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Truth be told: We have a leadership crisis, not a health care crisis

In the annals of history, the transformative impact of a few courageous leaders has left an indelible mark, altering the course of nations and reshaping the face of societies. From the visionary leadership of figures like Mahatma Gandhi and Nelson Mandela to the groundbreaking initiatives of Franklin D. Roosevelt and Winston Churchill, history is replete with examples of leaders who navigated their nations through crises, leaving an enduring legacy. Unfortunately, in health care, where headlines are dominated by the term “health care crisis,” it may be more accurate to attribute the root cause to a leadership crisis rather than a systemic failure.

These are my thoughts after working in the health care system for some time–but I feel we are better at acknowledging that there are fundamental problems in the health care system and that we are in a health care crisis. We have even realized some of the issues we are facing, but we lack the leadership and the roadmap to make the health care system better than it was initially. Our health care system needs to change–as people have adjusted, and the availability of information and treatment options have changed.

Understanding the Canadian health care landscape

With over a decade of experience working diligently in health care across various nations, I have witnessed firsthand the nuanced challenges within the U.K., Canadian, and U.S. health care systems. While these systems share commonalities, they exhibit fundamental differences in their approaches and responses to health care challenges. Canada is often hailed for its comprehensive health care model, which is an interesting focal point for this discussion.

Like many other developed nations, Canada is grappling with the challenges of an aging population. Environics Analytics estimates that as of 2023, there will be approximately 7.6 million Canadians aged 65 and older, which is expected to surpass 11 million by 2043. This demographic shift is one of the most significant trends in the country’s history, demanding a proactive and strategic response from the health care system. The strain on resources and the financial burden of end-of-life care further exacerbate the existing challenges.

Compounding the demographic challenge is that health care professionals, including physicians, are aging and preparing to exit the workforce. Data from the Canadian Institute for Health Information reveals a notable shift in the age distribution of physicians. In 2000, nine percent of physicians were 65 years and older, and seven percent were between 60 and 64. Fast forward to 2022, and the figures have risen to 15 percent and nearly 10 percent, respectively. The impending departure of experienced health care professionals underscores the urgency for effective leadership in the sector.

Despite being lauded as a global exemplar, Canada faces health care spending and efficiency challenges, particularly in end-of-life care. According to Penn Medicine News, comparatively, Canadians spend more than their high-income counterparts, with end-of-life care costs reaching $21,840 per patient. Paradoxically, these high expenditures do not translate into superior health care outcomes. Canada consistently underperforms on various quality indicators, pointing to structural inefficiencies and the prevalence of unwanted medical interventions at the end of life. The economic repercussions of such inefficiencies are profound, emphasizing the urgent need for strategic leadership in health care management.

The role of leadership in navigating complexity

However, the core issue lies in the statistics and the leadership vacuum that hampers effective decision-making. Strong leadership is indispensable in navigating the complexities of the health care system, which, despite its intricacies, adheres to basic principles of economics, leadership, and business. A robust society is built upon the foundation of physically and mentally strong individuals. This necessitates an investment in early childhood development and family support systems.

A disheartening reality surfaces as reports indicate that 90 percent of Canadian children fail to meet the recommended physical activity levels. This startling revelation underscores a critical aspect of health care leadership – the need for a holistic and preventive approach. Leaders must recognize the interconnectedness of societal well-being and individual health, advocating for policies prioritizing early childhood development, education, and family support systems as crucial components of a thriving society.

Addressing the physical well-being of children is not just about preventing immediate health issues; it’s an investment in the future workforce. Studies consistently show that physically active children perform better academically, have improved mental health, and are likelier to lead healthy lifestyles into adulthood. Thus, health care leadership should extend beyond hospital walls, encompassing broader societal aspects contributing to the population’s overall well-being.

Physicians in limbo

In the realm of medical professionals, Canada boasts a sufficient number of physicians, with thousands vying for coveted residency programs. According to the Canadian Residency Matching Service (CaRMS), approximately 3,700 medical graduates applied for residencies in 2021. Yet, a paradox unfolds as these aspiring health care providers face challenges securing positions, even with years of experience under their belts. The discrepancy between the demand for health care services and the available positions highlights a systemic issue that requires bold and unpopular decisions to rectify.

The shortage of residency positions not only affects the aspirations of medical graduates but also jeopardizes the nation’s ability to meet the growing health care needs of its population. This scarcity of opportunities runs counter to the abundance of talent within the medical community, showcasing a misalignment that requires decisive leadership to address. Furthermore, the current system’s failure to fully utilize the skills and experience of these eager medical professionals adds to the inefficiencies plaguing the Canadian health care landscape.

The leadership crisis in health care becomes more evident when leaders shy away from making decisions that address the underlying challenges. Unpopular decisions, by nature, require courage and foresight. Leaders must confront issues such as the distribution of health care resources, equitable access to services, and the optimization of existing infrastructure. Moreover, tough decisions are needed to overhaul outdated processes and embrace innovative solutions that align with the evolving needs of society.

Resource allocation and the aging population

One critical aspect that leaders must confront is the allocation of resources, especially in the face of an aging population. According to the CIHI, the health care spending per capita for seniors is approximately 5.6 times higher than that for individuals aged 1 to 64. Rather than fixating on end-of-life expenditures, there should be a strategic shift towards preventive measures and comprehensive health care strategies prioritizing overall well-being. This requires leaders to challenge the status quo and ingrained paradigms, paving the way for a health care system that is not merely reactive but proactive.

The allocation of resources, particularly in the context of an aging population, demands a nuanced understanding of the health care landscape. Leaders must grapple with questions about the prioritization of preventive care, the development of community-based programs, and the incorporation of technology to enhance efficiency. Instead of succumbing to short-term fixes, visionary leaders should explore sustainable solutions that align with the broader goal of fostering a healthier society.

Preventive care and community-based programs can significantly alleviate the strain on the health care system by addressing issues before they escalate into more severe and often more costly conditions. However, implementing such changes requires a paradigm shift in the leadership approach, moving from a reactive stance to a proactive, forward-thinking strategy. We know prevention is more cost-effective, but why are we so shy about implementing these practices and creating expectations that the general population will follow suitable measures? We understand that our society depends on healthy individuals, so why are we not taking the appropriate actions?

A global perspective on leadership crisis

The leadership crisis in health care extends beyond national borders, implicating not just administrators and policymakers but society as a whole. It demands a collective acknowledgment of the need for courageous leaders willing to make unpopular decisions for the greater good. A paradigm shift is imperative, where leaders prioritize the population’s long-term health over short-term political gains.

In a world of multifaceted challenges, leadership must be equally nuanced and courageous to usher in a new era of health care excellence. This crisis is not confined to Canada; it is a global concern that requires a collective effort to redefine health care leadership. The stakes are high, and the consequences of inaction are dire. It necessitates a reassessment of leadership qualities, moving beyond political prowess to embrace vision, transparency, and a commitment to the populace’s well-being.

Global collaboration is essential in addressing shared health care challenges. The exchange of ideas, best practices, and innovative solutions can transcend national boundaries and contribute to developing a more resilient and responsive health care ecosystem. The World Health Organization (WHO) and other international bodies play a pivotal role in fostering this collaboration, emphasizing the need for coordinated efforts to tackle global health issues.

The global impact of leadership failures

The consequences of a health care leadership crisis extend far beyond any single nation’s borders. In an interconnected world, where health crises can quickly escalate into global pandemics, ineffective leadership poses a significant risk. The COVID-19 pandemic is a glaring example of how inadequate leadership can exacerbate the impact of a health care crisis. Countries with strong, decisive leadership managed to navigate the challenges more effectively, implementing timely and effective measures to mitigate the spread of the virus and protect their populations.

However, nations with weak or indecisive leadership struggled to respond adequately, leading to devastating consequences in terms of loss of life, overwhelmed health care systems, and economic downturns. The global nature of the pandemic highlighted the importance of collaborative, visionary leadership that goes beyond national interests to address collective challenges. This underscores the urgent need to reevaluate leadership principles in health care, emphasizing qualities such as foresight, adaptability, and a commitment to the greater good.


In conclusion, the health care crisis that dominates headlines is, at its core, a leadership crisis. The Canadian health care system serves as a poignant example, showcasing the urgency for leaders who are unafraid to address the underlying challenges. To build a resilient and sustainable health care system, leaders must embrace transparency, truth-telling, and the courage to make decisions that may be unpopular in the short term but indispensable for the long-term well-being of society.

We can only reshape the narrative from crisis to opportunity through solid leadership, ensuring that future health care systems are robust, compassionate, equitable, and forward-thinking. As we navigate the complexities of an ever-evolving health care landscape, leaders must rise to the occasion, steering societies toward a healthier, more sustainable future. In a world where the health of a nation is intricately tied to the decisions of its leaders, the call for transformative and visionary health care leadership has never been more urgent. The path forward requires not only acknowledging the challenges but also embracing the responsibility to chart a course toward a health care system that genuinely prioritizes the well-being of its citizens.

Tomi Mitchell, a family physician and founder of Dr. Tomi Mitchell Holistic Wellness Strategies, is not only a distinguished international keynote speaker but also a passionate advocate for mental health and physician’s well-being, hosting her podcast, The Mental Health & Wellness Show. With over a decade of experience in presenting, public speaking, and training, she excels in creating meaningful connections with her audience. Connect with her on Facebook, Instagram, and LinkedIn and book a discovery call.

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