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, November 13, 2006

Conservative Leadership Hopefulls and Health Care Solutions

Apparently, health care is no longer the number one concern of Albertans; so for those who have been sitting in traffic for the past hour, are having trouble finding housing and shelter, etc., save yourselves some time and don’t read this entry-----boring! But for those of you who have been waiting in the emergency rooms, hospital hallways, on waiting lists, and, well, even if you are over 65, it may be worth while reading. Still boring, but factual stuff always is. What a pain it was for me to try to glean factual information from all the political double-speak.
It has been two weeks since I sent some questions to the “premiers to be” of Alberta and have two responses to date; Mark Norris sent a computer generated response thanking me for my “comments” and Gary McPherson actually sent me his approach would be to involve more disciplines as providers, and then asked me what I thought of the idea! Good for you, Gary. At least you put some personal effort into a real response and asked a doctor for an opinion; a novel approach for a politician. I guess I shouldn’t feel snubbed, though, since (from what I can determine) the Alberta Medical Association asked the candidates a number of excellent questions, and only Dave Hancock posted the questions and answers on his website. The Calgary and District Medical Association also posed several excellent questions, and from what I can tell, only McPherson, Hancock, Oberg, Dinning and Norris gave “answers” that were subsequently printed in the Associations’ news letter “Vital Signs”. So, having little or no response myself from the candidates (I’m just a Conservative voting member), I searched their Web home pages for answers to my questions (and the questions of others) on their position on Health Care in Canada, and in particular, Alberta. This is what I found and didn’t find. First, from the Calgary Region doctors:
1) “There currently is a physician shortage in Alberta which is expected to get worse over the next five years. As premier, what steps would you take to educate, recruit, and retain the physicians needed to care for Albertans”? This is a very good question and here are some of the answers given. McPherson, Oberg, Hancock, Dinning and Norris all said they would increase, or work at increasing, or fund additional spaces in medical schools. Please note that to train a family doctor takes EIGHT years, so this is unlikely to improve the situation over the next FIVE years. Mr. Dinning and Mr. Norris improved their answers by suggesting some modifications to the residency programs in Canada. Certainly, increasing the available residency programs in Canada may prevent our medical graduates being forced to go to other countries to obtain their residencies (and then not be eligible to return to Canada); however if these additional spaces are filled with “paying” foreign graduates, our boys and girls will be no better off. Still, it will shorten the time line for improving our doctor to patient ratios. My understanding is that there is, apparently, in some areas, a shortage of physicians prepared to teach, which of course makes increasing residency positions quite difficult. McPherson, Hancock, Dinning, and Norris all mentioned the recruitment of foreign doctors. Mr. Dinning attempted to do them one better by mentioning recruitment “nationally”. Well here is a news flash, folks. We have been doing this for many years and it has only gained us the ill will of other provinces and other countries. We continue to fall far behind in spite of a significant effort at recruitment for at least twenty five years. The question was what STEPS you would take to recruit. It is estimated that at present a full 50% of Saskatchewan’s physician force has been imported! The well of reasonably qualified international candidates is drying up.
Startling in its absence is the candidate’s response to the question of the “retention” of physicians. Not one of the candidates made one suggestion to address this problem. It seems to me that if we train physicians, only to have them leave the country after graduation, we have accomplished nothing! Sort of like poring water into a bucket with a large hole in the bottom!
The second part of the first question had to do with the recommendation from Alberta Learning that interest free status should be given to learners completing a residency program, and that repayment requirements for student loans not be initiated until residency requirements have been met. All of the candidates mentioned above thought this was a great idea. This is really a nice thought, and encourages students to undertake residency programs that may be longer and not have to worry about interest on student loans and repayment plans until they actually have a license and get a “real” job. The problem is, in medicine, we don’t need more super specialists; we need more generalists. We already have a shortage of family physicians and enabling students in medicine financial incentives to specialize will aggravate this problem. Certainly I would have thought seriously of continuing on in a specialty if I had not had financial pressures to get on with getting a job. I’m not saying that this idea isn’t great for some areas of learning. I’m just suggesting that in medicine it may be counter-productive and aggravate an existing problem.
2) What steps would you take to ensure the survival of the family practice doctor in Alberta? Wow, another great question; especially since encouraging them to specialize with interest free loans and delayed payment schedules will encourage specialization. Although many other professions and trades have been able to keep up with the inflationary cost of living in Alberta, family doctors are tied to a fee schedule that is rigid, and actually is punitive to those family physicians doing comprehensive continuing care in their practices. Mr. McPherson thought that perhaps interest free loans and tax incentives for new graduates would be helpful. It would seem he didn’t realize that it was the older physicians who were doing the less lucrative work (geriatrics, palliative care, etc) that were giving up their practices. The new graduates were finding niches that were far more lucrative (walk-in clinics, hospitalists, locum tenens, no one in the practice over 60 years of age, etc). He also thought that some of the ancillary medical people (chiropractors, holistic docs, naturopaths, etc) could take over more of the duties of family doctors. He apparently doesn’t realize that on an hourly basis, these practitioners are much more costly than traditional family doctors. Mr. Hancock said much, but primarily seemed to be pushing the concept of primary care networks, which I have commented on in previous blogs. He again thought there should be more use of alternate providers and emphasis on prevention. In short, it would seem (since he had no ideas as to help the family physician situation), he acknowledged, and perhaps even welcomed, the decline in the numbers of family physicians as a “cost savings” measure. Mr. Dinning referred to “primary care networks” and the present “funding” in place to help computerize their offices may be an incentive, but basically his position was that it was too bad family physicians were declining in numbers, and the issue was really between the AMA and the provincial government during negotiations (I guess he is inferring that money may be a root cause). Nothing new there! Mr. Norris enlightened us with the fact that negotiations are presently going on between the AMA and the government and he is sure that an agreement will be reached soon. Wow, that sure inspired me to be a family doctor! He did suggest that there was a NEED to look at ways to encourage medical grads to choose family medicine. Sorry, I thought the question was “how would you do that?”. Mr. Oberg actually came up with a very novel and unique suggestion “Increase the fee schedule for family physicians doing comprehensive care”. With that revelation I will close today’s mind boggling discussions on the future of health care in Alberta as seen by our “Conservative Leader Want-to-be’s” and premier hopefuls. I will continue their responses to more questions over the next few days. And of course, if any of their representatives wish to clarify, agree, disagree, etc. you are invited to comment.


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