Canadians love to brag about our universal health care system (and rightly so), but it’s not without flaws — and Dr. Marjorie Dixon, a reproductive endocrinologist and fertility specialist in Ontario, saw a major one in the fractured state of reproductive care. Women requiring gynecological procedures, like in vitro fertilization (IVF) and uterine-fibroid removal, are often bounced around to different doctors and run up against seemingly interminable wait times for referrals and surgery, she says — a lag that will get worse as the demand for fertility care increases. She channelled her frustration into building Anova Fertility & Reproductive Health — a provincially funded one-stop clinic for fertility treatment and minimally invasive gynecological procedures, about to open in Toronto’s north end. We talked to her about why outpatient care can be better than hospital care, and why one doctor can trump four.
What’s wrong with our current system of reproductive care?
Think of someone who is juggling her career and her family and has to have a small polyp removed. Her symptoms, like irregular bleeding, are brought to the family doctor first. That doctor sends her to a radiology office, where they do a sonohysterogram to identify the polyp. That information then goes back to the family doctor, who refers her to a gynecologist or a fertility specialist who can do the polypectomy. She is put on a waiting list to see the doctor, then a waiting list for surgery. That could take three to six months.
What motivated you to establish your own clinic?
I noticed there was such a variation in the quality of care afforded to patients. Continuous care with the same providers makes a difference. It’s nice to not have to get a speculum stuck into you more often than [is needed]. You don’t have to spit out the same story 16 times. Even residents say it’s better for patients: shorter recovery time, less exposure to complications. There are [minimally invasive procedures] that don’t need to be managed in a hospital — it’s like shooting a blade of grass with a cannon.
You’ve taken out a substantial loan to top up the financing of this project.
Yeah. Everybody’s like [sarcastically], “Great business decision!” It’s a ton of risk. I have a reputation; I do stand to lose. But it’s my passion.
Presumably, these issues will grow in Ontario, as more women undergo IVF with funding from the government.
Yes. There were segments of my patient population that I knew couldn’t [get treatment] — not because it wasn’t necessary but because they couldn’t afford it. That’s not the spirit of universal health care.
You’ve undergone IVF. Has your personal experience influenced this project?
I don’t think I’ve ever framed it in that way. My parents emigrated from Jamaica, and they always said, “Canada will take care of your health, and if you become a physician, you make sure you take care of everyone.” The emotional side of health care is just as important as doctors giving out medication. It matters to have an environment that’s also not archaic. Maybe this centre will become the template.