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AON Press Conference-Queen’s Park,Toronto February 27 2008
DR RANJIT SINGH
Good morning ladies and gentlemen and thank you for attending this press conference. I am Dr. Ranjit Singh president of the Association of Ontario neurologists and my colleague here is Dr. Keith Meloff our vice president. We hope to provide you with an insight into what we feel is an escalating and dangerous crisis in the provision of neurological care in Ontario. A neurologist is a medical doctor with specialized training in diagnosing and treating and managing disorders of the brain and nervous system. Neurologists do not perform surgery.
Our training includes an undergraduate degree, four years of medical school and a one-year internship together with three or four years of specialized training. Many neurologists have also received additional training in one particular area of neurology such as stroke epilepsy or movement disorders such as Parkinson’s disease. This is called a subspecialty. We function as consultants to other physicians in the diagnosis of complicated diseases involving the central and peripheral nervous systems. Some of these diseases include chronic pain, headache, epilepsy Alzheimer's disease, Parkinson's disease multiple sclerosis, brain and spinal cord injuries, brain tumors, amyotrophic lateral sclerosis (ALS] also called Lou Gehrig's disease and many more. Evaluation of these diseases is challenging and has become even more so as our population ages and as there is an increased need for information on the part of both patients and caregivers. A major part of our work is in the management of life threatening emergencies in intensive care units and in diagnosing brain death.
The demand for our expertise is increasing far beyond our ability to cope with these challenges. The population of Ontario grew 4.6% from 2002-2006 and with it we are seeing a significant increase in our elderly population as well. We have a serious manpower shortage in Ontario as our members are becoming older. Replacements will be hard to come by.
Appointments for new neurology consultations are now being booked 4-6 months ahead depending on which part of the Province you are in.. A patient with a new presentation of seizures, spinal cord tumor or recent stroke like symptoms cannot afford to wait for such long periods for diagnosis.Yet this is happening with increasing frequency. This is also complicated by the fact that many community-based hospitals and large communities of over 50,000 people are poorly equipped to handle even the simplest neurological emergencies. Many such hospitals are not providing proper support with staff and equipment for electroencephalography (EEG or Brain Wave Recordings) or for electromyography (EMG or electrical studies of nerves and muscles) used in the diagnosis of epilepsy or peripheral nerve and muscle problems respectively. The argument put forward by hospitals against providing these facilities is that they are not “profitable”.
Imagine that your young son or daughter has just had an episode of visual loss numbness on one side of the body and headaches with vomiting which is continuing but intermittent. Your family doctor tries to get an appointment with a neurologist and the earliest this can happen would be at the minimum six to eight weeks hence. An MRI scan was ordered and found to be normal. In the meantime this young patient is unable to carry on with normal activities. The diagnosis is most likely complicated migraine but to the patient and the family this is a disaster. The same arguments may be applied to diseases such as Parkinson's disease stroke and Alzheimer's disease. These conditions profoundly upset not only the patient but the family dynamics and neurologists are best qualified to handle these situations. These scenarios and many like them with the hardships they cause are totally unacceptable in a civilized society.
Compounding this is the fact that Ontario has proven to be an almost hostile environment as far as attracting new neurologists is concerned or perhaps even encouraging those who have left to return. Part of the reason has been a failure of the Ontario Medical Association and the Government of Ontario to nurture and create good working conditions for our specialty. The last agreement between the OMA and the Ontario Ministry of Health and Long-Term care has left our remuneration for services at the lower end of the scale compared to other physicians. Recently an internal memo even within the OMA recognized that an 11% increase in remuneration for neurologists will be necessary to compensate for previous neglect. We are very sceptical that this will become a reality but funds must be injected into the new agreement to bring remuneration for the services of neurologists in line with other specialties. The Government and the Universities must also urgently enroll more graduates into Neurology training.
All of this has done very little to encourage colleagues to come here or to stay when faced with better working conditions in other provinces such as Alberta. We cannot afford an outward migration of many of our colleagues. The 19,000 member American Academy of Neurology (of which I am a member) has recommended that the ideal distribution of neurologists should be 1:50,000. Applied to Ontario this would mean that at the moment we are short all at least 40 more neurologists. Clearly this situation must change.
DR KEITH MELOFF: Good morning ladies and gentlemen. I am Dr Keith Meloff, Vice President of the Association of Ontario Neurologists and I am a senior neurologist in this Province involved in clinical neurology in children and adults as well as research and teaching largely in the Toronto area. I also work on an itinerant basis in Northern Ontario as far as the Timmins area. Neurology services while desperately need in the North are not available and we cannot create incentives to encourage our colleagues to leave the South to go up there. They are already overloaded with patients here. I can give you many examples where my services up north have been of major value to the people there and they are grateful. As my colleague Dr Singh has told you, the Government must take our concerns seriously both in terms of providing more resources and in opening up an ongoing dialogue. To put this into perspective, 25 cents for each of the 220 million empties returned to the liquor and beer stores of Ontario last year would cover the global cost of care for Ontario patients by neurologists. Merely to inject some stability and certainty into Neurological services would cost pennies a bottle more. In concrete terms, an additional $30 million would do more than provide stability for care.
While resources must be distributed fairly to both teaching and community based hospitals and services, note must be taken of the fact that there are now several large cities in Ontario with large catchment areas for patients with neurological problems. A coordinated approach to identifying and dealing with these needs is needed urgently and the AON is ready to help.
DR RANJIT SINGH
The best care for patients with neurological disorders is provided by neurologists. If patients with neurological disorders are to obtain adequate medical care now and in the future, the Ontario Ministry of Health and Long-term care must change the way this important specialty is nurtured. Action must be taken immediately to stabilize the provision of care for patients with suspected or established neurological disease while increasing access. It is the only reasonable and moral choice and we hope
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