage division or just the work of a criminal enterprise?

NHS is hit by large-scale cyber attack as computer systems and phones in hospitals across England go down as hackers demand £415,000 not to wipe files
It would seem that all you need is the ransomware link to reach the hospital end users followed by a careless employee clicking on the link (John Podesta did just that in a simple phising attempt).

The larger the organization the higher the probability that a careless employee will open a disguised link or one could see a state or criminal enterprise recruiting a rogue employee to click on such a link once on the system. The weak link is the humans interacting with the system.

From one year ago.

"Eggins could not confirm whether it was Locky that hit the Ottawa Hospital’s computers.

Mark Nunnikhoven, vice-president of cloud research at computer security firm Trend Micro, said ransomware is a serious threat of which consumers and businesses need to be aware.

“It’s quickly becoming the ‘go-to’ move for cyber criminals. The reason why Ransomware is increasingly in prevalence is because its extremely profitable for the criminals,” he said. “This is a low effort, high return campaign.”
The Welsh side of the NHS has a different system so has been far.

The virus , or whatever it is ( I'm not a techie) , is spreading throughout the English NHsystem, clinics etc., have been told to close their systems ...there is chaos.

The only islands of calm would be the paper based systems, if any still survive in the UK.

At present we have two UK med students doing clerkships with us prior to returning to the UK to finish off their studies.

They have been warned that they might be jumping from the frying pan into the fire if they come to that they gather the qualifications required to work in the USA , Australia etc., ...modern day medical "mice" cannot trust their fate to only one hole, but as many holes as they can so if matters go sour in one country that they can move to another...they might use Canada as a stepping stone to the USA.

They have found the FP environment that they are enjoying here to be more friendly than in the UK where it is getting nasty, joining us at CME dinners etc.,'s fun ( as a member of the geezer generation) to show the young presentations of various conditions at the office.

They have been given the heads up regarding the dark clouds of the various noxious Bills building up over Ontario.
May 12, 2017 | Unregistered CommenterAndris
I was speaking with a Canadian-born, Polish-trained, UK FP who was in town this last week to write the final exam in Hamilton to get her Canadian license. She has not worked here, but wants to keep all her options open as the NHS continues to fall apart. She did say that there is so much work in the GLA that one has to be careful not to burn out. In the end she is going to likely settle in New Zealand, but will have her US, UK, and Canadian licenses just in case things go sour in one country or another.

All this instability in the various global health care systems means one does have to have multiple licenses to remain protected from government meddling, but it sure doesn't make for a stable future professional life.

We hear references to the Millennials participating in the 'gig economy' and one can see that for a physician this could mean moving from province to province on contract or from country to country as conditions change.
This ransomware " virus" was not aimed at the NHS and is spreading far and wide....soon to come here.

I had to Google " gig economy"--it is a business model where goods and services are traded on the basis of access rather than ownership: it refers to renting things temporarily rather than selling them permanently".

The younger generation of FPs might well become global Gig FP's---I had mentioned a few years ago having been at the Annual FP meeting in Quebec City that those who were getting the highest marks/ awards were planning to become locums.

It fits the millennial global gig FP hypothesis ---the central planners will be sctratching their heads--- the nomadic global gig FP , " travelling workers, " travelling tourists" will be expensive, their flights and lodgings would have to be covered.

Continuity of care will , presumably, have to be handled by non itinerant local team members.

One day, after the collapse, a post mortem will be carried out as to why the whole state run health care structure fell apart , it will be recognized that there was a near golden era , when the health care system worked prior to the series of government inspired " improvements" , where there were community family physicians tending to families from cradle to grave , who were devoted to their patients, and who did so efficiently and effectively at a bargain price.
May 12, 2017 | Unregistered CommenterAndris
"Continuity of care will , presumably, have to be handled by non itinerant local team members." - AL

There will be no continuity of care as we knew it. The chart or medical record will be the continuity. All proficiency will be judged by the documentation.

Time gone by it was possible to go, not only from cradle to grave, but further. I know 3 generation of Huntington's having made grandmother's diagnosis at the bedside. Two daughters were in ER with her 25 years ago and it was clear which one had also inherited the disorder. I see the granddaughter occasionally when she is in trouble and I may live to see the 4th generation.

That sort of familiarity will be unlikely in the new order.
May 12, 2017 | Unregistered Commentereklimek
Ed : and if the ransom malware crooks wipe out those paperless electronic records the history is vanished forever.

Having been raised in Wales and being familiar with Welsh bards ( and Celtic bards in general) and their history, you and I may well come to resemble such ancient bards maintaining an oral history of our practices and of the health care in general regurgitated in verse and song as we pluck our harps in some chieftan's great hall in exchange for scraps from the great table.
May 12, 2017 | Unregistered CommenterAndris
40 Trusts ( equivalent to LHINs) have had their computers captured , some hospitals can't use MarIs and CT scanners, all ITs have been shut off and they had to resort to pen and paper.

The payment must be made in Bitcoins and the price doubled after 3 days.
May 12, 2017 | Unregistered CommenterAndris
All will be fine. It is just medical information. Wait until the banks get cracked.
May 12, 2017 | Unregistered CommenterMovingforwardOntario
The pendulum will swing. The millenials are no different from any other generation of human beings who want a family eventually and a place to put down some roots.
I am optimistic.

I watched the "hippy" generation leading my age group at the tail end. We ended up more conservative than the leading edge of the Boomers.

There are ebbs and resurgences. Let's just hope we can move the fulcrum just a little bit.
May 12, 2017 | Unregistered CommenterMerrilee Fullerton
Any thoughts about the following article?:
May 12, 2017 | Unregistered CommenterMerrilee Fullerton
May 12, 2017 | Unregistered CommenterMerrilee Fullerton
All will be fine.Property taxes will rise, as housing prices rise, and a wealth tax will be created on RRSP/TFSAs.
May 13, 2017 | Unregistered CommenterMovingforwardOntario
The false documentation of SROM vs AROM is the coverup.

"Hospital staff promised an investigation and the Butlers called Sommers Roth & Elmaleh. Elmaleh, with co-counsel Jeremy Syrtash and Michael Hershkop, took on the case.

For the next nine years, there was no admission of culpability from RVH."
May 13, 2017 | Unregistered Commentereklimek
"Ontario’s health ministry is on high alert to ensure that computer systems at the province’s 145 hospitals remain secure following what a government source described as “a downtime episode” at Lakeridge Health in Oshawa."
From the article:
"Russia appears to have been the hardest hit, according to security experts, with the country’s Interior Ministry confirming it was struck"

Taking on the Russians may have more consequences than the hackers have anticipated. At least we'll probably find out who is at the root of these attacks.

Just wait until they figure out that some of these large FHT networks in Ontario are ripe for the picking.
Just out of curiosity. If the event occurs, who pays?
May 13, 2017 | Unregistered Commentereklimek

Just as they pay for the lawsuit you cited (HIROC insurance).
May 13, 2017 | Unregistered CommenterMovingforwardOntario
The CIA has said that for some of its top secret work they have reverted to using paper, typewriters, and human couriers again.

We have paper CPPs so the world could shut down and we could still function seeing patients. In fact I'm sure we could resurrect the floppy disk and drop the remittance at the OHIP office if the need arose. Oto/opthalmoscopes are battery powered and full land lines with phones that do not require power.

A lot of lessons were learned with the big blackout in 2003.

"Computer after computer froze, their files inaccessible, with an ominous onscreen message asking for about $300 worth of “bitcoin” — a cryptocurrency that allows for hard-to-trace transfers of money. Ambulances headed for children’s hospitals were diverted. Doctors were unable to check on patients’ allergies or see what drugs they were taking. Labs, X-rays and diagnostic machinery and information became inaccessible. Surgeries were postponed. There was economic damage, too. Renault, the European automaker, had to halt production.


The problem is even worse for institutions like hospitals which run a lot of software provided by a variety of different vendors, often embedded in expensive medical equipment. For them, upgrading the operating system (a cost itself) may also mean purchasing millions of dollars worth of new software. Much of this software also comes with problems, and the “no liability” policy means that vendors can just sell the product, take the money and run. Sometimes, medical equipment is certified as it is, and an upgrade brings along re-certification questions. The machines can (as they should) last for decades; that the software should just expire and junk everything every 10 years is not a workable solution. Upgrades can also introduce new bugs. How do you test new software when the upgrade can potentially freeze your M.R.I.? Last year, a software update “bricked” Tesla cars: they could not be driven anymore until another update fixed the problem. Many large institutions are thus wary of upgrades."®ion=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region

We are moving to be an interactive cooperative.WE can't impose social justice without the linking.

With the basic assured income, the raising of the minimum wage to $15.00, and the increase in taxes on property, we are reaching the desired social Utopian state.
May 14, 2017 | Unregistered CommenterMovingforwardOntario
Canary, although many of our older colleagues been " encouraged" to go the supposedly paperless EMR route, their paper practice skills remain embedded in their crania ...the powers that be would be wise to tap into that valuable ' how to' knowledge before it vanishes.

One is reminded of the old skills of household management where , decades past, the shopping for the week would be carried out on a Saturday, with the menu for the next week planned out...let's say roast beef on Sunday, on the Monday Shepherd's pie ( really cottage would a shepperd get hold of beef?...real shepperd' s pie would be lamb/ mutton) ...Tuesday roast beef sandwich and bones in a soup) ....home ec used to teach cooking, sowing, nutrition.

I was never taught to type, that and shorthand was for future secretaries ...I would concede that typing would be useful in the modern the old days if one presented one's school/ university work typed on paper it was thrown back " anyone could have done that, how do we know it's your work?"

The Kremlin switched back to type writers , handwritten notes and couriers some time ago, although it was interesting to see that the Russian interior ministry was badly hit by this malware--- it reminded me of my father telling me that when he worked in the Soviet Union as an accountant, computers were only allowed in Moscow with abacuses outside.

With the collapse of the USSR and prior to his death I managed to get him to visit me in Canada and he was amazed by computers--- he thought that the Canadians cashiers were brilliant, he would inspect the tape after shopping and be amazed by their accuracy being unaware of scanning of bar codes.

I'm glad to see that this latest IT debacle has put a stick in the spokes of the globalist social justice wheel.
May 14, 2017 | Unregistered CommenterAndris
In the meantime, the world awaits an escellating global cyberattack crippling international services as people return to work....does one unplug ones computers tonight?

According to the Daily MailBritsh FPs are demanding that patients be forced to pay to see them as the only way to save the FP crisis as FPs are leaving in droves...the British Medical Association describes general practice to be at the breaking point.

Our own provincial government , not learning from the NHS mothership's problems , is intent on piling up the straws on the backs of the Ontario FP "camel".
May 14, 2017 | Unregistered CommenterAndris
The NHS should just tweak that net income upwards about 10 to 20 percent and then advertise heavily here in Ontario for new docs. Problem solved. I think many recent grads with a few years under their belts would consider moving to Britain although Brexit will cloud the future for a while yet.

In two weeks in our neighbourhood there are 3 family docs retiring in their seventies and eighties who will release at least 5000 patients back onto the street with no new FPs to pick them up. Most of these patients are seniors as well.
The British NHS is dependant on foreigners to run it...10% of its MDs and 4% of its registered nurses , many of whom cannot speak English...if Brexit results in the closure of inflow from the EU then Britain may well have to turn to other English speaking countries who do not value their own MDs and nurses.
May 15, 2017 | Unregistered CommenterAndris
It will all be fine. Tax revenues are booming. Debt not cared about. Good times to be at Central. Lots of money to spend.
May 15, 2017 | Unregistered CommenterMovingforwardOntario
mfO...your tongue in cheek "the plan is good" mantra is taking on a rather dark shade....Are you now going with "It will all be fine"?

Ontario hospitals are in crisis. Patients are being denied care and treated like hot potatoes nobody wants...bad for budgets apparently.
.Patients are punted to the community without the necessary resources. Then they bounce back to the ER. But the family is told if they are admitted they will have to start the wait list for long term care all over families sit on sick elderly at home. The guilt.

Long term care settings are afraid to send their Patients to the ER too often for fear of showing up on the radar of performance measurers.

The MDs and nurses are demoralized.

And the aging has just begun......

However, there are plenty of health care management conferences to attend. Lots of people making good livings measuring and monitoring and providing input into the system about data and quality metrics. Meanwhile people cannot get basic care. How odd.
May 15, 2017 | Unregistered CommenterMerrilee Fullerton
"Debt not cared about. Good times to be at Central. Lots of money to spend." Mfo

Too complex for me.

Deficit / debt spending today will require increased taxation in the future, thus burdening future generations.


If debt is both owed by and owed to private individuals, then there is no net debt burden of government debt, just wealth transfer (redistribution) from those who owe debt (government, backed by tax payers) to those who hold debt (holders of government bonds).
May 15, 2017 | Unregistered Commentereklimek

Central is fine. Lots of revenue coming in (love the carbon tax). Debt seems not to matter,so all the debt worries of the past are gone.

Central is assured by the managers and consultants all is fine at the coal front.
May 16, 2017 | Unregistered CommenterMovingforwardOntario
" All well at the coal face" ---from managers and consultants staring at flow sheets far from the coal mine.

" Farming looks mighty easy when your plow is a pencil and you're a thousand miles from the corn field".

( Dwight Eisenhower)
May 16, 2017 | Unregistered CommenterAndris
May 16, 2017 | Unregistered Commentereklimek
The polls (internal) continue to show if the government in power can get enough young urban women to vote, it can get, at least a minority government (there are other targeted groups). The targeting of selected groups, already identified is huge agenda item. The "rural" areas are written off already. This will be the "first" urban election. GTA and GOA will drive this.

That and getting the PCs/NDP to touch the "third rail".

Debt accumulation is not an issue for these group, gaining immediate self fulfillment is. This will be a ward by ward demographic review to target the wards that have winning demographic structure and dump them money."Big data" at work.Getting Twitter/FB/Google to feed "ads" based on key word searches behind the scenes by central.

The old days of quiet, slow, newspaper driven, electioneering is gone. There already exists an overall firm 40% which will solely vote Liberal. They are hunting for an additional 5% to flip. If the economy stays "stable", they can find them.

Health care is not an issue for the targeted groups,as it is free and available. They want and can find widget based doctors through walk in clinics. They want in and out rapid care.
May 16, 2017 | Unregistered CommenterMovingforwardOntario
And it begins... with more regulations:
May 17, 2017 | Unregistered CommenterMerrilee Fullerton
“If the outcome of that process is a set of regulations that come up with a creative way to make sure that there is at least a minimum protection . . . and the Canadian health-care system is being protected against price gouging, then we’ll be in a good position,” Morgan said in an interview.

Most drug plans can do a reasonable job at maintaining costs at a level that represents value for money, he added, saying the situation could be improved if drug plans were universal."
May 17, 2017 | Unregistered CommenterMerrilee Fullerton

You need to accept, we are moving to a state driven system, where all the widgets do what central dictates,and preaches centrals values.
May 17, 2017 | Unregistered CommenterMovingforwardOntario
back to the paperless EHR

"if you're paid according to how many patients you see, and two thirds of your time is spent documenting patient visits, then you have to cram even more patients into what time you have in order to make your business viable, which means even more paperwork and even less time and so on until the physician is finally burned out."

"The result is a bureaucracy that puts controlling costs above quality and undervalues the clinical intuition around which medicine's professional identity has been constructed."
May 17, 2017 | Unregistered Commentereklimek
You can 2 of the 3: cheap, average, or fast.
May 17, 2017 | Unregistered CommenterMovingforwardOntario
As for policy, it is now driven by sociological views, not evidence based biology.

Vaccinations are our best example. Sociologically, defend one's privilege to ignore fact: biologically, for the good of the individual, and the population, vaccinations are required.

We still can't figure this one out.

It is going to get worse.
May 17, 2017 | Unregistered CommenterMovingforwardOntario
The ERs are now part of the margins.

"When I first started [as an emergency physician] 20 years ago, if one or two patients were in the department for over 24 hours, that would really have caught our attention. We’d be like, “What’s going on?” Now, there are 30, sometimes more."


EDs are in the margins.

Don't get sick without a healthcare "buddy", whom can "protect" you from healthcare care!
May 17, 2017 | Unregistered CommenterMovingforwardOntario
Just wait until June 1 passes and the MOH sees how many older urban FPs have thrown in the towel.

Health Connect is going to get a lot of calls.

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