“In brain we trust”

TORONTO SUN Mon, March 17, 2008

 DR. RANJIT SINGH AND DR. KEITH MELOFF

Neurologists are medical doctors trained to provide non-surgical care for patients with neurological disorders. We provide life-saving treatment for what are otherwise often disabling and lethal conditions and we save the system money.

But ever-more complex treatments and neurological disorders, along with an expanding and aging population, have prompted a crisis in neurology, with doctors working increasingly longer hours just to keep up with rising demand.

There are three reasons for this.

First, Ontario's population grew 4.6% from 2002 to 2006, with a huge increase in the number of elderly.

Conditions such as dementia, stroke and afflictions of the peripheral nervous system (ALS, peripheral neuropathies, etc.) disproportionately affect this burgeoning older population. Simultaneously, a better-educated public is demanding detailed evaluation of neurological symptoms.
 

Second, the number of neurologists has not kept pace. Last year was a bumper crop -- 27 non-visa trainees across Canada completed the gruelling, five-year program required after medical school. Yet few new neurologists were added in Ontario. Why?

Part of the reason relates to the last agreement between the Ontario Medical Association and the Ontario Ministry of Health and Long-Term Care. Although other MDs saw significant increases in incomes, neurologists did not. Neurologists currently earn what a family doctor practising in a family health team might make. This makes it hard to convince new, or existing, neurologists to remain in Ontario.

RETIREMENT AGE

Third, the aging of the work force compounds these problems. Many of the approximately 240 neurologists in Ontario are at, or fast approaching, retirement age.

Why should Ontarians care?

Ample evidence demonstrates the best and most economical care for patients with neurological diseases is delivered by neurologists. By underfunding neurologists, Ontario's health ministry is effectively rationing patient care. While the cheapest care is neglect, it comes with an immense cost.

The global cost of care for Ontario patients is about $55 million annually. To inject stability and certainty into neurological services would cost an additional $30 million, a small price to pay. Can we afford to neglect patients, who by virtue of their health problems, often can not advocate for themselves?

Right now -- when most needed -- trainee neurologists are not considering Ontario as a wise career choice.

Supplying the best care to patients suffering disabling neurological disease can be measured in dollars.

That care can be provided, rationed or simply denied. It is for the public to choose how its health care dollars are allocated, but it is our job as neurologists to provide quality care for our patients.

We urge the Ontario health minister to bring reason and morality into this discussion before it's too late.