New Private Medical Schools?!

[Guest ADD100]

Interesting story: "CMA threatens to set up private medical schools"

 

www.google.ca/search?hl=e...arch&meta=

 

(Click on "CMA threatens to set up private medical schools - Globe and Mail - 15 Aug 2005" to see article)

 

It would be nice if we can have more medical schools in Canada, but what implications would 'private' medical schools create? Higher tuitions fees and no quotas (I guess).

[Guest Ronin]

Here is the money quote:

 

But Dr. Schumacher said Canada needs 3,000 graduates a year to be self-sufficient. Shortfalls are being addressed, in part, by wooing doctors from abroad.

 

"We cannot continue plundering the developing world for physicians," he stated.

[Guest moo]

Private medical schools will never fly in this country. THere are hardly any private universities period. Those that exist have very little funding and research. Also, with private schools, you may need to have private hospitals and that for sure as hell won't ever happen, especially given who the current health minister is. (Mr. Dosanjh just yesterday was preaching at the CMA conference denouncing even the very idea of a two tier system.) It is doubtful that a private school would be able to allow its students to rotate through public hospitals because most big public hospitals in this country are already affiliated with medical schools.

[Guest ploughboy]

-----BEGIN PGP SIGNED MESSAGE-----

Hash: SHA1

 

 

 

"Something's gotta give" - Johnny Mercer

 

I would like to think that this is nothing but posturing by the CMA to get the gv't to continue to increase the number of med school seats, but I don't know enough about the politics of the CMA to know if that's an accurate assessment.

 

I totally agree with Dr. Schumacher that it is immoral to recruit physicians from developing nations, or developed nations with huge public health problems (e.g. physician recruitment from South Africa). I think that we need to produce more physicians domestically, and that we are going to have to make some serious changes in the delivery of health-care in the next decade or so due to our growing 'doctor deficit'. Something does have to give.

 

However, I don't think that a private medical school is the answer. If this private school isn't eligible for public funding, then I can't see the tuition fees being anything short of astronomical. Since the mid-1990s de-regulation of tuition in Ontario, there has been a significant increase in the median parental income of medical students: i.e. fewer students from poor families are enrolling in medical school. (Sorry, I don't have any citations handy but I know the refs are out there in the literature, and they've been discussed on this board before...) A private medical school, with higher tuition fees than the public system will only exacerbate the problem of physician shortages in rural and remote areas, as well as in poor urban areas.

 

Even though meds tuition at public universities is sky-high, it's my understanding that we are not paying the full cost of our tuition - it is taxpayer subsidized. If the private school is eligible for similar public funding, so that tuition levels are mearly 'crazy' and not 'insane', then what's the point? Why not put that government money into a public institution (eg expanding U of T meds to York U, or UWO to Windsor - sorry for the Ontario-centric examples, it's the place that I'm most familiar with).

 

 

 

"Don't believe it when they tell me there ain't no cure

The rich stay healthy, the sick stay poor" - U2, God Part II

 

On another note, I have a bit of a problem with another quotation from the article: "We didn't go from nothing to medicare. We had insurance plans; and we had some really good not-for-profit insurance plans."

 

- From the reading I've done on the development on medicare (and I did quite a bit of it for one of my courses last term), I understand that one of the major problems with pre-1960s Canadian health care was that *despite* the market presence of private, for-profit as well as doctor-run non-profit insurance schemes, a huge fraction of the Canadian population was uninsured or under-insured. While I didn't witness the development of medicare first-hand, and I certainly don't have Dr. Schumacher's qualifications, I would suggest that it would be more accurate to say those insurance plans were "really good for those who could afford them".

 

While a two-tier system may move some medical care expenses off the government books, total health-care spending won't necessarily decrease. It will just be pushed onto the backs of ordinary citizens. But hey, if it's off the government's books it's not a cost to society as a whole, right? (sarcasm)

 

On the other hand, given the choice between a physician-run, non-profit insurance company and a blood-sucking, American-style HMO (wow, now there's a value judgement!) I suppose I'd opt for the former.

 

Disclaimer: As I move gradually but non-linearly leftward in my political views, my own thoughts on the whole public/private/two-tier debate are still coming together, and my views will probably change one way or another over the next four years as I get a look at the healthcare system from the inside. Heck, my opinions might be different tomorrow!

 

 

pb (in a pissy mood tonight...)

 

 

-----BEGIN PGP SIGNATURE-----

Version: GnuPG v1.2.3 (MingW32)

 

iD8DBQFDArl8/HNgbK3bC2wRAqDHAJwPreTVVMxUcCbu9vkhmA5MmL18qgCdGcAY

Rum15u+cBt1RthqQ3Srxdoo=

=5g6z

-----END PGP SIGNATURE-----

[Guest aneliz]

A private medical school, by definition, would not be eligible for public money to subsidise it... similar to private elementary schools... they receive no public education money and the cost of the schools is supported by the students that attend them.

 

Compare a private elementary school to a public one: public school: no tuition fees. Private school: up to $10 000 + in tuition fees for elementary grades.

 

Public med school tuition is currently ~15 000 dollars... actual cost of med school operation per student (estimated by Dean of UWO at a Town Hall meeting) = $75 -80 000 per student per year.

 

It is going to be a different type of student that can afford that... or is willing to be $500 000 in debt at the end!

[Guest kosmo14]

whats a few extra hundred thousand when you are already so deep in it that the sun doesn't shine anymore:rollin

[Guest studentz]

i.e. fewer students from poor families are enrolling in medical school.

 

More like fewer students from families that are not affluent are enrolling.

 

I also agree that private schools won't work here. Many of the good private schools in the US have been around for a very long time and have very wealthy donors (NYU just received $105 mil.).

 

I don't think the number of med school spots is the biggest problem. Rather, the entirely public nature of the system (in terms of its financing) limits the number of residency spaces since each resident is paid using tax dollars, each residency spot costs far more than each med school space, residencies are tied to university health centres, and there are few med schools in this country. Canada simply cannot afford to have a large excess of residency spaces as the US does (many residency spaces in the US are in private hospitals). As for plundering physicians from the developing world, I believe it is wrong to actively recruit them but the only way to prevent them from coming here would be to discriminate against them in the immigration process and favour, say, people in trades. This isn't necessarily unethical since immigration policy must be tied to both the needs of the country and the realities that foreigners face here.

 

The CMA made a controversial decision today. The Canadian public is grosly ignorant of how much of our health care is private: most, if not all of us, will be private practitioners; the hospitals ARE all private but are non-profit and are financed publicly; and compared to many Eurpean countries, a larger portion of total health costs is paid privately in Canada. I fail to see how increasing the number of private, non-profit centres (in imaging, for example) will lead to a US-like system. As far as I know, the UK is the closest to the type of "two-tier" system that CHA advocates dream up whenever the word private comes up. Other coutries like Sweden and France, which have private components, do not resemble the nearly apocalyptic scenario painted by some in this country. There needs to be a far more intelligent debate on these issues so that the best way forward can be chosen rather than a less-ideal way forced on us by the courts.

[Guest ploughboy]

-----BEGIN PGP SIGNED MESSAGE-----

Hash: SHA1

 

 

Hey there,

 

studentz - I disagree with your argument about residency spots. Residents are a fantastic bargain because they work insane hours for relatively little pay. If the work done by residents were done instead by "real" doctors, it would cost the system tens of millions of dollars a year in extra salary.

 

I don't have a particular problem with private delivery of health care, as long as it is equally accessible to all. I gave some blood and pee'd in a cup for MDS today, and last I checked they were a for-profit entity. I'm just *really* leery about the introduction of additional "payers" (ie insurance companies) into the system. Dr. Kapur (quoted below, and who was quoted at length somewhere else in an article that I just can't put my finger on at the moment) makes a good point about "cream skimming" which I hadn't really thought of before but I think is absolutely correct: Sick people -- the really sick ones who *need* to get off waitlists and into treatment -- are less likely to be cleared for insurance, or will find that their diagnosis has led to a whopping increase in their premiums, or they might be dropped by their carrier completely (I've read first-person accounts of this happening in the States, but I've also read on the 'net that Elvis is alive and well and living in Burgoyne Ontario, so sometimes you have to take these things with a grain of salt...)

 

I admit that I do have to do some more reading about, for example, European health-care systems, but unfortunately that ain't gonna happen until at least October...If my patients were dying on waitlists, I'd be frustrated too. I just think that introducing private insurers will mean we're trading one set of problems for another. Anybody here tried to buy automobile insurance in Ontario lately? Get any bargains?

 

Anyhow, for those who don't read the paper regularly here is one of the latest articles from the Globe. For fun I've also included the National Post's editorial on private med schools, which set my eyes rolling...

 

Cheers,

 

pb

 

 

* * *

 

Private health care should be available to all, doctors say

 

Canadian Medical Association advocates complement to public health-care system

 

By Andre Picard

Thursday, August 18, 2005 Page A4

Public Health Reporter

 

 

EDMONTON -- All Canadians should have the right to buy private health insurance to complement their care in the medicare system, the country's leading doctors' group says.

 

The Canadian Medical Association said, in essence, that a recent Supreme Court of Canada judgment, which struck down a ban on private health insurance in Quebec because patients were not ensured timely access to care, should apply to all Canadians.

 

In doing so, the CMA, which represents the country's 62,000 doctors, also clearly rejected the notion yesterday that there should be a medicare monopoly. It did so just one day after doctors gave their backing to the existence of a parallel, private for-profit health system.

 

"We have to provide our patients with every possible solution," said Robert Ouellet, of Laval, Que., who proposed the motion to delegates at the CMA's annual meeting in Edmonton. The motion was approved by two-thirds of the delegates.

 

He noted candidly that while the proposal says purchasing private insurance would be contingent on the public system failing to deliver, practically speaking, patients would have to buy insurance long before they needed it, or they would likely be unable to get coverage.

 

Barry Erlick, a physician from Toronto, told his colleagues that buying private insurance would be a wise investment because the medicare system cannot keep pace with demand for services.

 

"Governments are failing my patients today," he said during the debate. "We are saying, 'Give our patients options to alleviate their suffering.' "

 

But Atul Kapur, an emergency-room doctor from Ottawa, said only healthy, wealthy Canadians would be able to afford private insurance and the privileged access to care it provides, and that would undermine medicare.

 

"This is not a solution that will help our patients," he said. "It will help private insurance companies to skim and cream healthy patients."

 

Steve Chambers of Edmonton argued that backing the idea of private insurance is a mistake because it lets governments off the hook and undermines the CMA's long-time support for medicare.

 

But John Rapin of Kingston said he resented the implication that those who support exploring various options of private and public delivery are undermining the current system.

 

"Discussing options such as private supplementation is not a blow to medicare," Dr. Rapin said.

 

After the vote, Ruth Collins-Nakai, an Edmonton cardiologist and the new president of the CMA, stressed that doctors are strong supporters of medicare. But they are looking to alternatives such as private insurance because they are "frustrated at not being able to provide timely care," she told a press conference.

 

In addition to backing private health insurance, the CMA delegates approved a motion saying that patients who turn to the private, for-profit system because they cannot get timely care in the public system should be fully reimbursed.

 

The doctors also soundly defeated a motion saying that a parallel private system should not be permitted in Canada.

 

And they called for governments to create uniform requirements for the accreditation and monitoring of both private and public health facilities.

 

All told, the proceedings at this week's gathering show that the CMA is now marching clearly down the path that leads to the creation of parallel private and public systems.

 

Just how far the CMA will go will become clear in six months, when it will produce a discussion paper that will "define and guide the relationship between the public and private sectors in the delivery and funding of health care in Canada."

 

A recent poll showed that 83 per cent of doctors supported the Supreme Court decision.

 

Under the Canada Health Act, only the publicly funded system can provide "medically necessary" services. These are defined loosely as care provided by physicians and in hospitals.

 

 

* * *

 

Who's afraid of private med schools?

 

There is nothing particularly startling about Canadian Medical Association President Albert Schumacher's warning that Canada isn't graduating enough doctors. The country's MD shortage is well known, as is the reason for it: the government's failure to put more students through the country's publicly subsidized medical schools.

 

It is, on the other hand, refreshing to hear Dr. Schumacher's ideas about how the enduring problem might finally be solved: starting private medical schools, which would admit students based on a combination of factors, including demand, merit and profitability.

 

This newspaper has long been a champion of a greater private role in our health care system. When we argue the point, we usually concentrate on the delivery of services and the provision of insurance - both areas that would be improved by private sector involvement.

 

Dr. Schumacher is right, though, that at the root of the system's current unacceptable wait times and lack of choice is a dearth of suitably trained physicians. It only makes sense to attempt to remedy the shortfall by allowing the demand for doctors to propel the education of more of them.

 

While not a Canadian tradition, private medical schools have a long and distinguished international history of producing well-trained physicians who serve their communities and produce important research. In the United States, four of the top five research-oriented medical schools (as ranked by US News and World Report) are private institutions, including the Johns Hopkins University, which is world-renowned for its education of doctors-to-be.

 

Rather incredibly, given Canada's irrational hostility to even the slightest private encroachment into healt care, starting a private medical school in this country is permitted, requiring only that the institution concerned first garner a provincial degree-granting charter. As government red tape and regulation goes, that is not a serious obstacle to overcome.

 

It is true that those who attended a private medical school would likely have to pay higher tuitions than their counterparts at the government-funded schools. But, last we checked, the Canada Health Act did not dictate universal access to medical school. And no aspiring medical student would be forced to choose the pricier alternative, though inevitably many applicants would be so eager to practice medicine as to be willing to take out loans and make the sacrifice to do so.

 

Better by far to have a private education option available for all those who want it than to continue punishing the Canadian public simply because, when it comes to doctors, the government cannot seem to count.

 

-----BEGIN PGP SIGNATURE-----

Version: GnuPG v1.2.3 (MingW32)

 

iD8DBQFDBli6/HNgbK3bC2wRAtL/AKCi68KrYff3moT3QWsmMwq9DvWg6wCdGpcD

KGocFD9fXUjmJUeZRmTjfVs=

=a5VN

-----END PGP SIGNATURE-----

[Guest kellyl20]

Kind of complicated, but private schools in BC also receive funding from the government, per student head.

So I guess private medical schools could be similarily ran.

[Guest ploughboy]

-----BEGIN PGP SIGNED MESSAGE-----

Hash: SHA1

 

 

 

 

So at Western's OMA/CMA dinner last night I button-holed Dr. Schumacher after his speech, and we had a little chat about what happened at the convention.

 

Regarding private insurance, he claimed that the media had somewhat sensationalized the actual motion and he didn't believe that it would lead to an American-style health-care system.

 

Regarding meds spots - He pointed out that the CMA has been pushing on gv'ts for the past 10 years to open up more meds spots, and it just ain't gonna happen (my words, not his). I took from our conversation that the call for a private med school has been born out of frustration, and an attempt at solving the situation pragmatically. I believe his exact words were "If plan A and plan B don't work out, you have to try plan C."

 

In response to my concerns about a private school skewing meds enrolment toward people from the high end of the socio-economic scale, he pointed out that it's already the case now that most med students come from high-income families (I believe he said most med students have parents in the top 20% of income earners). I couldn't figure out a way to say "but that's not faaaaaaiiiiiir" without sounding like a whiny little kid, so we sort of left it at that. I argue much better on ezboard than I do in real life!

 

Cheers,

 

pb

 

 

 

 

 

-----BEGIN PGP SIGNATURE-----

Version: GnuPG v1.2.3 (MingW32)

 

iD8DBQFDH7q6/HNgbK3bC2wRAj/9AJ9A/E/5c6pQ1PaTTPrCd3MiMFyviwCfc2LG

icqzkYldKcKLusTbK28Yvvo=

=3DVW

-----END PGP SIGNATURE-----