Thursday, July 21, 2005

Public Healthcare and the Doctor shortage

Andrew at Bound By Gravity and I have been having an ongoing debate of about healthcare and a public-private mix. What we seem to agree on is that the shortage of doctors is the real issue and that solving that problem may make it possible for both systems to exist without either suffering.

Please feel free to join in the debate and offer any ideas, suggestions or information you may have. I feel that this is important for all of us accross the political spectrum to join in and hear each other out on this. We can solve this problem if we can understand each other and reach compromises.

12 Comments:

At 3:49 PM, Blogger John Murney said...

Why not offer doctors more flexibility in terms of time-off, and other non-financial benefits? Surely money can't be the problem.

 
At 4:19 PM, Blogger Mike said...

John,

It actually the raw number of doctors...there just isn't enough of them.

 
At 1:23 AM, Anonymous public static said...

John, to expand on what Mike has said, medical schools aren't graduating enough Doctors to fulfill the demands the system has for Doctors. It isn't a matter of a lack of applicants either, most medical schools in Canada have a 3 year waiting list.

Also the system does not allow foreign trained Doctors into the system fast enough. My brother-in-law's sister's husband is a doctor who was trained in both India and England and practiced in India. He has been here since 2001 and still has not fulfilled the CMA's(?) testing requirements and is not allowed to practice until he has complete all of these exams. This process could easily be streamlined to get these Doctors in practice sooner.

 
At 1:10 PM, Blogger Kevin said...

Why not pay for doctors' education?

 
At 2:38 PM, Blogger Alison said...

Don't forget the other part of the shortage: nurses and technicians. We're graduating enough nurses, I think, but we're not giving them full time jobs. Most new graduate nurses work part-time, casual, or on-call at multiple institutions (which, incidentally, is also bad policy for infectious disease control) because the hospitals are trying to save money by not paying benefits.

The technician shortage, especially for anaesthesiologists (sure hope I spelled that right) is one of the big reasons that operating rooms are unable to open. That particular problem might not require a lot of money to solve because the workforce is smaller than the two big ones (nurses and doctors), but it could have a big impact if we got it right.

 
At 3:19 PM, Blogger Princess Monkey said...

Just to expand a little on Alison's point...there were a couple articles in the Star (I think) recently discussing the possibility of nurse anaesthetists and surgical assistants in Canada. The idea being that we can reduce wait times if we delegate appropriate responsibilities to the right people. For example a surgeon and a specially trained nurse would complete some surgeries, thereby freeing up the doc that would normally be the "second surgeon". Maximize the resources we have...you'd think it was rocket science...

 
At 3:33 PM, Blogger Mike said...

Those are all great suggestions. I suspect doing them all will have the greatest impact for the least cost.

 
At 1:41 PM, Blogger John Murney said...

From what I have read here, it sounds like more young people should be encouraged to seek careers as doctors. Perhaps our universities could put together marketing programs aimed at Science students, and possibly offer to help subsidize the tuition and books of medical students.

 
At 1:56 PM, Blogger Mike said...

John,

Absolutely. Couple that with the promise to forgive part or all of the student loan debts (and possibly living expenses) for students if they go to rural areas that need doctors.

For instance, graduate from Med school and after your residency, if you settle in Cochrane Ontario or someplace that desparately needs family doctors - 100% rebate. Stay in Toronto or Vancouver with a higher density, then 25% forgiveness. Something similar for going into specialties that are under represented, such as pediatrics or oncology.

 
At 6:46 PM, Blogger Psychols said...

My 2 cents......


I have yet to hear a convincing argument that privatization will achieve anything other than encourage doctors to abandon the public system to focus on providing lucrative elective treatment for those with adequate funds. Not a problem if we have enough doctors but given the current shortage would probably mean the partial collapse of the public system. There is no evidence at all that privatization will encourage our publicly funded universities to graduate more doctors, nurses or technicians. To me, privatization is a dangerous idea at this time.

I agree with posts about paying for a medical (or any) education but would add that we should provide interest free loans for the entire cost of the education and forgive 10% of the loan each year that the person works in Canada. Perhaps we can forgive 20% for each year that the person works in a rural environment. By entire cost, I am referring to the full cost that would be charged if the University or College were operating as a private entity. If adequate funding is available we will probably be able to graduate sufficient medical practitioners.

A problem with the public system may be related to the funding mechanism, as opposed to amount of available funds. The pay per visit formula encourages Doctors to either provide a quick prescription or a referral turning private practice medical system into a volume-volume-volume business. We all have, or know somebody who has, had to visit many specialists and undergo numerous tests in a protracted series of attempt at diagnosis and treatment. Some go to the hospital for anything more than a minor ailment because it is one of the few places where a diagnosis can be made reasonably quickly.

Accreditation of foreign doctors and other medical practitioners should probably be performed by a government agency that reports to parliament to ensure there is no pressure by practitioners to reduce competitive pressures. As Herbinator says, recognition of a wider range of practitioners may be appropriate but that is probably a decision best left to the government agency and based upon objective scientific research.

Cycles

 
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At 1:43 AM, Anonymous Anna said...

I am Anne from Egypt, I am a public health doctor, a specialist of occupational medicine...my husband has been a specialist of anaesthesia for more than 10 years now, participating in more than 1000 opearation including open heart surgery, we are dying to work in Canada but it seems so hard in spite of our being very hard workers and the shortage in Canada esp for anaesthesiologists...

 

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