Doctors in Canada: The Changing World of Medical Practice

John H. Gryfe is an oral and maxillofacial surgeon practicing in
Toronto.

The nature and delivery of health care has been a political
preoccupation in Canada for most of the twentieth century. From its
genesis as a 1915 insurance plan in Saskatchewan through the ineffectual
1985 doctors’ strike in Ontario, the relentless tide toward a
universal government-sponsored plan has pressured the medical profession
into philosophic changes unthinkable even 50 years earlier. Contrary to
popular belief, however, sociologist Blishen feels that this insurance
is the outcome of physician concern for almost 40 percent of a patient
population unable to pay its medical bills, not the brainchild of a
socialist government.

Once the autocratic domain of professionals protected by both
provincial and federal legislation, medicine no longer controls the
education and licencing of its practitioners. Today its collegial
decisions are increasingly being dominated by politicians, interested
laypeople, and taxpapers. A better-educated and better-informed public,
conditioned in recent years to participate as consumer advocates, has
earned an increasingly high-profile presence on medical legislative and
health institutional boards. Modern medical treatment relies on
information garnered from technology. Physicians have become reliant on
personnel whose knowledge controls the effective use of this technology.
The broad spectrum of treatment has necessitated the involvement of
numerous paramedical disciplines.

Once the fiefdom of a few chauvinist males, the practice of medicine
has been turned on its genetic head. The 1989 graduating class was 40
percent female, and their practice philosophy—more “expressively
oriented” to patient management than their male colleagues’
“instrumentally oriented” practices—threatens to divide a
profession already challenged by the dichotomy of generalist/specialist
differentiation.

In this well-structured study, Blishen has fashioned an intelligent
explanation for the changes in Canadian health care, which have been
exceedingly rapid, breathlessly dramatic, and uncomfortably public.