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?

Monday, February 13, 2006

Too Little, Too Late

My children tell me that if I was Labor Minister, the unemployment rate would be 0%.
They also tell me that I perceive life only as an opportunity to work, and worry that in my retirement, I will find that life will become “not worth living”. When we took our family drives many years ago they enjoyed teasing me by pointing to the most dilapidated, junky farm and saying: “Hey look, dad, there’s a great fixer-upper place”. They would then cringe when I would show some interest because they knew they would be part of the fixing up project.
Shakespeare said: “There is a tide in the affairs of men, if taken at the flood”. The modern expression for this same principle is “Timing is everything”. The introduction of the “innovative idea” in the last 10 years of using nurse practitioners, physician extenders, cast technicians, etc. is only thirty years too late.
In keeping with my basic personality in the early 1970’s, I had hired a Registered nurse for this very purpose. I spent time teaching her cast application and removal, and how to protect specific areas of the anatomy when applying a cast. She was taught minor suturing, did prenatal check-ups, diet counseling, house calls, and even came to some deliveries as the labor “coach”. Her participation in my practice significantly increased productivity and patient service but there was no way for me to recapture her salary from the services she provided. The fee for service system would not pay for a patient visit or any part there-of unless the patient was seen specifically by me, and the fee schedule never kept up with inflation. I had been one of the Calgary physicians that was doing “extra” billing (deliveries--$50.oo, complete check-ups--$10.oo, routine office visits--$3.oo) but when wage and price control came in, and eventually when “extra billing” became illegal, I no longer could afford the salary burden of two and one half employees and the program was discontinued.
I did not give up without a fight, however. During that time our group had made a proposal to the Alberta Medical Association. I still think it was a do-able proposal, in which the Alberta doctors would opt out of Medicare and do computer billing directly to the patient. The patient then would collect directly from the government. This would put the government in the position of dealing with the patient, who was both the tax payer, the voter and, most importantly, the insured. The patient would always know how much he/she was being charged for the visit and how much the government was paying for that visit. The Alberta Medical Association was in negotiations at that time with the government and had been threatening to back out of Medicare, but when presented with the “ways and means” they not only flinched, they rejected it outright.
It was during this time that another physician and I met with a friend of mine who happened to be the Dean of Medicine at the University of Calgary. We proposed that a certificate program be set up (two to three years depending on the field of medicine) that would train young people out of high school to be “physician extenders” or “assistants”. We, in our group, envisioned having this person to be “office and community procedure oriented and trained", and we could use one in each of our clinics (we had 6-8 physicians per clinic). I was informed subsequently by the Dean that the proposal died because “Nursing” insisted this type of person should go through a 3-4 degree nursing course first. The idea died because of medical politics.
Now this idea is being pushed as though it is going to save our Universal Health Care System. If it could be implemented, it would, of course, make the system more efficient as I had originally advised; however, the timing is wrong. In the 1970’s there was an abundance of young people looking at being health care providers. Now we have a severe shortage of doctors, nurses, and medical technicians. Recruiting from the nursing profession will increase the shortage of nurses and really serves no purpose. Only a small part of a registered nurses training could be applied to what is expected of an office based physician extender. This attitude that a physician’s assistant needs to have advanced training rather than being trained in specific office based procedural things, is counter productive. If a young person out of high school is looking at two alternatives, 1) to be a physicians assistant after a five year post graduate course and 2) be a computer programmer after a two to three year diploma course, with equivalent salaries and benefits, which do you think they will choose. My eldest daughter, six years after taking a two year diploma course in computer programming, had a salary equivalent to mine as a family doctor with 40 years of practice experience.
The fact of the matter is there is incredible competition out there for the bright young minds coming into the work place. The competition is national and international within the health care industry and other industries, and pits all vocations and professions against each other for this young talent. What can the health care industry offer to these young people to entice them? We are failing so far. The idea that there are abundant qualified foreign doctors and other health care workers to fill the void is simply not true. But that’s another blog!

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