tooty Posted August 3, 2009 Report Share Posted August 3, 2009 More and more of these clinics are popping up in Canada. What do you guys think of them? Would you join one as a family doc? I'm in favour of it. It would help to increase the number of family physicians and encourage good patient care. edit: here's an old discussion that I think is relevant. Link to comment Share on other sites More sharing options...
Mourning Cloak Posted August 3, 2009 Report Share Posted August 3, 2009 How does it increase the number of family docs? It's basically just a multi-disciplinary clinic (nothing new) with a membership fee. You can work in a multi-disciplinary clinic that doesn't charge a membership fee, too. One FP comments on Copeman: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16717272 Link to comment Share on other sites More sharing options...
future_doc Posted August 3, 2009 Report Share Posted August 3, 2009 tooty, this is an interesting topic. Yes, Mourning Cloak is correct, this does not increase the no. of family docs and it is a multi-disciplinary clinic with a membership fee - that really does not want non-members. The purpose of going this route is to maximize one's earnings while maintaining high standards for patients. In many cities, it is impossible to find a family doc. I would like to see a new grad in family medicine go private, opt out of the public system, and charge patients per visit. I expect that while practicing good medicine this doc will earn significantly more than being an assembly line family doc not being able to give any significant time to each patient he/she sees in the public system. Those who can afford it would prefer to have a doc who spends the time required and is never rushed. There is room for public and private. I would be hesitant to go into family medicine after all my years of study and high ideals, and so that I can pay the mortgage, the kid's private school, etc. I need to short change my patients so I have a steady assembly line flow to cover all expenses, personal and professional, etc. I would like to enjoy my practice and treat with my patients with the care they require and deserve. To me, unfortunately, this means family medicine is out, unless I were to go to the military and opt for the MOTP which is a marvelous program for those interested in family medicine. The suggestion made in the website article given by Mourning Cloak is most interesting. Link to comment Share on other sites More sharing options...
Mourning Cloak Posted August 3, 2009 Report Share Posted August 3, 2009 It is a fascinating question from a broader perspective, too. Bottom line: With the two tier-system, people with money get better medical care. Question: is that a problem, ethically? (bearing in mind that people with money generally get better everything anyways; there are lots of countries in the world that don't seem to have a problem with this kind of healthcare delivery) Question: is that a problem, legally? (what does the Canada health act actually say about "accessibility"? http://www.hc-sc.gc.ca/hcs-sss/medi-assur/cha-lcs/overview-apercu-eng.php) NB: I don't know the answer to either, being neither an ethicist nor a lawyer. Link to comment Share on other sites More sharing options...
leviathan Posted August 3, 2009 Report Share Posted August 3, 2009 We should all have the right to health care. But if you said we all have the right to a car, does that mean we should all be getting a Ferrari or Lamborghini? At the moment, I think Canadians are all getting Honda Civics, which are pretty reliable but not flashy in any way and sometimes don't get you where you need to be fast enough. But if you create a two-tiered system you will end up with the rich getting their Ferraris and the poor getting broken-down old cars that don't even start half the time, and rarely get where they need to be fast enough. So is offering universal broken down cars to everyone good enough to consider our system a success? Is this still offering everyone the right to healthcare as they deserve, or would you consider a Honda Civic the bare minimum that we need? Just remember that if we let the rich have their Ferraris, the poor don't get to keep their Honda Civics anymore. Doctors are limited, so if you give more to one small wealthy group, there will be even fewer for the rest. Link to comment Share on other sites More sharing options...
future_doc Posted August 3, 2009 Report Share Posted August 3, 2009 It is a fascinating question from a broader perspective, too. Bottom line: With the two tier-system, people with money get better medical care. Question: is that a problem, ethically? (bearing in mind that people with money generally get better everything anyways; there are lots of countries in the world that don't seem to have a problem with this kind of healthcare delivery) [/b] No, it is not a problem ethically. Hey, under the pure public system that calls for universality, there is no access anyhow, what about the homeless in need to medical care on E. Hastings St. in Vanc. or any city, what about those living in rural commmunites and our native cmmunity? We are not living up to the promise, the undertakings and the poorest fall through the cracks without even beginning to know how to fend for themselves medically speaking. We are like a third world country in many respects and I don't see our physicians running out to do pro bono work in these areas. The fact is that two-tier system or no two-tier system, the wealthy receive special treatment and attention. They know what a timely expensive Christmas gift to their family doctor means: access and being fitted in without an appointment. Or giving a 'gift' to the surgeon doing complicated surgery. These are facts of life. so, "no", there is no ethical problem I submit. Question: is that a problem, legally? (what does the Canada health act actually say about "accessibility"? http://www.hc-sc.gc.ca/hcs-sss/medi-assur/cha-lcs/overview-apercu-eng.php) NB: I don't know the answer to either, being neither an ethicist nor a lawyer. [/i] Legally, there is no problem with a two tier system so long as those in the private sector who choose their patients do not received payment from the public purse. They can both run on separate tracks, entirely independently of each other. I read the Canada Health Act overview on the above website. It is non-profit, comprehensive, strives for "universality" by giving "entitlement" to Canadian residents ('entitlement to' and 'access' are two entirely different things). It claims accessibility where and as available, this excludes residents of E. Hastings, rural comminities, reserves, etc. and in particular our native people have been treated like 10th class citizens to our shame, including medically. Words that have no meaning have no meaning. Accessibility is a word with limited meaning. It starts at the top, the policy makers, the politicians, government funding and priorities. The have nots for the most part are effectively ignored b/c they hav e no muscle, no political power. That is where the ethical problem exists. Legally, we have universality and accessibility. For all practical purposes what we have legally and in reality are entirely different. Link to comment Share on other sites More sharing options...
future_doc Posted August 3, 2009 Report Share Posted August 3, 2009 We should all have the right to health care. But if you said we all have the right to a car, does that mean we should all be getting a Ferrari or Lamborghini? At the moment, I think Canadians are all getting Honda Civics The problem is that many Canadians are getting nothing, no car, so to speak. And this is not just unfair, it is reprehensible. We should not have people in Canada living like they are in a third world nation and others receiving top medical care. Link to comment Share on other sites More sharing options...
leviathan Posted August 3, 2009 Report Share Posted August 3, 2009 The problem is that many Canadians are getting nothing, no car, so to speak. And this is not just unfair, it is reprehensible. We should not have people in Canada living like they are in a third world nation and others receiving top medical care. No, some Canadians are getting slower access to care....ie., their cars aren't lightning fast. But if you privatize, now they REALLY won't have access, unless of course they have lots of $$$. Link to comment Share on other sites More sharing options...
future_doc Posted August 3, 2009 Report Share Posted August 3, 2009 No, some Canadians are getting slower access to care....ie., their cars aren't lightning fast. But if you privatize, now they REALLY won't have access, unless of course they have lots of $$$. You are correct. When I made that comment, I was thinking of those citizens who do not have proper access to universal medical care, I was not thinking of privitization. Sorry, if I confused the issues. Link to comment Share on other sites More sharing options...
A-Stark Posted August 3, 2009 Report Share Posted August 3, 2009 No, it is not a problem ethically. Hey, under the pure public system that calls for universality, there is no access anyhow, what about the homeless in need to medical care on E. Hastings St. in Vanc. or any city, what about those living in rural commmunites and our native cmmunity? We are not living up to the promise, the undertakings and the poorest fall through the cracks without even beginning to know how to fend for themselves medically speaking. We are like a third world country in many respects and I don't see our physicians running out to do pro bono work in these areas. No access? Bull****. People in rural communities might have to travel a bit for certain specialized care. Still, in *my* rural community, I have never had any problem seeing a doctor the next day. Anyway, you seem to be decrying allowing people to fall through the cracks and then go on to somehow use this to justify graft and bribery as not issues of ethics. (And, for the record, there are certainly physicians working at, for example, the DTES's supervised injection site.) The fact is that two-tier system or no two-tier system, the wealthy receive special treatment and attention. They know what a timely expensive Christmas gift to their family doctor means: access and being fitted in without an appointment. Or giving a 'gift' to the surgeon doing complicated surgery. These are facts of life. so, "no", there is no ethical problem I submit. I would be stunned if this was particularly widespread, and if it is it would point to outright corruption and bribery. What a depressingly low opinion of professional behaviour - what an appallingly low standard! No ethical problem for giving preferential treatment in exchange for gifts? What BS. Legally, there is no problem with a two tier system so long as those in the private sector who choose their patients do not received payment from the public purse. They can both run on separate tracks, entirely independently of each other. Except there are significant regulations on the billing habits of physicians outside the system (not a bad thing at all). This has always been the case, though, and it is seldom a worthwhile venture for a physician to "opt-out". I read the Canada Health Act overview on the above website. It is non-profit, comprehensive, strives for "universality" by giving "entitlement" to Canadian residents ('entitlement to' and 'access' are two entirely different things). It claims accessibility where and as available, this excludes residents of E. Hastings, rural comminities, reserves, etc. and in particular our native people have been treated like 10th class citizens to our shame, including medically. Words that have no meaning have no meaning. Accessibility is a word with limited meaning. Residents of E. Hastings are vulnerable in many respects, but it is a gross distortion to suggest that significant public health resources are not directed there. They are. Rural communities cannot support tertiary care facilities, it's true, but that's why we have regional hospitals and tertiary and quaternary referral centres. Lumping living conditions and services on reserves in with the broader health care "issue" is silly and reduces complex problems simplistically. It starts at the top, the policy makers, the politicians, government funding and priorities. The have nots for the most part are effectively ignored b/c they hav e no muscle, no political power. That is where the ethical problem exists. Legally, we have universality and accessibility. For all practical purposes what we have legally and in reality are entirely different. And your solution is two-tier health care...? Or something? Link to comment Share on other sites More sharing options...
tooty Posted August 4, 2009 Author Report Share Posted August 4, 2009 (i haven't read the discussion since my op but i'll insert my opinion here anyway) i think the people against partial privatization have this extremist view of what patients will be charged. realistically, we can all afford, say, $100 a year. Even making $20,000 per year like i am now, I can afford $100. Say a family doc has enough time to see 2000 patients per year, if every patient pays $100, that's $200,000 extra that she would be earning. the issue of high overhead costs would be eliminated. more and more med students would see family medicine as a potential specialty. just $100/year, folks. that's all i'm asking. Link to comment Share on other sites More sharing options...
Jochi1543 Posted August 4, 2009 Report Share Posted August 4, 2009 No, some Canadians are getting slower access to care....ie., their cars aren't lightning fast. But if you privatize, now they REALLY won't have access, unless of course they have lots of $$$. Yes, and people with $$$ will get access regardless - tons of people fly to the US, Germany, Switzerland for cutting-edge medical treatment or simply treatment that requires too long of a wait in Canada. So really, this separation is harming the population a lot more than benefiting it, because the only people who will benefit from it already have choices. Link to comment Share on other sites More sharing options...
Jochi1543 Posted August 4, 2009 Report Share Posted August 4, 2009 (i haven't read the discussion since my op but i'll insert my opinion here anyway) i think the people against partial privatization have this extremist view of what patients will be charged. realistically, we can all afford, say, $100 a year. Even making $20,000 per year like i am now, I can afford $100. Say a family doc has enough time to see 2000 patients per year, if every patient pays $100, that's $200,000 extra that she would be earning. the issue of high overhead costs would be eliminated. more and more med students would see family medicine as a potential specialty. just $100/year, folks. that's all i'm asking. We already paid for healthcare in Alberta in the recent past, it was what, $45 a month unless you were very low-income/on AISH? I wonder what was the logic behind doing away with that, considering that now they are cutting costs like crazy. Should've just kept the charges. Anyone who's well-familiar with the history of these changes care to comment? Link to comment Share on other sites More sharing options...
tooty Posted August 4, 2009 Author Report Share Posted August 4, 2009 We already paid for healthcare in Alberta in the recent past, it was what, $45 a month unless you were very low-income/on AISH? I wonder what was the logic behind doing away with that, considering that now they are cutting costs like crazy. Should've just kept the charges. Anyone who's well-familiar with the history of these changes care to comment? yeah i dunno what that gongshow was about. but i'm talking about paying directly to the family doctor. Link to comment Share on other sites More sharing options...
Jochi1543 Posted August 4, 2009 Report Share Posted August 4, 2009 yeah i dunno what that gongshow was about. but i'm talking about paying directly to the family doctor. Oh, so co-pay? My US insurance was like that, and I have definitely been in a situation where I couldn't afford $20 in co-pay more than once. Link to comment Share on other sites More sharing options...
tooty Posted August 4, 2009 Author Report Share Posted August 4, 2009 Oh, so co-pay? My US insurance was like that, and I have definitely been in a situation where I couldn't afford $20 in co-pay more than once. there will always be people who won't be able to afford the copay of $100, or maybe even $20 per year, but that's no reason to discard this option because the vast majority of the population will be able to afford the copayments. Link to comment Share on other sites More sharing options...
Satsuma Posted August 4, 2009 Report Share Posted August 4, 2009 [/b] what about the homeless in need to medical care on E. Hastings St. in Vanc. or any city, what about those living in rural commmunites and our native cmmunity? We are not living up to the promise, the undertakings and the poorest fall through the cracks without even beginning to know how to fend for themselves medically speaking. We are like a third world country in many respects and I don't see our physicians running out to do pro bono work in these areas. What is stopping homeless people in any city from gaining access to medical treatment? There are many docs who target their work specifically for this population. They might have a difficult time finding a family doc, but there is nothing stopping them from walking into a walk-in clinic, urgent care centre or emerg. Is there more that can be done for this population...perhaps. But it is a population that is generally not high-functioning, that don`t always make good choices. These poor choices include finally coming to the ER for treatment, and leaving AMA before tests can be done, or sometimes even after tests have been done but before you even have a chance to look at that CT scan etc. The "system" can`t be blamed for those poor choices. The problem with Aboriginal health involves so much more than just accessibility to medical care. The government covers prescription drugs, vision care, dental services (what other Canadian gets dental covered by the government?!) and pays for the flight out to get medical/dental services. Sure, it isn`t ideal to have to fly somewhere far away from family when you are sick and be in a culturally different environment, but it is a reasonable effort by the government to get the access to care. Aboriginal health would be more greatly improved with the government focussing more $$ toward primary prevention and health promotion/education imo. And with respect to people flying off abroad to get "better" treatment. Just because you can pay for a test or procedure and can get it done somewhere...doesn`t mean it is evidence-based and better care. There is no healthcare system that is perfect. There is room for improvement in the Canadian healthcare system. But until that happens, we aren`t really doing that bad. Link to comment Share on other sites More sharing options...
future_doc Posted August 4, 2009 Report Share Posted August 4, 2009 What is stopping homeless people in any city from gaining access to medical treatment?...Is there more that can be done for this population...perhaps. But it is a population that is generally not high-functioning, that don`t always make good choices......The "system" can`t be blamed for those poor choices. The problem with Aboriginal health involves so much more than just accessibility to medical care........Aboriginal health would be more greatly improved with the government focussing more $$ toward primary prevention and health promotion/education imo. There is no healthcare system that is perfect. There is room for improvement in the Canadian healthcare system. But until that happens, we aren`t really doing that bad. You make valid points although I disagree with your point in bold, italics above. Politicians make decisions in the end to capture votes, the homeless don't vote and enough is not done for them, considering that society needs to help them out more especially b/c they make poor choices. Aboriginals have been neglected or abused by the rest of scoiety for generations. Healthcare is a furtherance of this. And yes, no healthcare system is perfect. Link to comment Share on other sites More sharing options...
future_doc Posted August 4, 2009 Report Share Posted August 4, 2009 No access? Bull****. People in rural communities might have to travel a bit for certain specialized care. Still, in *my* rural community, I have never had any problem seeing a doctor the next day. Sorry, mea cupla, I had thought there was a problem of finding physicians in rural commiunities. I don't think you are the representative typical patient in a rural community. Anyway, you seem to be decrying allowing people to fall through the cracks and then go on to somehow use this to justify graft and bribery as not issues of ethics. Please don't put words in my mouth. I do not justify graft or bribery as not being issues of ethics, nor do I approve of the preferential access to those givng 'gifts'. I am only stating the harsh reality as it exists. I would be stunned if this was particularly widespread, and if it is it would point to outright corruption and bribery. What a depressingly low opinion of professional behaviour - what an appallingly low standard! No ethical problem for giving preferential treatment in exchange for gifts? What BS. I have not stated once that I agree with this "gifting program of the wealthy to their doctors". I am simply reporting the facts as they exist in large cities, but don't ask for details or proof. It does occur, this is not my opinion, and I am aware of it. I did not discuss the ethics of this or imply this is proper. Also, I don't have my head buried in the sand. Residents of E. Hastings are vulnerable in many respects, but it is a gross distortion to suggest that significant public health resources are not directed there. They are. Rural communities cannot support tertiary care facilities, it's true, but that's why we have regional hospitals and tertiary and quaternary referral centres. Lumping living conditions and services on reserves in with the broader health care "issue" is silly and reduces complex problems simplistically. Neither of us have statistics, but I don't know nor do you that the public health resources that are directed there work efficiently. I do know that if a pregnant teen on drugs is picked up on the streets and is referred to the healthcare system, she sees a psychiatrist or psychologist, it is one or two appointments and she is back on the street with absolutely nothing positive accomplished...but, there is a chart and a thorough write up and the professionals are paid for their services. It is revolving door, and is lose-lose, nobody benefits although it is costly to the healthcare system. The professional who see these patients will tell you so. At least, I was told this by a treating professional in Vanc. If the teen is not pregnant, the best they can do is try to get the teen to use condoms, but this information or advice is useless until a bond of trust has been established with the patient. And this does not happen b/c the patient does not see the healthcare professional regularly or often. Then, it is "next patient through the revolving door". This is fact, not fiction, lots of money is spent in the healthcare system and nothing is accomplished for the vulnerable who truly need the help. The homeless need help, homeless teens need help, but what is given is not effective, while being costly. There is not an efficient use of our professional and financial resources, and this is not the fault of the treating professional nor the homeless person, it is the system. I do not know what suggestions to make for improvement. I do know the system is presently inefficient and does not truly help the targeted population as it should. And your solution is two-tier health care...? Or something? I don't have solutions, perhaps suggestions at most. This is a forum for us to debate ideas on controversial issues and hopefully, learn from each other or agree to disagree. And over the course of time, when we are part of the healthcare system, each of us in our own way will make contributions while hopefully improving the system. Link to comment Share on other sites More sharing options...
piratefan Posted August 4, 2009 Report Share Posted August 4, 2009 In terms of copayments, I think many of the previous posters have been a bit too optimistic about that the average Canadian with medical issues can afford. Many older Canadians live on $1000 or less per month (ie unlikely to afford a $1000 fee) - these are the same patients who are most likely to benefit from spending more time with the family doc at a boutique clinique. Those who are not living on a pension are often young persons living on disability as their multiple medical issues (chronic pain, fibromyalgia, diabetes) prevent them from holding a job. These are the patients taking up much (perhaps the majority) of the family physician's time -- it seems as though opening a boutique clinic leaves the private physician with the healthy and wealthy, while patients with the most complex health needs will continue to be serviced by the same overburdened family docs (although there will be less of them in the entirely public system). I have difficulty understanding how this is an ethically-appropriate solution. ~pf Link to comment Share on other sites More sharing options...
future_doc Posted August 4, 2009 Report Share Posted August 4, 2009 -- it seems as though opening a boutique clinic leaves the private physician with the healthy and wealthy, while patients with the most complex health needs will continue to be serviced by the same overburdened family docs (although there will be less of them in the entirely public system). I have difficulty understanding how this is an ethically-appropriate solution. ~pf A g r e e d. Link to comment Share on other sites More sharing options...
boodog Posted August 5, 2009 Report Share Posted August 5, 2009 i disagree, i believe private clinics are actually a great idea. a lot of seniors have pension plans, insurance, etc, etc. these can easily pay $1000-3000/yr. For those that are not as wealthy, many provinces have disability allowances usually paying around 1800/month. These same people on disability usually live in subsidized housing etc, so a big chunk of their benefit is not going to rent. Why not take a little money out of thier allowance ie. $100 per month and put it towards better medical care. I think it is brilliant. Certainly it is one of the more cost-effective solutions to better health care that the government could implement. Link to comment Share on other sites More sharing options...
tooty Posted August 5, 2009 Author Report Share Posted August 5, 2009 In terms of copayments, I think many of the previous posters have been a bit too optimistic about that the average Canadian with medical issues can afford. Many older Canadians live on $1000 or less per month (ie unlikely to afford a $1000 fee) - these are the same patients who are most likely to benefit from spending more time with the family doc at a boutique clinique. Those who are not living on a pension are often young persons living on disability as their multiple medical issues (chronic pain, fibromyalgia, diabetes) prevent them from holding a job. These are the patients taking up much (perhaps the majority) of the family physician's time -- it seems as though opening a boutique clinic leaves the private physician with the healthy and wealthy, while patients with the most complex health needs will continue to be serviced by the same overburdened family docs (although there will be less of them in the entirely public system). I have difficulty understanding how this is an ethically-appropriate solution. ~pf i read that seniors take up the majority of healthcare costs, but are these seniors really that poor? where can we look this up? even living off $1000 per month, i don't think $50 is too much to ask PER YEAR. if it's standard to charge a co-payment, it would give huge incentive for med students to go into family medicine, bringing more doctor's into the field. between paying $50 per year and not having a family doctor, wouldn't people choose the former? it might also allow the government to cutback a little in compensating these doctors, freeing up more money to go into training new ones. all too often i hear the argument that we need to keep our healthcare system "Canadian," which takes care of the poor and hungry blah blah blah.. as if there's something magical about our system being completely universal. OUR SYSTEM SUCKS. our GDP is 11th in the world and yet our healthcare system is ranked, what, 37th by the WHO? people with or without money are suffering. no kind of fancy manipulation of resources is going to get around the fact that we need more money into the system, imo anyway. for you nay-sayers about 2-tier/co-pay/privatization etc, instead of pointing out problems with change (which is easy to do), how about proposing some changes yourself? Link to comment Share on other sites More sharing options...
AdamP Posted August 5, 2009 Report Share Posted August 5, 2009 there's also the discussion on user fees that periodically comes up, I think mainly to stop people going for frivolous things. Why not if you make >30,000 a yr. (~national average I believe) pay 5-10 for each FM or ER visit? Link to comment Share on other sites More sharing options...
tooty Posted August 5, 2009 Author Report Share Posted August 5, 2009 there's also the discussion on user fees that periodically comes up, I think mainly to stop people going for frivolous things. Why not if you make >30,000 a yr. (~national average I believe) pay 5-10 for each FM or ER visit? i like it. basically anything that can offset the dreaded overhead costs by those family physicians would help. i'm also in favour of completely "digitalizing" information keeping in the doctor's office to improve efficiency, but that's another discussion. Link to comment Share on other sites More sharing options...
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