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A Conversation with Dr. Day: the Joys of Notoriety

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A Conversation with Dr. Day: the Joys of Notoriety News A conversation with Dr. Day: “I’m not the voice for private medi- cine. I believe in a strong public sys- the joys of notoriety tem,” he adds, while arguing for a sys- tem in which hospitals receive funding ew will likely ever assume the directly proportional to the number of Canadian Medical Association patients they treat, rather than a block F (CMA) presidency with such ad- grant. “I’d like to see hospitals compet- vance notoriety. ing with one another for patients.” “Dr. Profit” and “Darth Vader” are Founder of Cambie Surgeries Co. among the tags that have been attached and medical director of the for-profit to Vancouver-based orthopedic sur- Cambie Surgery Centre since 1985, Day geon Dr. Brian Day for having founded says his practice now routinely attracts and continued to operate a successful elite athletes from the National Basket- private surgical facility. He’s become ball Association and various European embroiled in a public mudslinging professional soccer leagues. He began match with federal New Democrat practising at the Vancouver General leader Jack Layton over whether the lat- Hospital in 1978, and eventually de- ter paid for hernia treatment at a private cided to focus his efforts on the embry- Toronto clinic with a credit card. And onic field of orthopedic sports medi- the Ottawa-based Canadian Health cine and arthroscopy. “I liked sports Coalition has installed a “Fact check on and I liked dealing with sports injuries Courtesy of Dr. Brian Day Brian Day, MD” section on its Web site. and they’re great patients because they Shortening wait lists is the priority for Day, All this before Day even assumes the all are motivated. They all want to get shown here with his wife, Dr. Nina Bland. presidency on Aug. 22 during the better, as quickly as possible. They CMA’s 140th annual meeting in Van- want to get back.” couver. The son of a pharmacist who was Arthroscopy Association of North The controversies, though, seemed murdered by a pair of drug addicts in America in 2004, as well as involve- to amuse, if not delight, the 60-year-old his own home after being followed ment in the formation of the Canadian father of 6 during a recent interview from his pharmacy, Day grew up in Independent Medical Clinics Associa- with CMAJ. post-war Liverpool, describing it as a tion; he has served as president since Day grinned and noted of the Layton once-proud shipbuilding port that its creation in 2005. dust-up that “one of my rules is that I had become economically depressed Day also takes pride in having been always tell the truth.” after its main industry was “destroyed in the vanguard of the use of technolo- As for the labels, “Dr. Profit is not by the unions.” gies in medicine, noting that he was a bad. I’d sooner be called that than Dr. He recalls being told by visiting doc- pioneer in the creation of the world’s Loser. And Darth Vader turned out to tors, as a 9-year-old working in his fa- first surgical robot, was involved in the be a good guy when he didn’t kill Luke ther’s shop, “it’s better to be a doctor.” “first live satellite transmission to Skywalker.” Why? China,” teaching a course to Chinese Day expressed pride in becoming “Well, because the doctor tells the medical students, and was an early the first orthopedic surgeon to assume pharmacist off.” proponent of the use of electronic the helm of the roughly 65 000-mem- Day graduated from high school at health records. ber association and beating chal- the age of 17 and enrolled at the Univer- “I’ve always liked toys,” he says, lengers for his presidency (CMAJ 2006; sity of Manchester medical school, be- adding that frustration over the lack of 175[6]:566). This is the third time in coming a doctor at 21. He interned as a access to new medical technologies lay at CMA history that the presidency has general surgeon at the Manchester the root of his involvement in Canadian been contested. Royal Infirmary and then at the Ham- medical politics. “In the late ’80s, early Notoriety, says Day, “helps my mersmith Hospital in London, before ’90s, the crunch started to come as health cause.” In his mind, that cause is sim- accepting a residency in orthopedics at care got more expensive and we were be- ple, clear and compelling. “I don’t the University of British Columbia in ing denied access to the latest technol- want to do this and not make a differ- 1973, where he also completed a Mas- ogy. The other way that they rationed our ence,” he notes, re-affirming his oft- ter of Science degree. access was to cut down on our operating stated belief that private health care Day chaired the resident academic time. It got cut down from 22 hours a delivery can help to reduce wait lists. program for the university’s depart- week to 5 hours and the Canadian Or- The latter issue is the one on which he ment of orthopaedics 1978–94 and the thopaedic Association recommends 15 hopes to leave his imprimatur. “To Orthopedic Test Committee of the hours to maintain competence.” me, access and wait lists are my num- Royal College of Surgeons of Canada “That’s when we decided to build ber 1 issue. I think that leads to every- 1989–94. Other professional activities our own centre. Or else we had to leave thing else.” have included a stint as president of the the country.” CMAJ • August 14, 2007 • 177(4) 333 News “Now I’ve seen that the private sector Surgeons of Ontario, which was pillo- and have the option of either accepting has a role to play,” Day adds. “It can ried by former Supreme Court Justice or challenging OHIP’s decision before complement the public system and yet Peter Cory in an April 2005 report. Cory an independent panel. The recorded all of the rhetoric is built up around the found that audits took too long to com- hearings must be held in accordance ‘anti-private sector’ component, plete, the methods of assessment and with procedural standards, and find- notwithstanding the fact that 30% of the collection were unfair and the hearing ings can be appealed to the Divisional health care in Canada is already private.” process left doctors feeling they were Court of Ontario. Day and his wife, Dr. Nina Bland, a presumed guilty from the start. The board will have to power to sus- family physician and former Canadian Cory wrote that “The medical audit pend a doctor’s right to bill OHIP and tennis champion, have 4 young chil- system in Ontario has had a debilitat- must report all findings of misconduct dren: Alexander, Jamie, Stephanie and ing and, in some cases devastating … to the college. Among other changes Andrew. Day has 2 children by his first effect” on physicians. are a new method for calculating inter- marriage, Christopher and Jonathan. Cory recommended adopting most of est awards, a provision that allows “The most stressful thing I do is go the reforms suggested by the OMA, in- doctors to recover legal costs and limi- watch my kids play soccer,” the Everton cluding establishing an independent tations on the authority of auditors to football fan says. Notoriety, by con- physician audit board. “extrapolate” and order reimburse- trast, “doesn’t stress me out.” — Willett says the new system incor- ment for a large number of claims Wayne Kondro, CMAJ porates many of Cory’s recommenda- based on the review of just a few. — tions. the OMA plans to continue Wayne Kondro, CMAJ DOI:10.1503/cmaj.070965 working with government to set up the committees. DOI:10.1503/cmaj.070962 The new Physician Payment Review Board will comprised between 26 and Ontario overhauls 40 members, at least 20 of whom must be practising physicians. Panels of 4 C. difficile outbreaks in medical audit regime (including 3 physicians) will handle in- dividual cases. Gatineau, Sault Ste. Marie ntario’s medical audit system If the agency decides the medical will become less onerous this services weren’t provided, weren’t virulent strain of Clostridium O fall as a result of recent medically necessary, were unprofes- difficile that has killed close to provincial legislation that limits the sionally delivered or were misrepre- A 2000 people in Quebec spread worst abuses of its widely criticized sented, the physician will be notified to a Gatineau hospital this spring, hos- predecessor, the Ontario Medical As- pital officials have confirmed. sociation (OMA) says. There were 15 cases of this strain of The new system addresses many of C. difficile at the Santé Service Sociale previous system’s shortcomings by pro- de Gatineau’s Hull hospital campus in viding “transparency and fairness,” says April and May, says Denis Saint-Jean, OMA President, Dr. Janice Willett. “It the hospital’s director of communica- will also provide accountability on tions. As of July 5, 3 people remained ill physician billing.” with C. difficile. “The legislation is … a big improve- “Through surveillance by our infec- ment,” she added. tion control team, we found out that Bill 171 (the Health System Improve- the strain we have now is the same ments Act, 2006), which was passed in more strenuous strain that they have in June, establishes the Physician Payment Montréal,” Saint-Jean says. Review Board, charged with determin- Officially known as NPA1/027, the ing whether a physician’s billings to strain produces levels of 2 kinds of tox- the Ontario Health Insurance Plan ins that are 16–23 times more potent (OHIP) for medical services have been than the common strain of C.
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