"Why the U.S. Needs a Single Payer Health System"

[Guest Ian Wong]

Here's a very interesting read regarding the pros and cons of a single-payer health-care system such as we have in Canada, and the multi-payer system that exists in the US where insurance companies compete with each other.

 

This article is authored by a group of US physicians arguing for the establishment of a single-payer system in the US, so admittedly it's got a huge bias, but there's some very interesting quotations. eg:

 

Private insurers take, on average, 13% of premium dollars for overhead and profit. Overhead/profits are even higher, about 30%, in big managed care plans like U.S. Healthcare. In contrast, overhead consumes less than 2% of funds in the fee-for-service Medicare program, and less than 1% in Canada's program.

 

Blue Cross in Massachusetts employs more people to administer coverage for about 2.5 million New Englanders than are employed in all of Canada to administer single payer coverage for 27 million Canadians.

 

I'm not sure how many of them are completely accurate, but it's well worth a read.

 

"Why the U.S. Needs a Single Payer Health System"

www.pnhp.org/basicinfo/single.html

 

 

Ian

UBC, Med 4

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<pagetext>The Toronto Star is currently putting out a large series of articles regarding the doctors shortage in Ontario and the rest of Canada, and is well worth picking up a copy or two to check these out. I couldn't resist grabbing a copy of yesterday's paper (Oct.12), which had a large section regarding the obstacles faced by foreign doctors trying to find work in Ontario.

 

Anyway, check out the Toronto Star.

www.thestar.com

 

Ian

UBC, Med 4

 

Article URL

 

<!--EZCODE BOLD START--> Welcome mat out for foreign MDs on The Rock<!--EZCODE BOLD END-->

<!--EZCODE ITALIC START--> Foreign-trained MDs get to open practices<!--EZCODE ITALIC END-->

 

By Vanessa Lu

Health Policy Reporter

 

CORNER BROOK, Nfld. — After struggling for several years to get licensed in Ontario, Dr. Foluso Ola is finally living his dream of working as a doctor.

 

Because he studied in Nigeria, it isn't a simple road to practise medicine, especially in Ontario, where doctors are often required to repeat large chunks of their training.

 

"Newfoundland was the most welcoming place for foreign-trained doctors," said Ola. "My advice to others is to leave Ontario. It's not a good place for foreign medical graduates to start."

 

In Newfoundland, graduates of certain universities, notably in certain English-speaking countries like South Africa, Australia or Ireland, can get immediate provisional licences to practice. Others like Ola can complete a clinical skills assessment program, and after demonstrating they meet Canadian medical standards, they can earn a provisional licence to work, on the condition they complete national licensing exams within three years.

 

Ontario has not granted provisional licences. The licensing body has put a priority on protecting the public by ensuring foreign-trained graduates have the same standards and even experience as Canadian graduates.

 

Within days of completing the assessment course, Ola was working overnight stints in the Corner Brook emergency room, and in September he set up a family practice in Twillingate, on the island's northeast shores.

 

His views echo the thousands of foreign-trained graduates who say restrictive licensing rules make it near impossible to practise in Ontario. Health Minister Tony Clement is vowing to introduce rule changes to open up the system for immigrant physicians. Close to a million people are without a family physician, and that number could double by 2010, as retirements loom.

 

Ola, 33, was born in Ottawa to parents who were studying in Canada, but he grew up in Nigeria, where he went to medical school. He practised for a number of years, but decided to immigrate to Canada due to political instability at home.

 

Now, after spending more than $15,000 for the Newfoundland assessment program, plus living costs for himself in Corner Brook and until recently an apartment for his family in Ottawa, he knows he can finally begin his career again.

 

His wife Abiodun, 31, and daughter Tolu, 7, and son Akin, 1 1/2, have joined him in Twillingate and are now settling into life in rural Newfoundland.

 

"I like small places, and I really love family medicine," Ola said. "In family medicine you get to see the whole spectrum of medicine. You have to make sure you're on top of your game."

 

Ola plans to stay here as long as possible, even though there's the pull of family in both Ottawa and Toronto.

 

"The main thing that makes doctors leave Newfoundland is the poor pay. Then, it's the weather," Ola said.

 

While nothing can be done to change the island's weather, the province's 930 doctors have been on strike since Oct. 1 as they press for wage hikes. They have shut their offices and cancelled elective procedures, as they demand pay parity with counterparts in Atlantic Canada.

 

The provincial government — facing a severe budget deficit — is crying poor. Patients have nowhere else to turn but emergency rooms, where waits for minor problems can exceed 12 hours.

 

Without a significant pay hike, doctors are warning the Roger Grimes government that it will begin to see a mass exodus of physicians to other parts of the country.

 

Newfoundland has always depended on foreign-trained graduates to work in the province, especially in the remote outport communities. Estimates suggest as many as half of the island's doctors trained outside Canada.

 

It has traditionally been the entry point for doctors from all over the world, but usually after a few years, they leave for other provinces, creating the revolving door effect.

 

In Baie Verte, an old mining town two hours northeast of Corner Brook, more than 50 doctors — most foreign-trained physicians — have come and gone in the past decade.

 

One of the stalwarts is Dr. Francois deWet, a native of South Africa, who has been there for five years. Unlike some of the foreign-trained doctors who use Newfoundland as a stepping-stone into Canada, deWet says he wants to stay there.

 

"I don't blame them for leaving. If they can go and have a better quality of life, better remuneration, and in some cases better facilities, why not," he said.

 

As soon as deWet hears a doctor is thinking about writing family medicine qualifying exams — not required to practise in Newfoundland, but mandatory for provinces like Ontario — he knows it's time to advertise for a replacement.

 

Three doctors work at the local hospital, which serves a population of 6,500.

 

In his own case, he hasn't bothered to write the qualifying exams, so he wouldn't be allowed to work in Ontario.

 

"It galls me to think that after 10 years of working in rural Newfoundland, I can't work in Ontario," deWet said. But if Ontario were to change its rules, policy makers in provinces like Newfoundland worry that it would lose its edge in recruiting foreign graduates. One doctor said such a move would create "a huge sucking sound" right off the island.

 

"I think there would be a considerable impact on our ability to recruit and retain doctors," said Dr. Robert Young of the Newfoundland and Labrador Medical Board. The mish-mash of licensing rules across the country is prompting a call for national standards. That's in part to ensure physician quality is the same, and also to eliminate the poaching of doctors from poorer provinces.

 

It has always been easier to qualify to practise in places like Saskatchewan and Newfoundland, where it is possible to get provisional or temporary licences, pending exams.

 

While that helps provinces cope with doctor shortages, it also creates high turnover, where doctors stay for a few years, get Canadian experience, pass national certification exams, and then move on to larger provinces like Ontario or British Columbia.

 

A national task force, created by Health Canada, including professional representatives, provinces and territories, met for the first time last month with a mandate of delivering recommendations by next December.

 

The lack of national licensing standards for foreign doctors creates uncertainty for patients.

 

Every time Baie Verte's deWet books a vacation, he'll get a flood of calls from patients checking to make sure he'll be coming home.

 

"I reassure them, it's just a holiday. Then they ask, `Are you interviewing for another job?'," deWet said. "Sometimes I think I should get a T-shirt that says: `No, I'm not leaving.'"

 

Ola said he's planning to stay for a while. He's happy with the pace of life and the welcome he has received.

 

"I find it's about the best place to come in, to get into the system. Elsewhere, no one has time for a new doctor. Over here, they have time for that," Ola said. "Foreign-trained doctors should leave the big cities, and come to the smaller provinces to try and fit into the system.

 

"I'm living testimony that it works."

[Guest McGillGrad]

This is the type of info that is kept a secret for some strange reason. I say this because I have done some research on Canadian IMGs and their difficulties coming back to Canada. If people are willing to sacrifice a few years in NF then they could go back to their home province and practice there.

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<pagetext>Here's an interesting article by the Globe and Mail. During my time in Toronto and now here in Ottawa, I've been surprised how much more coverage this is getting here than in Vancouver. Just about every day I was in Toronto, the Toronto Star would air articles regarding the doctor shortage in Ontario. I'm finding the exact same thing here by the Ottawa Citizen.

 

Ian

UBC, Med 4

 

globeandmail.com/servlet/...emp/1/1/6/

 

Why your doctor is rebelling

By MARGARET WENTE

 

Thursday, October 31, 2002

 

Do you want to know why your family doctor is so steamed? Ask David Phillips, a GP who practises at the Albany Medical Clinic in a middle-class neighbourhood in Toronto. "I had my teeth cleaned last week, and the bill was $90," he fumes. "I give a patient a complete checkup, and I bill OHIP $53.55."

 

And that's just the beginning of the family doctors' gripes. The stress is a killer. The hours are rotten. They spend way too much time trying to get their sickest patients moved up on the waiting lists. And now the government is trying to reform them.

 

Primary-care reform is something you may not know much about, except that it will be good for you. Senator Michael Kirby is all for it. Roy Romanow is all for it. Every health-care reformer in the past 30 years has been all for it. And now it is official government policy in Ontario, which has mounted a huge push to move doctors into "family health networks" and away from fee-for-service payments.

 

In theory, primary-care reform will give us better medicine, cheaper. It will improve access to care and make the system more efficient. There's just one problem. In practice, the doctors hate it.

 

Ontario's Health Ministry said it was going to get 80 per cent of the province's family doctors signed on to the scheme by 2004. To date, it has signed up less than 4 per cent.

 

"We're simply not interested in participating," says Douglas Mark, who practises in Scarborough. He's president of the 3,200-strong Coalition of Family Physicians of Ontario, which has basically told the province to drop dead unless it can come up with something better.

 

In a family health network, a group of doctors work together with other health-care professionals in a team. Their patients get round-the-clock one-stop shopping, and the doctors' group gets an annual flat rate for every patient. The patients have to promise they won't shop around.

 

But the doctors say the funding formula is too stingy, too complicated, and saddles them with too much risk. They dislike the bureaucracy and the paperwork and the complicated contracts they and their patients are supposed to sign. "The more we see it, the less we like it," says Dr. Phillips.

 

The real problem is, they don't trust the government, which has been capping fees and hitting them with nasty disincentives for years. They don't even trust the Ontario Medical Association, which has been negotiating on their behalf. They're not crazy about the concept, either. One of the ideas behind family health networks is that some of the work doctors do can be performed by lower-paid professionals. But they don't buy it. "My patients," says Dr. Phillips, "don't want to see a nurse-practitioner. They want to see me."

 

Doctors are a famously hidebound group. They hate change. That's why some experts want to make primary-care reform mandatory. This would be a bad idea, because life as a family doctor is already severely unattractive. Every province is desperate for more GPs, and Ontario has about the worst shortage in the country. In Toronto, a reasonably attractive place to work, it took two years for Dr. Phillips's clinic to recruit two new associates.

 

"Family medicine is in crisis," says Dr. Mark. "Ninety per cent of new graduates are not going into comprehensive medicine. They're going to work in walk-in clinics, or emergency wards, or doing fill-in work. They don't want to take on the larger overheads and the large amounts of bureaucracy we face." And fewer graduates than ever are choosing any type of general practice at all. Why go to medical school for 10 years to become a GP, when a dental hygienist can bill more for her time than you can?

 

If you still think health-care reform is imminent, this story adds up to a whole pile of bitter pills. Talk is cheap, but changing the way things work is excruciatingly hard. Restructuring the system is always much more expensive than everyone thinks it's going to be. When it's done by a bunch of bureaucrats, it generally goes badly. And the "efficiencies" and savings everyone hopes for seldom materialize. Even the government's own point-person on family health networks now acknowledges that changing the system won't save a dime.

 

For years, provincial governments have beaten doctors with large sticks to contain costs. Now they need carrots to recruit them back. But they don't have carrots. They can't afford them.

 

"I hope we can save our profession," says Dr. Mark. "We are essentially a species of animal that can no longer reproduce."

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