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?

Tuesday, February 14, 2006

College of Physicians and Surgeons

What a nice piece by Danielle Smith in today’s editorial page of the Calgary Herald supporting family doctors. Other than reporting the shortage of family doctors, it is rare for the news media to turn their attention to the community, I suppose because of the more acute and visible problems in the “acute” sector, (“when your up to your ass in alligators it’s hard to remember you came to drain the swamp” phenomenon).
The College of Physicians and Surgeons of Alberta (CPSA) has always struck me as on unusual organization (that’s probably an understatement). As a profession, we take great pride in the fact that we are “self regulated”. The purpose of the CPSA was to ensure that its members were of the highest quality, conducted themselves as a profession, and provided good quality medicine to the people of Alberta. It has tremendous power over the physicians in Alberta since it is the licensing body and has the authority (through legislation) to grant and take away licenses. It has vulnerability in that it exists by virtue of the provincial government’s approval and therefore some of their rulings could be “tinged” by political expediency.
Curiously, it is totally supported financially by annual fees paid by practicing physicians in the province. In other words, we pay the college to protect the public from us! (a somewhat negative but accurate observation). This frankly, to me, seems weird. We are forced to pay for them financially, but their existence is dependant on government approval. Little wonder at times their positions seem to have political overtones.
When I started practice, the college told us that we could only put two notices in the local paper informing the public that we were opening a practice. It was not to be embellished in any way. We could be listed in the telephone book but not in the Yellow Pages. At that time other health providers such as chiropractors, were advertising in the Yellow pages of the phone book with great framed and attractive ads. They also advertised on radio and television, but this was not allowed by the college for physicians. As a young physician I wondered “did they think advertising was beneath physicians (a form of arrogance), and if they truly believed we were the better health providers, why didn’t they allow us to compete by advertising for the public good”. As years went by, the “old school boys” were slowly replaced by new members (who themselves, by the time they were elected, were “old school boys”) so again their decisions were always at least ten years behind the times.
When the Grace Hospital was sold and the new private owners applied for a license to operate as a private hospital, the province rightly punted the application to the CPSA since it was the mandate of the CPSA to accredit hospitals under 100 beds. Curiously, the CPSA with-held their approval, even though the standards for this private hospital were as high, or higher, than similar small hospitals in the province. Perhaps some political posturing? You think?
A few years ago it was suggested ( a good guess would be the Health Regions of Alberta or some other government related group), that the CPSA investigate the practice of family physicians limiting their practices in both scope and numbers. Fortunately, it is ridiculous to even contemplate that a governing body, responsible for quality care, should tell a self employed worker what they must do, when that worker does not feel qualified or capable. Wouldn’t it be more appropriate for that governing body to look into the possibility that its members are working too hard, since fatigue causes as much impairment as intoxication? To my knowledge that question has not been raised except in residency programs, and I expect it never will be.
Now the CPSA have ruled that Dr. Kim Wilmot and Dr. Jim Mayhew cannot charge for being available. When I was the Calgary District Hospital Group’s Chief of family medicine a few years ago, I received a complaint from the college stating that some of the family physicians in my department (two) did not provide someone to be on call on occasion. At that time, there were 200+ family doctors in my department, most of them doing a wide range of care including obstetrics, hospital care, nursing home care, as well as their community office care. When I informed the college that many walk-in clinic doctors didn’t have someone on call 24 hours a day, I received a one sentence reply: “We don’t get complaints about walk-in clinic doctors not being on call”. So it would seem the more services you offer and the more responsible you are as a family doctor, the more is expected of you, and the more likely you will get at odds with the college. The less the public expects of you, the less likely they are to complain, and the less likely the college will get involved. I spoke to the two family physicians involved in the complaint, and I believe shortly after, they dropped their hospital privileges, a solution for the college, but not for the patients of the two doctors involved.
It would seem that the college has stated that physicians cannot charge for being available. Will that simply lead to family physicians migrating to areas of medicine where it is not necessary to be available? Keep in mind, there is a shortage of family physicians and so there are many options for them.
Besides, provincial governments across Canada have for years been paying physicians for being available. Many of the programs to entice physicians to work in rural communities are flagrant examples of paying physicians to be available. The entire Hospitalist Program in Calgary is an example of the region requiring physicians to be available to care for hospital patients. These physicians have been recruited from communities and graduating classes and are paid far more than community physicians ever were, for looking after hospital patients. How is it that governments and Health Regions can pay for physicians “to be available” but the public doesn’t have the same right? Or, to put it another way, why is it that physicians can be paid by the region for being on call for the Calgary Health Region, but not by their patients. The whole thing smacks of political prejudice on the part of the CPSA. And let’s face it. It is easier to thump on individual doctors when you are the licensing body, than stand up to the government to whom you owe your existence.

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