Dr. William Silver, founder of Medicare Decisions by Consensus, has bucked the system more than once in an effort to improve patient care.

Frustration with the Canadian health-care system has pushed Dr. William Silver into action more than once in his half-century as a physician. Sometimes the actions he took, such as resigning from one practice and moving to another, were to save his own sanity. Sometimes his decisions, such as recent efforts to create a non-politicized Canadian health-care system, have caused others to question his sanity. At all times, Dr. Silver’s goals were to improve patient care.

Born and raised in southern Saskatchewan, Dr. Silver received his medical training at the University of Saskatchewan and McGill University. In 1958, he moved to the small Saskatchewan town of Porcupine Plain to work in general practice. After five and a half years, however, he became so frustrated with the lot of small-town doctors that he resigned from his position to become an orthopedic surgeon.

In retrospect, after learning about the co-operative approach of primary health-care team members at a recent U.S. conference, Dr. Silver said he would have appreciated that kind of support decades ago.

“If I had had a team like that in Porcupine Plain, I would have never left. I would have had so much fun and it would have been so satisfying to get all this stuff done. The reason people are leaving is because they’re bogged down with all the non-medical junk they’re expected to do and they’re not trained to do. Nurses are the key,” he added. “They’re the people who can turn things around. They’ve got to have the structure, and the relationship between the nurse and the doctor has to be clarified. Otherwise, neither of them will get enthusiastic. People have to know where they stand.”

After Porcupine Plain, Dr. Silver spent 19 years in Saskatoon as a full-time orthopedic surgeon and salaried teacher at the University of Saskatchewan’s college of medicine. He then moved to Regina and practised for 10 more years before calling it quits. His resignation came a few years after a memorable run-in with the provincial health minister.

“In 1994, I got word from my section head I could only do one total knee and total hip a month, so I couldn’t really do orthopedics. It was a policy. They were trying to save money by rationing care. If you asked anyone in government, they said elective surgery is surgery that doesn’t really need to be done. The public didn’t know enough to realize there were being duped,” he said.

Dr. Silver had four patients he felt needed operations within four months. After letters to his section head, chief of surgery and chief of medical staff garnered no changes to his operating schedule, he wrote to the patients to say he had tried but the government would rather save money than see them get treated.

“I sent a copy to the minister of health. Well, the fit hit the shan then. The deputy minister contacted the college of physicians and said: ‘Investigate this doctor for unprofessional conduct.’ The registrar sent me a confrontational letter with 16 questions. ‘Who was I that I should demand care for my patients over other patients?’ I wrote a real good letter and got the lawyers to read it and I sent it back.”

During the next few months, the SMA issued a press release supporting Dr. Silver, who was eventually found not guilty of the charges, and the Royal College of Physicians and Surgeons of Canada sent a letter saying physicians must be advocates for their patients. Shortly after that episode, Dr. Silver joined the SMA board and continued fighting similar battles against waiting lists.

His experience cemented his annoyance with the political aspects of the health-care system and, in 1998, he retired from practice. “The waiting lists were so long. The elderly people were deteriorating. If you’re in a wheelchair longer than six months, it’s too late. You have to do a total joint at the right time. I was really frustrated with that. That frustration made me close my office.”

He decided Canada’s health-care system needed better leadership at the top. “The minister of health is spending all his time putting out fires. He can’t study policy. The lifespan of the minister of health is about 18 months in Canada.”

Dr. Silver made presentations to health-care commissions and committees, advocating for a de-politicized system. “I got some stuff off my chest and some support from the opposition.”

In 2002, he told Roy Romanow that Canada needed an independent health-care council that wasn’t political and wasn’t dominated by any particular interest group. He was disappointed with Romanow’s idea of a Health Quality Council, saying “federally, it has some value, but the Health Quality Council has no power.

“They can advise all they like and the government can ignore them. We need an independent council to look after health care. It shouldn’t be political. It should be separate and it shouldn’t be dominated by a group like the SMA. It should be representative of the doctors, nurses, patients, and we should have experts like health economists, administrators and business people.”

In 2006, Dr. Silver created Medicare Decisions by Consensus, a non-profit corporation aimed at achieving those goals. He and two other board members, both of whom are not health-care workers, created the website www.fixcanadashealth.ca and pamphlets to expound on their ideas and encourage others to take up the cause.

“Decisions by consensus. I figured that is the key. We’ve been getting decisions without consensus ever since 1962. Romanow, in his recent talk in Regina, figured there’s no other way to do medicare except to confront doctors and that’s because Tommy Douglas chose to do it that way. So many administrators have got this set in their brain that you must not agree with doctors because they will just screw it up to their own advantage, and they don’t trust doctors. So we have been working since before 1962 without good medical input.”

Medicare Decisions by Consensus advocates for an independent body of 13 elected members with the power to run health care, “and we won’t have politicians using it for their purpose and we won’t have doctors using it for their own gain, either,” said Dr. Silver. “We need an independent authority with patients’ input. Some of my doctor friends disagree with me. They’re afraid the patients will mess it up and I don’t agree with that.”

The authority would have decision-making power over who would be paid well to do their jobs. “If a doctor is a councillor, he must not have a practice. He must not run back to his profession and serve their interests.

He is a doctor who is committed to the public good and not to the doctor good. If he’s going to argue for more pay for doctors, he has to prove how that will improve patient care. “The only reason to pay doctors more is to get something better for patients. This whole body is focused 100% on patient care,” said Dr. Silver.

Funding would be provided by the provincial or federal government, since one council would exist federally and one in each province or territory. “Those bodies will have provincial/federal conferences and they will decide what is more efficiently done in Ottawa and what is more efficiently done in the provinces. You could negotiate doctors’ fees for the whole country centrally and then the Northwest Territories could convince Ottawa the doctors in the Northwest Territories need a subsidy of $10,000 a year because of location, but the basic fees would all be the same,” proposed Dr. Silver. “You centralize what you can and the local conditions should be done locally. You might pay more for a certain specialist in Saskatchewan than you do in Toronto.”

A council would be able to act more efficiently than governments which, when they make a decision, make a “10-year decision, good or bad and they don’t have the knowledge to interfere with the health-care system without causing a disaster. Many doctors will say, ‘The government’s got to do something.’ I’ve said, ‘No, let’s not get them to do something because if they do the wrong thing, it will be even worse.’ ”

Dr. Silver presented his consensus council idea to a recent SMA representative assembly meeting and received a warm response. Dr. Vino Padayachee, president at the time, told the Medical Post, “His presentation was very well-received by those present. It sounded like a very positive direction to be going(in). We support the ideology behind what he’s doing.”

Medicare Decisions by Consensus is admittedly an “expensive hobby,” but the energetic 74-year-old doctor who competes in triathlons and road races doesn’t plan to give up any time soon. “I think it will come. I’m just going to do what I can. It might work and it might not … It all depends whether people feel I’m on the right track or not. If they do, I’ll get support. If they don’t, I’ll go spend all my time on my farm, which won’t be a hardship for me. But I want to give this a shot. We’ve had this system for 44 years and it’s never changed. That’s not healthy.”

Deana Driver is a writer in Regina.