What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Wednesday, January 25, 2006

If We Build It They Will Come

Let us at least allow ourselves the possibility that private systems and a Universal Government system could co-exist. All too often we hear from the idealists and those who paint in black and white. In Canada, the “Friends of Medicare” claim that physicians and nurses will leave the government system and go to the private system if a private parallel system were to exist. Are these health care providers being treated so badly in the public system that they would vacate it in significant numbers? If this is so, perhaps we need to address the problems in the public system that would cause this.
My own experience is that most Canadian Doctors at this time are quite satisfied with the system but not with the difficulty in addressing their patient’s needs. If adequate resources were present I doubt that there would be many desertions. There would seem to be within our public system an ever increasing array of options for physicians. A parallel private system would simply provide more options. The physicians that felt strongly about control of their freedoms in medical practice left Canada over the last number of years, mostly for the U.S. They, at present, are getting progressively fed up with the HMOs in the U.S. and 2004 was the first year in many years that more physicians returned to Canada from the U.S. than left for the U.S. If we had a parallel private system Canada could experience a huge influx of Canadian doctors and nurses.
In fact, the private system would be actively recruiting them.
If we are reading the mainstream news media, we must ask ourselves if our governments actually want more doctors and nurses in Canada. Are they still practicing cost containment with long waiting lists? Recently, it has been reported that hundreds of residency spaces each year, are taken up by foreign medical students. We are told that no qualified Canadian medical student is turned down, but this unfortunately is true only if you selectively use the term “qualified”. There certainly are medical students in Canada that pass their exams and must go internationally to obtain residencies in their chosen fields. At times, after completing their residencies abroad and wishing to return to Canada, they are denied licensure. We moan about foreign physicians not being given practicing privileges in Canada, but how many young Canadian physicians are hitting bureaucratic road blocks to training and practicing in Canada? The fact is a foreign medical student has to pay large sums of money to do a residency in Canada. A Canadian medical school graduate has to be paid during their resident training. To sum up: our residency program in Canada is making money by selling these spots to foreign medical students (who most often will not practice in Canada upon completion of their residency program) at the expense of Canadian students and the people of Canada they would serve upon completion.(a residency program can be from 2 to 5 years, depending on the specialty, after medical school graduation, and is requires to practice medicine in Canada in your chosen field).
The cost of shortening waiting lists would be tremendous. Not only would government have to keep up with existing demand but would have to pay for “the catch up”. Decanting this off to a private system at a discounted cost could act as an incentive. What if the government paid half the cost and the patient picked up the rest. Yes, some patients would be jumping the queue, but what if this was available only after being on a list for three months? Waiting lists for everything would shorten. Right now there is no incentive other than public pressure to shorten waiting lists.
Jack Layton’s position of outlawing private facilities and not allowing doctors to work in both private and public facilities is politics at its worst. Right now all abortions and cataracts in the Calgary region are done in private facilities. Would that mean that these procedures would be done in hospitals? We don’t have the capacity to do our joint replacements in hospitals at present. Allowing doctors to work in both the public and private facilities makes better use of our physicians (at least they are working). At present most surgeons are severely rationed as to time in our public system. Mr. Layton’s “solutions” would certainly mean longer waiting lists. It is time our political leaders took part in honest dialog and quit using the chronically ill and poor to garner votes.
I think Canada has to open its doors to many options for work opportunities for health care providers including a parallel private health care system. If we build it, they will come! Many Canadians need a “hand up”, we don’t all need a “hand out”.


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