Category: World

Dr. Leisha Hawker reserves a full work day each week just to do paperwork. She sees no patients and works through form after form, so she can get home in time to put her daughter to bed.

She’s not alone in this routine.

The Halifax family doctor, who is also the president of Doctors Nova Scotia, said it’s estimated that most physicians in the province spend about 10 hours a week dealing with unnecessary paperwork.

This means someone else could do it, or it doesn’t need to be done at all. She said this work accounts for about 500,000 hours of physician work per year in Nova Scotia, and often falls on nights and weekends.

“A lot of younger physicians that have a family will do two shifts,” Hawker said. “You’ll go home and take your kid to judo or swimming or whatever it is, put them to bed and then log back in and do more work and then go to bed late at night.”

In 2019, the provincial government partnered with Doctors Nova Scotia to research physician administrative burden and how to reduce it. A new report released Monday builds on this research and draws conclusions that apply to the whole country. 

The Canadian Federation of Independent Business’s report, Patients Before Paperwork, shows Canadian doctors spend 18.5 million hours annually on unnecessary administrative work — the equivalent of 55.6 million patient visits. 

“Health ministries across Canada are facing many complex challenges,” the report said. “A chronic shortage of health professionals, an aging population and capacity constraints all have put pressure on the health-care system and the physicians who support it.”

Target to reduce administrative burden

An Angus Reid poll from September 2022 found half of Canadians are either unable to see their family doctor within a week, or they can’t find a doctor at all.

Monday’s CFIB report concludes that if governments across Canada set a target to reduce physician administrative burden by 10 per cent, they could reduce fatigue and burnout, improve the quality of patient care and open the equivalent of 5.5 million patient visits a year.

“We know that all of the premiers are working with the federal government on hashing out a new deal on the health-care side, that is very important,” said Ryan Mallough, CFIB’s vice-president of legislative affairs.

“But we want to make sure that we’re not forgetting about the other things that we can do in the system … if it’s eliminating a form that doesn’t need to be filled out by a doctor or if it’s reducing a 12-page form to a three-page form. That adds up and it is going to free up doctors’ time to see their patients.”

Nova Scotia leading the way

Nova Scotia has been working on reducing physician administrative burden since 2019.

Mallough said this is trailblazing work, and he hopes other provinces will follow suit.

“We know that medical associations have been flagging this with their provincial governments, but as far as we know, no one has come out and done anything as robust as what Nova Scotia has done,” he said.

The provincial Office of Regulatory Affairs and Service Effectiveness took the lead on the project and outlined 15 actions that would reduce unnecessary administrative burden by 10 per cent by 2024.

Leanne Hachey, the executive director of the office, said 500 physicians were surveyed in Nova Scotia.

“We heard that burden looks like many different things. It looks like paperwork that’s too long, forms that are duplicative, different bodies asking for the same information, things that they have to do on paper as opposed to doing digitally. Processes that just don’t make sense.”

Hachey said her office has acted as a liaison between doctors and provincial departments to help them work together and make changes. 

Joe Gillis, a physician in Yarmouth, N.S., said his desk is often piled with forms, which he’ll “pick at it during the course of the day.”

But he said if he doesn’t keep on top of it, things like insurance and income assistance forms, medical reviews for drivers and disability tax credits can “get out of control.”

He said he’s happy to see the government committing to reducing this type of extra work, but the province has a long way to go.

“Health care is difficult right now, both as a patient and provider,” Gillis said. “And I think anything we can do to alleviate that difficulty is just a step in the right direction for everybody.”

He said he’s already heard about some notoriously long and cumbersome forms being shortened, but he hopes more technology will be used in doctor’s offices to further reduce the work.

‘Taking a fork and chipping away at an iceberg’

The provincial Office of Regulatory Affairs and Service Effectiveness has less than a year to complete their goal of a 10 per cent reduction.

Hachey said the office’s physician impact assessment tool shows they’re halfway there, but she believes they’ll meet the target, or even surpass it.

“Sometimes it does feel like you’re taking a fork and chipping away at an iceberg because there is so much,” Hachey said. “What we have to do is start, show some success, make sure that physicians feel the impact and then start to do more.”

She said the focus is on saving minutes of work for each physician. 

“But when you build that up to 2,500 physicians that may be doing it 50 times a year, those minutes start to add up to big hours and to annual patient visits.”

Hawker said the 10 per cent reduction target is the equivalent to about 150,000 patient visits per year. Currently, there are nearly 130,000 Nova Scotians on the primary care wait-list. 

“That would be a visit for every single person that would be on the wait-list,” Hawker said. “So even a 10 per cent reduction in administrative burden could have significant impacts on patient care and the health-care system.”

Hachey said her office has already heard from the British Columbia and Manitoba governments about reduction efforts, and hopes more will come forward.

Members of the World Trade Organization (WTO) have denounced the United States for its abusive series of appeals against the global trade watchdog’s panel rulings over its import tariffs and flawed labeling of goods origins, urging the country to fulfill its obligations as a WTO member and stop its unilateral and protectionist moves.

At the latest Dispute Settlement Body (DSB) meeting held here on Friday, five WTO members — China, Norway, Switzerland, Turkey, and Hong Kong — required the plenary meeting to pass five panel rulings regarding duties imposed by the United States on steel and aluminium imports and U.S. origin marking requirement applicable to goods produced in Hong Kong.

Before the meeting, the United States had appealed four panel rulings regarding duties imposed by Washington on imports of steel and aluminum products from China, Norway, Switzerland and Turkey.

The United States had also filed a seperate appeal against another ruling issued last month, in which Washington deliberately mislabeled products made in Hong Kong as “Chinese-made.” The shift in the origin of those goods to be imported to the United States was ruled “not justified” by a DSB panel.

The world’s largest economy also declared it would postpone implementing a panel report regarding a dispute initiated by the European Union (EU) targeting U.S. anti-dumping and countervailing duties on imports of ripe olives from Spain.

ABUSIVE APPEALS

Washington has a long history of trade bullying. Though it used its right of appeal as a WTO member, its action amount “to effectively blocking” WTO rulings, according to a statement by the EU on Friday.

The EU noted that the panel reports have been appealed, but these appeals cannot be currently heard by the Appellate Body, given that it cannot function.

Previously, it normally takes three months for the WTO Appellate Body to rule on any appeals it receives. However, the appeal court has halted operation because the United States has blocked the appointment of new judges and required an overall reform.

Therefore, appeals cannot be processed, and related rulings cannot move forward.

Canada noted that since Dec. 11, 2019, the Appellate Body has effectively been non-functioning, according to a statement delivered at Friday’s meeting.

The United States tends to appeal every unfavorable panel report and refuse to comply with the results of any proceedings of the DSB, China’s Ambassador to the WTO Li Chenggang told a DSB meeting.

“These troubling behaviors of the U.S. have clearly depicted an image of the U.S. as a unilateral bully, a rule breaker and a supply chain disruptor,” Li said.

So far, 127 WTO members have attempted on 61 occasions to start the selection process for filling vacancies on the Appellate Body. Still, the United States blocked the proposed decision.

Canada stressed in its statement that all parties to the dispute must fulfill their good faith commitment under the Dispute Settlement Understanding by making every effort to find an acceptable solution. In the long run, no member would benefit from a situation where disputes remain unresolved.

It said that a member acting in good faith should find no comfort in an unfair — and short-term — advantage that has arisen because of the absence of a functioning Appellate Body.

The EU also encourages all parties to find a solution that preserves the rights of both the complainant and respondent.

PROTECTIONIST MOVES RULED UNJUSTIFIED

In March 2018, the United States began imposing Section 232 duties on steel and aluminum products to protect its domestic industry under the guise of national security.

Given that Washington has exempted 70 percent of its steel imports from the additional duties, the restricted imports only accounted for 5 percent of U.S. steel consumption, in which defense use took only roughly 0.15 percent, Li said at the meeting.

“In other words, Section 232 measures are overwhelmingly protectionist, as its contribution to national security is negligible at best,” Li noted.

From the outset, the United States deployed these additional duties as an instrument of economic coercion, using them to force other members to enter into quota arrangements or make concessions to the United States in trade negotiations, said the Chinese ambassador.

These measures have been widely opposed, sued by several WTO members and found WTO-inconsistent by all panels. The findings of the panel in this dispute demonstrated once again that a security exception is not a “safe harbor” for unilateralism or protectionism, Li added.

Alparslan Acarsoy, Turkish ambassador to the WTO, said at the 15th Trade Policy Review of the United States held on Dec. 2022 that the United States imposed additional tariffs on imported aluminum and steel products, which clearly violates WTO rules.

He urged the United States to cancel the additional tax measures to avoid further damage to the multilateral trading system.

Türkiye believes that the United States has systematically and structurally damaged members’ confidence in the multilateral trading system, he added.

“Before the panel, the U.S. relied upon Section 232 reports that formed the basis of the measures to argue that the worldwide excess capacity of steel could damage its domestic steel sector such that it would not be able to increase or maintain production of steel required to address national emergencies,” said Jayant Raghu Ram, a writer with Indian law firm Lakshmikumaran &Sridharan Attorneys, in a recent article. “This excess capacity, according to the U.S., constituted an ’emergency in international relations.'”

“However, the panel wasted no words in dismantling the U.S. tenuous defense and held that the situation of excess global steel capacity” did not “constitute an ’emergency in international relations,'” Ram said.

On Aug. 11, 2020, the United States required Hong Kong products exported to the United States to be labeled “Made in China,” which the WTO ruled in late December 2022 violated the country’s obligations under the trade organization’s rules.

The Hong Kong Special Administrative Region (HKSAR) government welcomed the ruling.

The ruling has once again confirmed that the United States has disregarded international trade rules, attempted to impose discriminatory and unfair requirements unilaterally, unreasonably suppressed Hong Kong products and enterprises, and politicized economic and trade issues, said Algernon Yau, secretary for commerce and economic development of the HKSAR government, in a statement.

“When President Biden of the less conservative Democratic Party was voted into power in 2020, it was expected that the U.S. government would tone down its nihilistic rhetoric towards the multilateral trading system and withdraw measures that seemingly violate WTO law, most notably the Section 232 measures,” Ram added.

“However, irrespective of such change in guard, the United States continues to maintain status quo in respect of such measures,” he said.

“Though the U.S. detraction from the rule of law in the WTO’s rules-based system is not unknown or surprising, WTO members may find relief in the fact that the panel has outrightly held these infamous measures as inconsistent with WTO law,” Ram noted. 

Shortly after 35-year-old Novak Djokovic despatched another considerably younger player to win a 22nd Grand Slam title, his coach Goran Ivanisevic was asked how long the new Australian Open champion could stay at the top level.

“Definitely two, three more years,” said Ivanisevic, who has helped Djokovic win seven of his major titles.

“His level is unbelievable. He is from outer space. His brain is working different.”

Djokovic, who turns 36 in May, showed all facets of his greatness on the way to beating 24-year-old Stefanos Tsitsipas in Sunday’s Melbourne final.

The Serb has won five of the past seven Grand Slams he has played in, although this victory came in a tournament where Spanish teenager Carlos Alcaraz – the world number one before the event and new leader of the next generation – was ruled out through injury.

BBC Sport analyses why Djokovic remains so difficult for the younger players to topple.

The aura

Pretty much every younger opponent talks before a match about treating Djokovic like any other opponent – playing the man and not the name.

But how many truly believe it and don’t get overawed?

Greece’s Tsitsipas was the last of four players at least a decade younger than Djokovic to be beaten by him in Melbourne.

In the past four years Djokovic has lost only five of the 45 matches he has played against opponents under the age of 23.

Djokovic has won six of his seven Grand Slam finals in that period against players born in the 1990s, with Russia’s Daniil Medvedev landing the younger generation’s only success in the 2021 US Open.

Tsitsipas insists Djokovic’s stranglehold on the younger players isn’t a “curse”.

“I don’t see this as something annoying. This is very good for the sport, to have competitors like him, to have champions like him,” said Tsitsipas, who has lost his past 10 meetings with Djokovic.

Whether Tsitsipas sincerely thinks that is a different matter. If he does, it feels like he is an exception.

It has been telling that Russian fifth seed Andrey Rublev and American Tommy Paul – the players whom Djokovic made light work of in the Australian Open quarter-finals and semi-finals respectively – discussed the dread which players feel when seeing his name in their part of the draw.

Rublev, 25, laughed when he said after his last-16 win that he wished Djokovic was in the opposite side – but it was no laughing matter as he became increasingly despondent on the way to a straight-set beating.

“A lot of players have a lot of respect for his game,” said 25-year-old Paul, who was also despatched in three sets.

“No-one really wants to see him on their part of the draw.”

The on-court mentality

When the going gets tough on court, Djokovic gets going.

That is particularly relevant in the biggest moments of the biggest matches and is a key reason why he has won 22 of the 33 Grand Slam finals he has played.

Tsitsipas said Djokovic, who saved 23 of 29 break points during the Australian Open, including two of three in the final, is a player who “pushes you to your limits” on the court.

“He’s very important for us that want to get to his point one day. Getting our asses kicked is for sure a very good lesson every single time,” he said.

“He has made me a much better player. He has made my levels of concentration higher and higher every single time I get to play him.

“You have to be really involved and you have to be dedicated to the game when you play against him.”

The technique and tactics

Everyone has a game plan going into a match against Djokovic. Executing against someone of his talent is another story.

As Paul put it after the semi-final, Djokovic can make them “play so bad”.

The American offered some insight into his tactics and how Djokovic neutralised those plans.

“I wanted to serve and volley some. I didn’t serve and volley once,” he said.

“When I did make my first serve, I felt like he was returning it to the baseline. I was automatically on defence.

“I wanted to throw in drop-shots. I didn’t get an opportunity to do any of that because he was hitting so deep.

“I wanted to change up pace with my slice. I missed my first three slices of the match. I was like ‘all right, I’m going to start hitting my backhand, I’m not slicing well’.

“He didn’t let me do all those things because of things that he did so well.”

The body

Djokovic has long appreciated the need to take care of his body to prolong his career and achieve success into his 30s.

He has regularly cited changing to a gluten-free diet more than a decade ago as a recipe for his success.

While he does not consider himself a vegan, Djokovic steers clear of eating meat, fish and other animal-based products.

Taking up yoga and a daily routine of stretches has been key in helping maintain the extraordinary elasticity which he continues to show when chasing down balls on the court.

“The way he’s taking care of his body, the way he approach about everything, the food, it’s amazing. It’s unbelievable, the level,” said Ivanisevic.

When Djokovic outlined his reasons last year for not having a vaccination against coronavirus, he said he wanted to be “in tune with my body as much as I possibly can”.

He added he had “always been a great student of wellness, well-being, health, nutrition”.

The resilience

With success comes scrutiny and Djokovic often finds himself at the centre of drama – whether it is of his own making or not.

Last year he was unable to defend his Australian Open title after being deported from the country following a row over his Covid-19 vaccination status.

Djokovic had also been hampered by a hamstring injury at Melbourne Park, which Ivanisevic reckoned would have ruled out “97% of the other players”.

“If I turn back the time two and a half weeks ago, I wasn’t really liking my chance with the way I felt with my leg,” said Djokovic.

“Then it was just a matter of survival of every single match, trying to take it to the next round.”

Another curveball was thrown his way before Friday’s semi-final against Paul.

His father Srdjan was pictured outside Rod Laver Arena with supporters of Russian president Vladimir Putin, creating a controversy which Djokovic said was “not pleasant” to deal with.

Nevertheless, he managed to put all these distractions behind him as he levelled Rafael Nadal’s record of men’s majors.

“It required an enormous mental energy really to stay present, to stay focused, to take things day by day,” Djokovic said.

Few would bet against the world number one winning more majors than any other player in the history of the sport, unless Tsitsipas, Alcaraz or the rest of the younger generation – plus 36-year-old Nadal, set to go for a 15th triumph at the French Open in June – can stop him.

“Of course, 35 is not 25, even though I want to believe it is. But I still feel there is time ahead of me. Let’s see how far I go,” said Djokovic.