Clinic’s financial crisis offers cautionary tale
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If you needed an example of the gravity and magnitude of Manitoba’s physician shortage, you couldn’t do any better than to study the problems afflicting the Manitoba Clinic.
One of the biggest privately owned health-care facilities in Canada, the Manitoba Clinic was recently granted bankruptcy protection after accumulating more than $8 million in operating debt. The clinic must now restructure its operations and finances under court supervision.
Although the clinic has been around for more than 60 years, it opened a new 10-storey building in 2018 on Sherbrook Street, the eastern edge of the Health Sciences Centre campus. The bankruptcy marks a dramatic reversal of fortune for what was intended to be a state-of-the-art home for as many as 85 general practitioners and medical specialists.
There is little doubt the idea behind the clinic was solid: more room to examine patients, consult on complex medical issues and provide out-patient diagnostic and surgical procedures in a brand-new building located near Manitoba’s largest hospital.
The clinic was arguably a net benefit in the battle to recruit and retain medical specialists.
However, the dream held by the owners of the clinic was never fully realized. The clinic failed to find enough physicians to occupy its vast space. It needed a share of the fees physicians were charging for medical services to cover its overhead; too few physicians means not enough money to cover basic costs.
And then the pandemic hit, severely restricting surgeries and other complex medical procedures, and driving down patient visits. This once again limited the amount of money physicians could bill and remit to the clinic.
The owners of the clinic certainly share more than a little responsibility for a business model that may have been deeply flawed. However, there are many structural issues at work here that have also contributed.
The Progressive Conservative government was warned early in the pandemic that it needed to do something to support privately owned primary-care clinics. The pandemic was hammering doctors in private practice and threatening the viability of their facilities. Contrary to these warnings, the PC government did very little to aid the clinics.
Although it did provide support to businesses during the pandemic, many clinics found they could not qualify. And Manitoba was the only province to charge private clinics for protective masks, gowns and gloves.
The folly of this approach by government has now become glaringly apparent.
Although Canada has a universal, publicly funded health-care system, most primary care is delivered through facilities owned and operated by physicians. They cover the costs of their clinics by billing government for every visit and procedure they provide. It’s not a perfect system, but it has provided government with one main advantage: relieving taxpayers of the cost of building and maintaining a complex primary care network.
If the existing network fails, more people will be forced into hospital emergency rooms for basic primary care. And given the fact most ERs are already overwhelmed, that is simply not an option.
The provincial government must re-examine its relationship with physicians, and the way it supports private clinics. This may involve re-imagining the fee-for-service structure we currently have; it will also likely mean expanding the range of services that can be provided in private clinics. Physicians are already clamouring for increased involvement in outpatient surgical and diagnostic procedures such as endoscopies.
Whatever the array of solutions, government needs to move quickly to shore up private clinics, or it risks losing a foundational part of the public health-care system that, if truth be told, none of us can afford to lose.