--- author: TVO Today date: '2026-10-22' guest: '' layout: post.njk source: https://www.youtube.com/watch?v=AF2Cxd3cJCA speaker: TVO Today tags: - healthcare-privatization - public-health-funding - physician-shortage - medical-education - rural-healthcare title: 私立诊所与扩招医生能否拯救安省医疗体系？ summary: 本期节目深入探讨安省医疗体系的两大核心挑战：一是第60号法案推行私立诊所承接公费手术后，研究显示公共资金大量流向营利性机构，等待时间却不降反升，并伴随违规收费与公立医院资源被分流的隐患；二是安省北部医生严重匮乏，北安大略医科大学（NOSM）校长分享了如何通过本土化招生与分布式培养体系破解边远地区的医生留存难题。 insight: '' draft: true series: '' category: politics-society area: society-thinking project: [] people: [] companies_orgs: - Canadian Centre for Policy Alternatives - NOSM University products_models: [] media_books: [] status: evergreen --- ### 安省医疗私有化扩张与等待时间争议 **>>**: 我们将以迅速的方式为人们提供所需的护理。
Original English **>>**: We're going to give people the care they need in a rapid fashion.
**>>**: 那是道格·福特省长在2023年的质询时间里为第60号法案《您的健康法》进行辩护。该法案扩大了安大略省医疗护理的私营交付范围，意味着现在允许更多私立诊所提供一些由公费资助的手术和医疗处置。我们指的是像白内障手术、诊断影像以及髋关节和膝关节置换术这类项目。三年过去了，这起作用了吗？新的研究表明，流向这些机构的公共资金增长速度快于对医院的拨款，而等待时间仍在继续上升。因此，我们来深挖一下相关证据。
Original English **>>**: That was Premier Doug Ford in question period back in 2023, defending Bill 60, the Your Health Act. The bill expanded private delivery of care in Ontario, meaning more private clinics are now allowed to offer some publicly funded surgeries and procedures. We're talking things like cataract surgeries, diagnostic imaging and hip and knee replacements. Three years later, is it working? New research suggests that public payments to these facilities are increasing faster than hospital funding, and that wait times are still going up. So we dig into the evidence,
**>>**: 获得医疗服务不仅关乎各项手术的等待时间，还关乎是否有足够的医生。这在安大略省北部是一个特殊的挑战。我前往萨德伯里，去了解北安大略医科大学（NOSM University，原北安大略医学院）是如何尝试在北部培养医生并鼓励他们留在那里的。我是杰扬·杰加纳森（Jeyan Jeganathan）。欢迎来到《The Rundown》。安大略省政府表示，扩大私立诊所的作用可以帮助患者更快获得护理。但证据到底显示了什么？安德鲁·隆赫斯特（Andrew Longhurst），非常高兴你能做客《The Rundown》。你最近怎么样？
Original English **>>**: Then getting access to healthcare isn't just about wait times for procedures. It's also about having enough doctors. That's a particular challenge in northern Ontario. I headed to Sudbury to find out how NOSM University, formerly the Northern Ontario School of Medicine, is trying to train doctors in the north and encourage them to stay. I'm Jeyan Jeganathan. Welcome to "The Rundown". The Ontario government says expanding the role of private clinics can help patients get care faster. But what does the evidence actually show? Andrew Longhurst. Great to have you on "The Rundown". How are you doing?
**>>**: 我很好，你怎么样？
Original English **>>**: I'm well, how are you?
**>>**: 我挺好的。谢谢你。非常欢迎你的到来。你是加拿大政策替代中心（Canadian Centre for Policy Alternatives）的高级研究员。你最近题为《算不过来的账》（Not Adding Up）的报告显示，自2017年以来，有41亿加元的公共资金流向了私立机构。请帮我们理解一下，安省居民应该从这个数字中读出什么？
Original English **>>**: I'm doing great. Thank you. Great to have you. You are a senior researcher at the Canadian Centre for Policy Alternatives. And your recent report entitled Not Adding Up, shows a $4.1 billion of public funding went to private facilities since 2017. Help us understand what should Ontarians take away from that number?
**>>**: 是的，这是一个巨大的数字。我们在安大略省看到的是，省政府在过去八年里相当激进地朝手术和医学影像私有化的方向推进，而这41亿加元意味着这些资金没有进入公立医院。这正发生在一个省政府拨款无法满足公立医院基本运营成本的时期。我们通过这项研究看到的是，流向私立营利性机构用于手术和医学影像的公共资金增长速度，快于全省对公立医院的公共资金增长速度。这给那些公立医院带来了相当大的压力，因为它们无法提供我认为本省所需的手术量和医学影像扫描量。归根结底，这项研究评估了这种增加向营利性机构提供公共资金以将这些程序私有化的政策导向，是否真正减少了等待时间。这项研究在过去八年中发现，全省大多数医疗处置的等待时间实际上反而增加了。
Original English **>>**: Yeah, it's a large number. And what we're seeing in Ontario is that the provincial government, over the last eight years has moved quite aggressively in the direction of privatising surgeries and medical imaging, and that $4.1 billion means that those are dollars that are not going into public hospitals. It comes at a time when the provincial government funding is not meeting the basic operating costs of public hospitals. And what we have seen through this research is that public funding going to private for profit facilities for surgeries and medical imaging has been increasing at a faster rate than public funding for hospitals in the province. And this is putting considerable pressure on those public hospitals because they are not able to deliver the number of surgeries, the number of medical imaging scans that I think we need to see in this province, and ultimately this this research evaluates whether this policy direction of increasing funding, public funding for for profit facilities to privatise those procedures is reducing wait times. And what the study finds over the past eight years is that we are seeing the majority of procedure wait times actually increase in the province.
**>>**: 安德鲁，在我们进一步讨论等待时间之前，先帮助我们的观众和听众理解一下，当我们谈论私立营利性机构时，我们实际上在谈论什么？
Original English **>>**: Now, Andrew, before we'll talk a little bit more about wait times, but just to help our viewers and listeners understand, when we talk about private for profit facilities, what are we actually talking about here?
**>>**: 是的。这种形式的私有化涉及将公共资金拨给私立营利性机构，将这些医疗处置外包出去。这也被称为外包承包或营利性交付。所以有许多不同的术语。但它的实质意味着，省政府正在利用公共医疗保健资金，让这些处置在私立营利性环境中进行。因此，我们大体上看到这些医疗程序对安省居民来说是免费的。但该研究同时揭示的是，这是一个非常危险的滑坡，因为我们在该省确实存在一个系统性问题：尽管这些机构拿了公共资金来执行这些程序，但仍有相当数量的此类机构存在直接向患者非法收取服务费用的行为，这既违反了省立法，也违反了《加拿大卫生法》。
Original English **>>**: Yeah. So this form of privatisation involves public dollars going to private for profit facilities for those procedures to be outsourced. It's also called contracting out or for profit delivery. So there's a number of different terms. But what it means is that the provincial government is using public healthcare dollars to have those procedures delivered in a private, for profit setting. And so we see largely that these procedures are coming at no cost to Ontarians. But what the research also uncovers is that it's a very slippery slope, because we do have a systemic problem in the province where, despite these facilities receiving public dollars to perform those procedures, we have a significant number of these facilities engaging in unlawful billing of patients directly for services, which is against the provincial legislation and also against the Canada Health Act.
### 公共资金外流、医疗质量隐患与非法账单 **>>**: 好的，让我们看一下这张图表。它对比了2017至2018年度与2024至2025年度之间向这些机构支付的公共资金。总支付额从大约4.57亿加元上升到近6.74亿加元。现在，当我们看百分比变化时，外科手术的增幅很大，医学影像的增幅较小但也很显著。安德鲁，省政府将公共资金导向私立机构的论据是什么？
Original English **>>**: All right, let's look at this graph. It compares public payments to these facilities between 2017, 2018 and 2024 to 2025. Total payments rose from about 457 million to nearly 674 million. Now, when we look at percentage change, large increase for surgical procedures, smaller but significant increase in medical imaging. Andrew, what argument does the province make for directing public funding to private facilities?
**>>**: 是的。安省政府的主要论点是，朝这个方向推进将缩短等待时间。其理由是，这在整体医疗保健系统中创造了更大的处置服务能力。但是我们在八年的研究期内看到的是，在12项公费资助的医疗处置中，有8项的等待时间实际上延长了，这包括受到私有化影响的两个关键领域：核磁共振（MRI）扫描和白内障手术。我们实际上看到等待时间增加了。但尽管如此，政府的论点一直是这会是一个缩短等待时间的政策方向。因此，我对开展这项研究非常感兴趣，因为我认为我们有必要了解这种政策导向是否确实实现了省政府所声明的缩短等待时间的目标。正如我所发现的，不幸的是，它的效果适得其反。
Original English **>>**: Yeah. The main argument from the Ontario government has been that moving in this direction will reduce wait times. The argument is that it creates it creates greater capacity in the overall health care system to deliver procedures. But what we have seen over the eight year study period is that we have seen wait times for eight out of 12 publicly funded procedures, including two of the key areas subject to privatisation, MRI scans and cataract surgeries. We've actually seen wait times increase. But that said, the argument from the government has been this will be a policy direction that reduces wait times. And so I was very interested in conducting this research, because I think it's important that we understand if this policy direction is indeed achieving the stated objective from the provincial government of reducing wait times. And as I found, unfortunately, it's doing the opposite.
**>>**: 安德鲁，你提到了白内障，所以我想问，如果有人确实提前几个月做完了白内障手术，他们为什么要在意手术是在医院做还是在私立机构做呢？
Original English **>>**: Andrew, you mentioned cataracts, so I'm going to ask if someone does get their cataract surgery months sooner, why should they care whether their procedure happens in a hospital or a private facility?
**>>**: 是的，这是一个极好的问题。我认为，从北美以及国际上——包括向私立营利性机构外包历史悠久得多的英国——的大量学术研究中我们得知，这里最大的担忧是我们往往会看到医疗质量的滑坡。正如我提到的，当营利性投资者进入这个领域，进入外科护理、医学影像以及传统上在医院环境中提供的其他医疗服务时，我们往往会看到这些投资者寻求提高他们的利润率，而这是以牺牲医疗质量为代价的。因此，当我们查看分析了数以千计患者预后的大型研究时，我们往往会看到，相比非营利环境，在营利性环境中提供的护理通常质量较差。因此，我认为这是一个令人担忧的领域。 除此之外，来自安省、魁北克省、卑诗省、阿尔伯塔省以及国际上的越来越多证据还表明，政府让这些服务在私立营利性系统中交付往往要支付溢价。比如，当我们看到白内障手术转移到私立营利性机构时，我们往往看到公共成本显著增加。因此说到底，当我们在私立营利性场所进行的相同处置费用是在医院环境中的2到3倍时，这对纳税人和政府来说几乎毫无经济意义。而且当前我们还明知全省各地的公立手术室和核磁共振机并没有得到充分利用，它们在一天中的相当长一段时间里处于闲置状态。因此，当我们在实际获得更少价值且医疗质量下降的情况下，把公共资金投向这个方向，这在政府和纳税人的财政角度上是完全说不通的。
Original English **>>**: Yeah, it's a great question. And I think what we know from a large body of academic research, from both within North America as well as internationally, including in the United Kingdom, where there's a much longer history of outsourcing to private, for profit facilities. The the big concern here is we tend to see lapses in the quality of care. And as I mentioned, when we see for profit investors moving into this area, moving into surgical care, moving into medical imaging and other health care services that are traditionally provided in the hospital setting, we tend to see these investors looking to increase their profit margins, and that comes at the expense of quality of care. So when we look at large studies that have looked at outcomes across thousands of patients, what we tend to see is that care is generally inferior when it's provided in a for profit setting, compared to a not for profit setting. So this is, I think, an area of concern. On top of that, we also have growing evidence from from Ontario, from Quebec, from BC, from Alberta, as well as internationally, that governments tend to pay a premium to have these services delivered in the private for profit system. So when we see cataracts, for example, moving into private for profit facilities, we have tended to see a significant increase in cost to to the public. So at the end of the day, it hardly makes any financial sense to taxpayers, to the government when we are seeing the same procedures being performed in private for profit settings 2 to 3 times as expensive as they are to provide them in the hospital setting. And this is also at a time when we know that public operating rooms across the province and MRI machines are not being fully utilised, they are sitting idle for good chunks of, of, of the day. So it really doesn't make fiscal sense on the part of government and taxpayers to to have public dollars going in this direction when we're actually getting less value and it's reducing the quality of care.
**>>**: 我想转换一下话题。谈一谈公立医院的拨款。我们手头有一些数据。这是一张图表，对比了营利性外科诊所、营利性影像诊所与右侧安省公立医院基金的资金增长情况。私立机构资金的增长速度快于医院资金，尤其是在第60号法案之后。这种拨款差距会如何影响公立医院及其提供的护理质量？你对此做了一些强调。当我们谈论医院以及我们所看到的情况时，例如，苏区医院（Sioux Area Hospital）同样面临着赤字和短缺问题。你能帮我们剖析一下我们在当地现场看到了什么吗？
Original English **>>**: I want to shift gears a little bit. Talk a little bit about public hospital funding. We have some data here. This is a graph that shows it compares funding growth for for profit surgical clinics, for profit imaging clinics, and Ontario's public hospital fund, which is on the right there. Private facility funding increased faster than hospital funding, especially after Bill 60. How can this gap in funding impact public hospitals and the quality of care they provide? You highlight a little bit about that. When we talk about in hospitals and what we're seeing, for example, we have the Sioux Area Hospital, for example, dealing with deficits and shortages as well. But can you help us break down sort of what what we see on the ground there?
**>>**: 是的，这是一个真正的隐患，因为目前在全省范围内，成百上千的一线员工正在被解雇。无论是护士、个人支持人员还是其他关键的医疗保健专业人员，这些人员对于为全省居民提供及时的医疗服务是必不可少的。你提到了苏区医院的例子。这家医院与全省许多其他医院一样，承受着巨大的财务压力。在过去四年中，大多数医院都处于赤字状态，因为省政府的拨款未能满足基本运营成本。我们知道这些成本每年以大约6%的速度上涨，这一数据来自代表各医院的安大略省医院协会（Ontario Hospital Association）。而我们知道，如果拨款跟不上步伐，他们就不得不进行削减。 现在我们在汉密尔顿的麦克马斯特看到了削减，我们在汉密尔顿健康科学中心（Hamilton Health Sciences）看到了一线医护人员的大幅削减。这只会给那些公立医院带来更大的压力，让它们更难提供更快的手术和医学影像服务。同样，全省许多医院没有资金为他们的核磁共振设备配备夜间、全天候24/7或周末运行的人员。所以再次以苏区医院为例，那里只有一台核磁共振机，他们没有足够的资金和人员配置让那台核磁共振机全天候24/7运转。如果我们在安大略省真的有兴趣削减等待名单，那么在我们已经拥有基础设施的地方增加这种能力，将是一个行之有效且已被证明的策略。纳税人已经为那些基础设施买过单了。我们不需要去建造新的私立营利性设施。我们只需要把这些资金配置到我们已有基础设施到位、但缺乏人员配备资金的地方。手术室是另一个绝佳的例子，绝大多数手术室没有资金支持在晚间和周末开放运营。因此，存在着未经配备人员、缺乏资金支持的闲置产能可以得到更好的利用。但相反，正如你通过那些数据所展示的，我们看到了这些公共资金向私立营利性机构的转移和更快增长，我们看到政府政策在向有利于那些营利性机构倾斜，而这是以牺牲公立医院为代价的。
Original English **>>**: Yeah, it's a real concern because right now across the province, you know, we are having hundreds upon hundreds of front line staff laid off. So whether it's nurses or personal support workers or other critical professions in healthcare that are that are necessary to delivering timely healthcare services for residents across the province. You brought up the example of the Sioux Area Hospital. This is a hospital not unlike many others across the province that is under significant financial strain. We have a majority of hospitals over the last four years that have been in a deficit position, because provincial funding has not been meeting the the the basic operating costs. We know that those costs have been rising at about 6% per year. This comes from the Ontario Hospital Association, which represents the hospitals. And we know that if funding is not keeping pace, they are having to make cuts. And right now we're seeing McMaster in, in in Hamilton. We're seeing at Hamilton Health Sciences, we are seeing significant cuts to frontline health care providers there. This is only going to put greater pressure on those public hospitals and make it more difficult for them to deliver faster access to surgeries and medical imaging. Again, many hospitals across the province don't have the funding to be able to staff their MRI machines into evenings, run them 24 over seven, run them on weekends. So again, the Sioux Area hospital, another example where there's one MRI machine, they don't have the funding and the staffing to run that MRI machine 24 over seven. If we were really interested in Ontario in working down waitlists, this would be an effective and proven strategy to increase that capacity where we already have the infrastructure. Taxpayers have already paid for that infrastructure. We don't need to build new private, for profit facilities. We simply need to be allocating those dollars where we have the infrastructure in place, but we don't have the funding to staff those facilities. Operating rooms. Another great example, the vast majority are not are not funded to be operating into the evenings and weekends. So there is unstaffed unfunded capacity that could be put to better use. But instead, as you as you as you've shown with those figures, we've seen a movement of those public dollars increasing more rapidly in private for profit facilities where we've seen government policy shifting and favouring those for profit facilities at the expense of public hospitals.
**>>**: 当我们谈论人手不足以及资金从公立流向私立时，那里的员工是否也在发生同样的流动？我们公立系统的人才是否正在流失到这些私立机构中去？
Original English **>>**: When we talk about, you know, not having enough people there and money moving from public to private, there are staff also making that same migration. Are we losing people in our public systems to these private facilities?
**>>**: 这是一个极好的问题，也是一个重大的隐忧，因为我们往往会看到这种情况，而且我也参与了针对阿尔伯塔省完全相同问题的研究。我们在阿尔伯塔省已经看到，该省一直在相当激进地推进手术和医学影像的私有化。在那个走这条路比安大略省稍早一些的省份——所以我认为把它作为一个案例研究很有帮助——我们已经看到了劳动力从公立医院转移到私立营利性机构的现象。在阿尔伯塔省以及安大略省，主要限制因素之一就是公立医院是否有手术室护士、麻醉师、医学影像技师来执行这些处置。因此，当你增加对那些私立营利性机构的资助时，它们是从现有的同一个有限人才池中抢夺人手，而他们毫无疑问是来自公立医院，转而将时间投入到私立领域。因此，是的，我们正在看到这种对本已承受巨大压力并面临短缺的劳动力的抽调。因此，仅仅将这些劳动力转移到私立部门并不能增加整个系统的承载能力，这只是把劳动力转移到了私立营利性部门而已。
Original English **>>**: It's a great question, and it's a significant concern because what we tend to see, and I was involved in research looking at this very same issue in Alberta. We have seen in Alberta, it's a province that has been engaged in privatising surgeries and medical imaging quite aggressively. And in that province, which has been down this road a little longer than Ontario. So I think it's helpful to use it as a case study. We have seen a shift in the workforce moving from public hospitals to private, for profit facilities. One of the main limiting factors in Alberta, as well as in Ontario, is having operating room nurses, having anaesthesiologists, having medical imaging technologists available to perform the procedures in public hospitals. And so when you are increasing funding for those private for profit facilities, they are pulling from that same limited pool of staffing that exists, and they are most certainly coming from public hospitals to focus their time in the private sector. So, yes, we are seeing that pull with a workforce that is already under tremendous strain and facing shortages. So simply moving that workforce into the private sector isn't increasing the capacity of the system. It's simply shifting the workforce to the private for profit sector.
### 双轨制隐忧与政策建议 **>>**: 安德鲁，当你对数据进行分析并审视这里的数据集时，有多少证据表明安大略省可能正在滑向美式双轨制系统？或者说，这仅仅是该省在单纯地扩大服务能力？
Original English **>>**: Andrew. When you crunch the numbers and look at the data sets here, how much evidence is there that Ontario is perhaps moving towards a two tier system? Or rather, this is the province simply expanding its capacity?
**>>**: 嗯，通过信息自由申请获得的一个令人担忧的发现是：尽管安大略省政府声称由于这一政策导向，安省居民绝不需要为医疗保健服务自掏腰包，但我过去八年揭露的情况显示，发生了超过700起针对患者的非法收费事件，患者被要求自掏腰包支付本应属于安省健康保险计划（OHIP）涵盖范围内的服务。在2023年推行极力鼓励这一政策方向的第60号法案之后的几年里，我们看到患者自掏腰包、被迫陷入被告知必须自费的违法情况中，有近三分之一与白内障手术和眼科程序有关，而这正是安大略省政府在私有化方面动作相当激进的领域。因此这告诉我们的是，尽管政府辩称安省居民绝不会自掏腰包，但这其实是一个保守的估计，因为这是一个投诉驱动的系统，必须由患者对被非法收费提起投诉。我们仍然看到了大量患者最终自掏腰包的实例。 而这恰恰是我们谈论走向美式双轨制系统时的担忧所在，营利性部门之所以从事这些行为，是因为归根结底他们是在寻求收入最大化并提高利润率。而实现这一目标的方法之一，就是既拿公费，又直接向患者收取费用，通过非法向患者收费来达到目的。这违反了《加拿大卫生法》。因此这种担忧是非常真实的。随着安大略省走上这条路，我们在其他省份包括走这条路比安省长得多的阿尔伯塔省和魁北克省都看到了同样的局面，而随着我们看到这个营利性行业在该省成为一个更加举足轻重的参与者，这种情况只会进一步加剧。
Original English **>>**: Well, one of the concerning findings coming through Freedom of information was that despite the claim from the Ontario government that Ontarians will never pay out of pocket for health care services due to this policy direction, what I've uncovered over the last eight years is that there have been over 700. Instances of illegal billing of patients where patients are being asked to pay out of pocket for services that are covered under OHIP. And in the years following Bill 60, which was legislation that has really encouraged this policy direction since 2023, we have seen that nearly a third of those contraventions of the legislation where patients are paying out of pocket, being put in a situation where they are being told they have to pay out of pocket. Nearly a third were related to cataract surgeries and eye procedures, and this is the very area where the Ontario government has been quite aggressive in privatising those procedures. So what it tells us is that despite the argument that Ontarians will never pay out of pocket, we have what is a conservative estimate because this is a complaint driven system where patients have to make a complaint about being illegally billed. We still see a significant number of instances where patients are ending up paying out of pocket. And this is precisely the concern when we talk about movement towards a US style two tier system, where this for profit sector engages in these practices, because at the end of the day, they are looking to maximise their revenue and increase their profit margins. And one of the ways you do that is by taking both public money and by taking patient dollars directly, by billing patients illegally. Contrary to the Canada Health Act. So the concern is very real. As Ontario goes down this road, we're seeing it playing out in other provinces, including Alberta, Quebec, that have been down this road much longer than Ontario, and this is only going to increase, as we see this for profit industry become a more significant player in the province.
**>>**: 话虽如此，安德鲁，如果让你根据你的调查结果就未来的政策向省政府建言，你会建议什么？
Original English **>>**: With that being said, Andrew, if you could advise the provincial government on policy moving forward based on your findings, what would you suggest?
**>>**: 首先，在安大略省政府大刀阔斧推行此类处置私有化的时期里，我们在12项公费资助的处置中看到有8项的中位等待时间在延长，包括核磁共振扫描、白内障手术以及所有的癌症手术。我们看到等待时间增加了。因此我认为省政府有责任重新思考这个政策方向。这显然行不通。这实际上导致了大多数排队等待接受这些处置的安省居民面临更长的等待时间。因此，如果这项政策导向并没有像安省政府所声称的那样缩短等待时间，那么就是时候重新反思了。是时候遵从事实证据了，而我们从国际证据中看到的是，增加公立医院的能力是减少等待时间的有效长期策略。因此，这些投资应该重新分配给公立医院，那些医院目前最终不得不解雇员工。所以我们处于这样一种境地：如果能将这些资金重新分配给公立医院，就能增加人员编制能力，并帮助安大略省更迅速地缩短等待时间。
Original English **>>**: Well, first of all, the fact that we've seen median wait times for eight out of 12 publicly funded procedures, including MRI scans, including cataract surgeries and all cancer surgeries. We've seen wait times increase over the period in which the Ontario government has quite aggressively privatised these procedures. And so I think it is incumbent upon the provincial government to rethink this policy direction. It's clearly not working. It's actually resulting in longer wait times for most Ontarians who are who are waiting on waitlists to get these procedures. So if this policy direction is not reducing wait times, as the Ontario government claimed it would, it's time for a rethink. It's time to follow the evidence and what we see from that evidence internationally is that increasing public hospital capacity is an effective long term strategy to reduce wait times. And so those investments should be reallocated to public hospitals, where they are ending up having to lay off staff. So we are in a situation where if those dollars could be reallocated to public hospitals, it would increase the staff capacity and help Ontario reduce wait times more rapidly.
**>>**: 安德鲁，很遗憾我们不得不在此打住了。很遗憾，我也应该向我们的观众和听众说明，我们确实向卫生部索取了一份声明，但在录制之前没有收到回复。但是安德鲁，非常感谢你。非常感谢你对此带来的深刻见解。
Original English **>>**: Andrew, we're going to have to sorry that we're going to have to leave it there. Unfortunately, I should mention as well to our viewers and listeners, we did ask the Ministry of Health for a statement as well, but did not hear back before our taping. But Andrew, I want to thank you so much. Really appreciate the insights on this.
**>>**: 这是我的荣幸。非常感谢。
Original English **>>**: It's been my pleasure. Thank you so much.
### 安省北部的医疗困境与NOSM的本地化培养模式 **>>**: 所以说，这些问题是全省性的，但北部面临着一系列独特的挑战。我最近有机会在萨德伯里与北安大略医科大学（NOSM University）校长坐下来交流，听听为什么该医学院专注于培养“来自北方、服务北方”的医生。非常荣幸能见到你。
Original English **>>**: So yeah, the problems are province wide, but the North faces a unique set of challenges. I recently got a chance to sit down with the president of NOSM University in Sudbury and hear about why the medical school is focussed on training doctors from the north for the North. A pleasure to meet you.
**>>**: 嗨。很高兴见到你。你最近怎么样？很好。萨德伯里今天天气非常棒。
Original English **>>**: Hi. Nice to meet you. How are you doing? Excellent. Beautiful day here in Sudbury.
**>>**: 确实是。天气绝佳，阳光明媚，树叶也正在变色。你是NOSM——北安大略医科大学的校长。很多人可能对这所机构并不熟悉。请帮我们了解一下这所学校的使命。
Original English **>>**: There we are. Gorgeous weather. The sun is out. The trees are turning. You are the president of NOSM, the Northern Ontario School of Medicine University. A lot of people may not be familiar with the institution. Help us understand a little bit of their mission.
**>>**: NOSM于2005年作为北安大略医学院创立。当时它是湖首大学（Lakehead University）和劳伦森大学（Laurentian University）的一部分，拥有特殊的使命：为北部地区提供医疗保健人员，并支持北部的经济发展。2022年，它成为一所独立的大学。你可以知道，我们自主颁发学位，拥有同样的使命：服务北部，并对乡村、法语区、原住民以及偏远地区的健康给予特殊关注。
Original English **>>**: NOSM started as the Northern Ontario School of Medicine in 2005. At the time, it was a part of Lakehead and Laurentian University and special Mission to provide health care workers for the North, support economic development in the North. In 2022, it became a standalone university. You know, we give out our own degrees, same mission, the North, and special attention to rural, francophone, indigenous remote health.
**>>**: 那么，跟我们聊聊在北部为北部培养医生的重要性吧。
Original English **>>**: Now, tell us a little bit about the importance of training doctors in the north for the North.
**>>**: 极其重要。这是我们的全部使命所在。关于分布式学习，我们所知道的是，人们更有可能长期留在他们受训的地方工作，尤其是当他们本身就来自那里时。对我们来说，这意味着尽可能让我们的学习者深入社区。在我们这里同时完成本科医学培训和住院医师培训的学生中，有90%会长期留在北部工作。
Original English **>>**: Super important. It's our whole mission. What we know about distributed learning is that people are much more likely to stay and work long term where they've trained, especially if they're also from there. For us, that means getting our learners out into the community as much as possible. 90% of our learners who do both their undergraduate training and their residency training will stay and work in the North long term.
**>>**: 当我们谈到实际来自北方的学生时，我们是否清楚你们大致从该地区招收了多少人？
Original English **>>**: And when we talk about students who are actually from the North, do we have an idea of how many people you're kind of recruiting from the area?
**>>**: 我们的绝大多数学习者都来自北方，即使不是直接来自那里，他们也与这里有联系。这是我们在招收来这里的学生时所看重的事情之一。
Original English **>>**: Most of our learners are from the north, and if they're not directly there, they have a connection to it. It's one of the things that we're looking for in students who come here.
**>>**: 安大略省北部占全省陆地面积的90%，但人口仅占这里的6%。请帮我理解一下，招募和留住人才这已经是一个存在相当久的问题了。但是对于像你们这里这样的社区来说，挑战是什么？
Original English **>>**: Now, northern Ontario covers 90% of the province's landmass, but holds only 6% of the population here. Help me understand, this is a this has been a problem for quite a while. Recruitment and retention. But what are the challenges for a community like yours here?
**>>**: 你提到了其中一点。它幅员辽阔且极具多样性。因此，在安大略省北部的不同地区，挑战略有不同。如果你想从具体概念上去理解，它的面积比德国和法国加起来稍微小一点。如果我要从校区的一端开到另一端——因为我把整个安大略省北部都看作我的校园——从魁北克边界开到曼尼托巴边界，大约需要18个小时。因此，挑战在于远离其他一些服务设施，交通问题比安大略省南部严重得多；而在医疗人员稀缺、设施规模小的偏远小社区，那可能在很长距离内是唯一的医疗设施。因此，保持这些设施满负荷运转极其重要。
Original English **>>**: So you raised one of them. It's huge and diverse. So the challenges are a little different in the different parts of northern Ontario. If you want to put that in kind of terms, it's a little bit smaller than Germany and France combined. And if I was to drive from one end of my campus, because I consider all northern Ontario, my campus, from the Quebec border to the border with Manitoba, it's about 18 hours. So the challenges are far away from some other services issues with transportation, much more significant than in southern Ontario and in smaller communities where you have a small medical staff and small facility, it can be quite the only facility for a long distance. And so very important to keep those facilities functioning at full capacity.
**>>**: 在现实中这具体是什么样的？对于那些需要长途跋涉的患者，你有什么故事可以分享吗？
Original English **>>**: What does that look like on the ground? Do you have any stories of patients who are travelling those vast distances?
**>>**: 噢，太多太多了。我自己也是一名家庭医生。我的职业生涯始于北部的穆斯法克特里（Moose Factory），现在我作为一名家庭医生又回到那里工作了。比方说，穆斯法克特里一位需要来萨德伯里做手术或检查的患者，首先必须坐飞机或乘火车到达蒂明斯（Timmins），然后在并不总是最好的公路上、并不总是最好的天气条件下开车几个小时去赴约。所以你可以想象，如果每次去看专科医生，你都必须请2到3天假，在酒店住上几个晚上，并且有时要在非常不安全的交通条件下出行，才能获得所需的护理。
Original English **>>**: Oh, so, so many. So I'm also a family doctor. My started my career in the north in Moose Factory, and I'm back working there again now as a family doc, say a patient from Moose Factory who needed to come to Sudbury for a procedure or a test would have to first get either on a plane or a train to get to Timmins, and then many hours of driving on. Not always the greatest highways and not always in the best weather to get their appointments. So you can imagine if every time you had to go to a specialist appointment, you actually had to take 2 or 3 days off work and three days a couple nights in hotels and sometimes not very safe travel conditions. To receive the care that you need.
### 北部医生的留任困境、职业倦怠与政策诉求 **>>**: 当我们谈论家庭医学、医生短缺时，这些并非安大略省北部所独有，只是这里多了很多层阻碍。在把医生留在当地方面，面临哪些挑战？我们听说医生来这里待上一两年，很难扎下根来。对家庭的社区支持，无论是他们的伴侣还是他们的孩子。请跟我多谈谈这一点。
Original English **>>**: When we talk about family medicine, the doctor shortage, these are not unique to northern Ontario, but it's just added layers. What are some of the challenges when it comes to keeping doctors here? We hear, you know, doctors come up here for a year or two, hard to kind of stay grounded. Community supports for families, you know, whether it's their partners, for their children. Talk to me a little bit about that.
**>>**: 是的。挑战相当多，而且显然因社区的规模以及偏远程度而异。配偶的就业是一个重要因素——如果他们所从事的专业在当地没有岗位需求的话。住房是一个大问题，在许多小社区没有很多额外的存量住房。因此，为来到这里的人找到良好的住房是一个问题；你刚才已经提到了孩子的教育等等。不过很多人确实热爱这里。我也想聊聊一些成功的故事。马拉松（Marathon）是苏圣玛丽（Sault Ste. Marie）和桑德贝（Thunder Bay）之间的一个小社区。虽然它现在的医护人员比期望的要少，但在很长一段时间里，它的人员配置都非常齐备，由在这里生活了一辈子的长期医生组成。
Original English **>>**: Yeah. So there's, there's quite a few and it varies on the size of the community for sure, and how isolated they are. Employment for spouse. If there isn't a need for the career that they're trained in, is, is an important one. Housing is a big issue. There's not a lot of additional housing stock in many small communities. And so finding, finding good housing for someone who comes up, you've already mentioned education and things for the kids. A lot of people love it though. Like, I'll talk a bit about some of the success stories as well. So Marathon's a small community in between Sault Ste. Marie and Thunder Bay. It's shorter than it would like right now for medical staff, but for a long time was quite well staffed with really long term physicians who've lived their whole life there.
**>>**: 莎拉医生？
Original English **>>**: Doctor Sarah.
**>>**: 比如莎拉·纽伯里（Sarah Newbery），她是我的好朋友，也是我的副院长之一。他们发现生活在那里是一种非常令人满意的生活方式。关键在于找到合适的人。所以这取决于我们在医学院录取谁。这也是北安大略医科大学很重要的原因之一。我们专注于将那些可能认为这是极具吸引力职业的人招入医学界，让他们在北部受训，以便他们为日后长期的职业生涯做好准备。
Original English **>>**: Like Sarah Newbery, who's a good friend of mine and one of my associate deans. And they found that it's a really satisfying lifestyle being there. It's a matter of finding the right people. So it's who we admit to medical school. It's one of the reasons NOSM University is important. We focus on trying to get people who might find that an attractive career into medicine. Trained and training in the north, so that they're ready for that long term career. Afterwards.
**>>**: 不难想象，职业倦怠是其中很大的一部分。你不仅工作时间长，而且还深深融入了社区——在小社区里，这不仅仅体现于你所做的临床工作，还包括去杂货店或者去办琐事时，在某些情况下你就是镇上唯一的医生。请跟我谈谈北方医生所面临的职业倦怠。
Original English **>>**: One has to imagine that burnout is a big part of this. Not only are you working long hours, but you're also embedded in the community and small communities. It's not just in the clinical work that you're doing. It's also, you know, you go into the grocery store or you go in to run errands. You are the doctor. In some of these cases. Talk to me a little bit about some of the burnout that doctors in the North Face.
**>>**: 是的，当你在那里的时候，你很难摆脱工作。我在穆斯法克特里工作时总觉得，只有离开那个社区，我才算真正完全放假。你说得对，有时人们会在杂货店走近你，说：“嘿，医生，我能给你看看这个斑块吗？” 这就像是：“呃，这里真的不太适合脱衣服。” 但这是一把双刃剑：你无法抽身逃离，你太融入其中了，那里的每个人既是你的朋友也是你的患者。这固然非常让人有成就感，但也是一种额外的负担。 此外，当出现人员短缺时，你会感觉尤为明显。如果你在一个大社区，有100名家庭医生，一个人病了或者休假了，你只减少了1%的人力；如果你是五个人中的一个，一个人病了或者休假了，你就减少了20%的人力。这极大地放大了留下来的人所承受的压力。
Original English **>>**: Yeah, it's hard to get away, you know, when you're there. I always felt when I was working in Moose Factory, I was really only fully off if I was out of the community. And you're right, you know, sometimes people come up to you in the grocery store and you're like, hey, doc, can I show you this spot? It's like, well, it's not really the right place to take off your shirt. But there's that two edged sword to it. You can't get away. You're very embedded. Everyone there is your friend as well as your patient. But which is very satisfying, but also is a bit of extra burden. You also really notice when there's a shortage. If you are in a large community and there's 100 family doctors and one person sick or away, you're down 1%. If you're one of five and one person is sick or away, you're down 20%. And that amplifies the pressure on the people who are left.
**>>**: 当谈到你和我提到的一些问题时，你认为省议会（Queen's Park）对北部独特的这些问题理解程度如何？
Original English **>>**: When it comes to some of the problems that you highlighted, and I highlighted, how well do you think Queen's Park grasps the issues that are unique to the North?
**>>**: 差异非常大。有时候你真的很幸运，在省议会遇到了来自北方、真正理解这一点的人。显然，无论来自哪个政党，我们来自安大略省北部的省议员都能理解北方的背景。对于卫生部的工作人员，我们现在真的很幸运，实际上副卫生部长戴夫·理查森（Dave Richardson）对安大略省北部及其运作方式有着良好的理解。但很多人从未走出过安大略省南部，确实无法体会所涉及的漫长距离、额外的压力，以及我们试图提供支持的某些社区极其微小的规模，还有在这些小社区保留医疗服务的重要性——这不仅关系到居住在那里的人的健康，更关乎社区本身的生机。如果失去医疗服务，没有医院、没有急诊室、没有产科护理，你就很难在经济上发展社区、吸引新企业并保持社区的活力。
Original English **>>**: Highly variable. Sometimes you're really lucky and you get someone at Queen's Park who's from the north and really gets it. So obviously our MPP from northern Ontario, no matter what political party they're in, they all get the context of the North with the ministry staff. We're really lucky right now. Actually, the Deputy Minister of Health, Dave Richardson, has a good understanding of northern Ontario and how it works, but lots of people have not been out of southern Ontario. Really can't don't grasp the distances involved. The extra pressure, the the really small size of some of the communities that we're trying to support and the importance of keeping service in those small communities, not just for the health of the people who live there, but for the health of the community. If you lose your health care, you don't have a hospital, you don't have emergency room, don't have access to obstetrics. It's hard to grow your community economically, to attract new business, to keep the community vibrant.
**>>**: 无论是针对副部长还是卫生部长西尔维娅·琼斯（Sylvia Jones），你有哪些政策建议可以帮助解决其中的一些问题——有些是长期存在的——从而吸引更多医生进来，留住现有的医生，并为北方的患者提供服务？
Original English **>>**: What are some policy recommendations that you would have, whether it is for the deputy minister or the health Minister, Sylvia Jones, that would help fix some of the issues, some long standing, that would help bring more doctors in, keep the doctors who are here and serve patients of the North.
**>>**: 是的，我想说的第一点是他们现在实际上做了很多。现在确实是非常繁忙的时期，有很多正在推进的文件。我和琼斯部长谈过好几次。我只想说：别把脚从油门上松开。对初级保健团队的投入正在产生巨大的影响。医学院和住院医师项目的扩招目前还没有显现出成效，但几年后就会见效，它正在路上。这需要漫长的时间周期——四年的医学院和2到5年的住院医师培训才能看到完整的结果，但它们最终会有回报。另外，在理解北方不同的背景时要保持灵活性；要在蒂明斯或北湾（North Bay）取得成功所需的条件，与在瓦瓦（Wawa）或马拉松所需的并不完全相同。
Original English **>>**: Yeah, well, I'll say the first thing is they're doing a lot right now. Actually, it's a very busy time. There's a lot of active files. So I've spoken to Minister Jones a number of times. I would just say, don't let your foot off the gas. The investments that are going into primary care teams make a big difference. The growth of medical schools and residency programs isn't making a difference yet, but it will in a couple of years. It's coming. The. It takes a. There's a long runway for years of medical school and 2 to 5 years of residency. To see the full results, but they will pay off. And just to be flexible with understanding the different contexts in the North, what's required to make things successful, you know, in Timmins or North Bay is not exactly the same as what's required, say, for Wawa or Marathon.
### NOSM的“独门秘诀”与对未来的展望 **>>**: 你提到了学校，所以我们现在有了多伦多都会大学（TMU），我们有了特别以家庭医学为导向的约克大学。但你们拥有留住人才的“独门秘诀”。我并不强求你必须把秘诀分享给那些大学，但是否有什么适合你们的做法，是这些机构和其他组织需要领会、以此帮助在北部提供医疗保健的？
Original English **>>**: You mentioned the school, so we've got Toronto Metropolitan University. We have York University with a specific mandate towards family medicine. But you guys have a secret sauce of keeping people here. And I don't want you to share that necessarily with those universities, but is there something that that works for you that these institutions and other organisations need to kind of clue in on as to helping provide health care in the North?
**>>**: 是的，我们确实会分享我们的秘诀。我们一直在与TMU和约克大学密切合作规划他们的方案，还与西蒙菲莎大学（Simon Fraser）的新医学院等开展合作；医学在很多方面是非常具有协作性的。我认为最核心的事情是：在学习者培训的早期让他们接触到综合性的医疗照护模式，这真的非常重要。我们的学生整个第三年都是这样度过的：他们去到一个以家庭医学为核心的小社区，但整整一年他们也在那里轮转参与所有其他专科，之后他们才会前往大医院进入更细分的专科培训单元。我认为这是一个能带来巨大改变的关键要素，我们一直在与全国乃至全世界的同行探讨这种模式的重要性。
Original English **>>**: Yeah, we do share our secret sauce. We've been working very closely with TMU and York on their on their plans and also the new medical school at Simon Fraser and, and others medicines quite collaborative that way. I think the main things are it's really important to expose your learners to comprehensive models of care early in their training. And we have our entire third year. Our learners go to a smaller community rooted in family medicine, but where they do all the other specialities as well for their whole third year of their training before they go into the sort of subspecialized blocks in the larger hospitals. And I think that is one particular element that makes a huge difference, and that we've been talking to colleagues around the country and around the world about the importance of that model.
**>>**: 听起来多年来医生和患者一直在呐喊我们需要帮助。但从你的话中听起来，无论短期还是长期，你对解决北部医疗保健问题抱有乐观态度。
Original English **>>**: It sounds like for a number of years, doctors, patients were banging the drums to be like, we need help. But it sounds from you that there's optimism, whether it's short term or in the long term, that healthcare in the North will be fixed.
**>>**: 医疗保健总是有起有落，充满挑战。我的意思是，在从业30多年中，这是我经历过的第三次下行周期，但通常总会迎来回升。我们看到几年前还在苦苦挣扎的一些社区现在情况有所好转，但就在相距几个小时车程的地方，仍然可能存在严重的短缺。我大约两周前刚刚驱车走访了安大略省西北部我们的一些社区。例如，德莱登（Dryden）刚刚招聘了我们的一些应届毕业生，他们做得很不错。肯诺拉（Kenora）离得并不太远，反方向的苏望远镇（Sioux Lookout）也不算太远。这两个社区仍然面临相当严重的短缺，并且正在努力填补缺口。
Original English **>>**: Healthcare always has challenges and goes up and up and down. I mean, in this over 30 years now, and this is the third down cycle that I remember, but there normally isn't up. We are seeing some communities that were struggling a couple years ago doing better now, but right down the road, a couple of hours, you could still have significant shortages. I just drove around northwestern Ontario visiting some of our communities about two weeks ago. And for example, Dryden has just recruited some of our new graduates. They're doing very well. Kenora is not that far away, and so Lookout's not that far away the other way. Both of those communities still have quite significant shortages that they're working on filling.
**>>**: 迈克尔·格林（Michael Green）医生，非常荣幸。非常感谢你。
Original English **>>**: Dr. Michael Green, it was a pleasure. Thank you very much.
**>>**: 很高兴见到你。
Original English **>>**: Nice to meet you.
**>>**: 你认为允许私立诊所承接更多公费资助的医疗处置对安大略省有益吗？该省的医疗保健是否走在正确的轨道上？请告诉我们。发送电子邮件至 TheRundown@TVO.org，或者一如既往地在我们的 YouTube 页面上留言。在此之前，我们明天见。
Original English **>>**: Do you think letting private clinics do more publicly funded procedures is good for Ontario, and is healthcare on the right track in this province? Let us know. Send us an email to TheRundown@TVO.org. Or as always, drop us a comment on our YouTube page. Until then, I'll see you tomorrow.