Doctors in Canada

[DeadPoolX 9]

As far as I can tell, there's a shortage of physicians in Canada and no end to how many patients need them. Maybe I'm a little slow on the draw about this, but I've only been living here since August.

The problem as I see it is that doctors have little-to-no incentive to stay in Canada. Why should they? They go through the same medical school training as those in the U.S. (which can easily be a decade long and more depending on the specialty), but end up making a lot less money. In addition, the number of patients they can see is limited in a day.

After everything it takes to get into medical school, pass it and go through residency, why should doctors accept what Canada's offering? Don't say "Doctors should be happy with just treating patients and pay should be secondary." Okay, most doctors do like treating patients. However, income is always a concern. Prices are generally higher in Canada than they are in the U.S. and since the American dollar has once again become valued more than the Canadian dollar, that's not helping. I've even heard people say that doctors should treat people for free. That's ridiculous. They have the ability to save lives and yet, they should do it for free? How about some other people do their job for free as well? Most wouldn't like that, but for some reason, physicians are expected to forgo payment.

I'm not suggesting we make doctors multimillionaires. Very few of them are in the U.S. and medical practices there earn more. But I think it's odd -- and wrong -- that someone who's spent years training and can treat the sick makes less than many other professions in Canada. For instance, accountants see fewer clients per year than doctors see patients. Somehow accountants make quite a bit more. I realize accountants are very handy (I'd certainly have one if I could afford it), but is their job quite as necessary to life as a physician in our society? There are other careers that make a lot more too. Even in the U.S., movie stars, athletes and CEOs far outweigh a doctor's earnings.

So to save the medical profession in Canada (since it seems the majority of physicians are heading south to the United States) there needs to be some major changes:

1. If the government insists on handling health care (and they do), then they have to increase a doctor's income. Unless it can somewhat compare to what a doctor makes in the U.S., a physician would have to be either extremely altruistic or patriotic to stay in Canada.

2. Allow physicians to see as many patients as they wish. If Doctor Jones can see 40 patients in a day, why not let him? If Doctor Smith can only see 15 patients, that's fine too. It really isn't the government's place to limit how many patients a doctor can see. I know the idea is to keep medical practices from utilizing an "assembly line" form of treating patients; however if doctors can only see a certain number of patients, they're probably pretty damn choosy about who they see and severely limit their patient load. That means fewer people who can see a doctor, especially in this environment where physicians seem scarce.

3. Make procedures and tests more readily available. It's ridiculous to wait months for an MRI or even more importantly, an operation. Contrary to popular belief, a doctor does not order an MRI, CT or PET without good reason. Surgery can't wait long in many circumstances. This is why I've heard of Canadians coming to the U.S. for tests and procedures. It costs a lot more, but they'll get it done immediately.

To sum it up, I'm not trying to bash the Canadian health care system, but there seems to be something wrong if so many Canadian doctors are leaving for the United States and Canadians have to wait months (or at best weeks) to see a doctor, get a test or procedure completed.

[Kathryn41 3,205]

Part of the doctor shortage problem - at least in Ontario - isn't so much from Doctor's leaving the country but from protective actions from the Ontario Medical Association that restricts the number of training seats available in Medical Schools each year and disallows immigrant doctors trained in other countries from practising medicine unless they go through the Province's specified training programs. This problem has been coming for a long time, and health advocacies having been pushing for a number of years now for the OMA to allow more positions in medical school for both new doctors and immigrant doctors. For many years - until the crisis was actually at hand - the OMA refused, then were suddenly faced with an aging population and retiring doctors, or doctors going into specializations which didn't carry as heavy a work load - as well as a few leaving the country (but not as many as you would think) and suddenly there is a doctor shortage. Doctors unfortunately, are not replaced overnight. The OMAs hostility to recognizing foreign medical training (and yes, US trained doctors faced the same restrictions as doctors from other countries when I was still working for an MP in Ontario) prevented many readily available trained doctors from starting practice. It was a big joke that there were more foreign doctors driving cabs in Toronto than practising medicine in Ontario. The doctor shortage in Canada is mainly a self-creation from short-sighted, protectionist medical associations who wanted to guarantee maximum incomes by restricting the numbers of doctors allowed to practice, and not a result of Canadian doctors fleeing the country for American positions. If you look at the statistics, you will also see a good number of Canadian doctors returning to Canada from practicing in the US as well. The medical brain-drain isn't as big as the failure to plan for meeting increasing needs for trained medical personnel and keeping caps on positions for too long.

Oh, regarding seeing as many patients as they wish - most GPs will tell you they would rather see less people and give them better service but they are not able to because of the doctor shortage. In Chatham-Kent when I lived there my GP had an annual practice of 24,000 patients. She said she had colleagues with caseloads of 27,000. The recommended level from the OMA was 7500 - but that would have left far more patients without a doctor. She was considering leaving practise because of burn-out due to the high patient load.

Edited November 24, 2008 by Kathryn41

[DeadPoolX 9]

Wow.

That was very informative. I didn't know about that situation. Thanks for telling me.

As far as GPs preferring fewer overall patients, you might be right. I'm not sure. I suppose I tend to think of specialists, all of whom would probably rather see more patients. Even if that's not the case, I still find it wrong to artificially limit the amount of patients a doctor can see. If doctors themselves wish to limit themselves, that's one thing. They'd know best about their own capabilities.

[thetreble 19]

To sum it up, I'm not trying to bash the Canadian health care system, but there seems to be something wrong if so many Canadian doctors are leaving for the United States and Canadians have to wait months (or at best weeks) to see a doctor, get a test or procedure completed.

Been happening for years, mate. YEARS. The mass exodus began probably 15 or more years ago. My family felt the brunt of it as we had to change Family Doctors every 3 years due to every one leaving! This has created things like not being able to get in to see the doctor for a few weeks and long waits while you get there. It sucks.

I didn't really read what you are proposing, but I agree there really is no incentive from a career point of view. I figure doctors in Canada are there because they have families and love Canada. You can make so much more money in the US as a doc.

[Ontarkie 14,222]

I saw some show on TV about the money the Doctors in Canada make compared to the doctors in the US make, I also had a Doctor and OBGYN that works in both Canada and the US Sault On, and Sault Mich. One thing from the show and my doctors own words, was Doctors In Canada don't pay as much liability insurance so they dont need the higher salary the US doctors need plus if you ever try to sue a doctor in Canada (its hard as hell for starters) if you made it to court they got some kind of support from the government and it the gov that pays up not much from the doctors. Anyways that something my Doctor and the show both said is a big advantage in Canada.

[thetreble 19]

Interesting to know, Ontarkie.

[MrsCat 6]

I saw some show on TV about the money the Doctors in Canada make compared to the doctors in the US make, I also had a Doctor and OBGYN that works in both Canada and the US Sault On, and Sault Mich. One thing from the show and my doctors own words, was Doctors In Canada don't pay as much liability insurance so they dont need the higher salary the US doctors need plus if you ever try to sue a doctor in Canada (its hard as hell for starters) if you made it to court they got some kind of support from the government and it the gov that pays up not much from the doctors. Anyways that something my Doctor and the show both said is a big advantage in Canada.

I would add also that in Canada, its extremely hard to win a suit against a physician. Typically, the physicians will have had to be grossly negligent in his duties to breach this standard of care. Ex: leaving sponge post surgery may not be enough to do it (cause apparently this happens occasionally), but a physician who knows there's a sponge in there and does nothing to inform the patient is likely grossly negligent.

[SapphireDreams 71]

I saw some show on TV about the money the Doctors in Canada make compared to the doctors in the US make, I also had a Doctor and OBGYN that works in both Canada and the US Sault On, and Sault Mich. One thing from the show and my doctors own words, was Doctors In Canada don't pay as much liability insurance so they dont need the higher salary the US doctors need plus if you ever try to sue a doctor in Canada (its hard as hell for starters) if you made it to court they got some kind of support from the government and it the gov that pays up not much from the doctors. Anyways that something my Doctor and the show both said is a big advantage in Canada.

I was going to post the same thing. I actually read an article on here about the differences. The liability insurance differences are pretty major. Canadian Dr.'s pay a lot less insurance. I am going to track down the article and re-post. It was a good one.

[DeadPoolX 9]

Hmmm... well, a vastly limited ability to sue the doctors would make a difference. Half the reason it's so expensive to be a doctor in the U.S. is due to malpractice insurance.

Even still, there needs to be some sort of supportive plan to keep physicians here. The idea of making quite a bit more money in the U.S. is probably pretty damn appealing.

[thetreble 19]

I do believe it comes down to money.

[TayL 0]

Keep in mind also the population density issue. Canada has a lower population density than most countries our size. What does this mean? Tests such as MRIs are harder to get. It doesn't make financial sense (even in a purely capitalist model, as opposed to a socialist) to have an MRI in Bumf***, Ontario, population 1000, which happens to be an hour from the next town. (Apparently, there are places like this up north) You can't make back the operating costs.

Specialists are the same. They go to the cities where they are inundated by patients and the "country folk" have to wait. Yes, there are some issues in the cities (overcrowded hospitals in the most crowded areas), but a lot of it stems from the fact that our population is so extremely spread out!

I live in a village of 500. The nearest place with an MRI is about 30 minutes away. That town didn't get an MRI until five years ago. Prior to that, I think we had to go an hour and a half to get an MRI. The reasoning was that our area simply didn't have enough tests per year to justify the purpose and upkeep. When the MRI machines came down in price slightly, the area fundraised like mofos to get our MRI.

We ARE underserviced, yes, but the problem is made worse by the fact that we're spaced out all over the place!

[thetreble 19]

You bring up an excellent point, TayL. I actually was going to say something similar. We must keep that in mind while thinking about the doctors and why they would choose to go to the US to practice instead of staying in Canada. From an overall costs perspective, it doesn't make financial sense,.

[DeadPoolX 9]

Good point. The state of California has a higher population than all of Canada, plus it's confined to a smaller space. As you said, that can affect medical care or at least, its availability.

Apparently, my home city of Houston, TX has more MRI machines than Canada does as a whole. Houston's population is around 5.3 million people, but it's absolutely gigantic in geographical size. Another factor may be that the Texas Medical Center is there, which is the largest concentration of medical facilities in the U.S. and some have said even the world.

In a completely unrelated note... I almost spelled "center" as "centre."

[Cassie 8]

Keep in mind also the population density issue. Canada has a lower population density than most countries our size. What does this mean? Tests such as MRIs are harder to get. It doesn't make financial sense (even in a purely capitalist model, as opposed to a socialist) to have an MRI in Bumf***, Ontario, population 1000, which happens to be an hour from the next town. (Apparently, there are places like this up north) You can't make back the operating costs.

Specialists are the same. They go to the cities where they are inundated by patients and the "country folk" have to wait. Yes, there are some issues in the cities (overcrowded hospitals in the most crowded areas), but a lot of it stems from the fact that our population is so extremely spread out!

I live in a village of 500. The nearest place with an MRI is about 30 minutes away. That town didn't get an MRI until five years ago. Prior to that, I think we had to go an hour and a half to get an MRI. The reasoning was that our area simply didn't have enough tests per year to justify the purpose and upkeep. When the MRI machines came down in price slightly, the area fundraised like mofos to get our MRI.

We ARE underserviced, yes, but the problem is made worse by the fact that we're spaced out all over the place!

Aye that sounds like when they fundraised like crazy down home to get a CT scanner in our hospital, which is considered a regional hospital. Now they're run off their feet because now people don't have to drive all the way to Halifax to get their CT scans done.

[TayL 0]

Yup. In our area, there were people who had been waiting up to a year for MRIs for "non-life threatening" illnesses and injuries. They work the MRI literally 24/7 because we're now overworked with it! If you're willing to go for a "night shift" MRI, you can have it within days. If you insist on having it during daylight hours, you might be a year. A lot of people in my area agree to go for a midnight MRI just so they can get it done quickly!