Massive physician shortage coming?

Well the potential 'earning potential' argument tied to people either taking the time and money to go through school or immigrate to the US starts to fall flat when one takes a hard look at the fact that just like Canada the US is also experiencing a potential shortage of doctors and already has to deal with maldistribution of doctors, especially in rural areas. The US is also facing an impending shortage and just like Canada servicing and aging demographic is also a big issue and potential problem. If becoming a doctor in the US is such a great potential earner and worth the time and effort then why the the shortage of US citizens becoming doctors? The quick answer is that just like Canada the lack of doctor numbers and the problems with the distribution of doctors has very little to do with the money doctors make.

Similar to Canada it's general practitioners numbers are and issue. If large numbers that of Canadian doctors are indeed flocking with dollar signs in their eyes then it's not apparently helping that much and/or the doctors that aren't flocking to the needed practices (primary care) and the needed places.

Just google 'United states physician shortage' for lots of info about it.

The brain drain to the US is largely a myth anyway and was hyped and still gets hyped when it's suits a political argument. http://www.chsrf.ca/mythbusters/html/myth29_e.php
There's no flocking, just some trickling. Right now it's estimated that over time it's been between half to one percent of total doctors when the numbers of doctors that come back are calculated in as well. In recent years the numbers are even showing a reverse drain. Doctors trickling north rather then south. Interesting that of the few doctors that do leave Canada 50% do go to the US but the other 50 go somewhere else.

Fidel addressed a couple of the issue related to the cost of schooling, funding and the type of doctors people choose to become. The US has the same sort of problems.

He mentioned the under-estimation of the numbers of doctors needed. This under-estimation contributed to the lack of real physical space and the numbers of students going through medical schools. In recognition of this problem many schools increased the size of their programs and some set up new medical schools. This was done a few years ago and there is a lag time of about ten years before we see the results in terms of numbers. Similarly as you'll find in the numerous links that turn up in the google search the US has or is working on the same issue. Last time checked the increase in actual spaces are filled and there are still people who would like to become doctors who can't get in. This indicates that the problem isn't that people don't want to be doctors because being a doctor in Canada stinks because of health system bladdity blah. It's just another disengenuous talking point based on a 'wishful' reality rather then reality.

One of the biggest problems which again is similar between our two countries is the distribution of doctors. More doctors tend to want to work and live in larger populated and urban areas rather then rural areas. This trend isn't necessarily just about the jobs or the money that can be made but about where people want to actually live and mirrors the general trending of population movement from rural to urban that's occured over the past century or so. The question then becomes well how do you get doctors to work where they're needed.

Huh? Where in Canada are there emergency rooms with 23-hr waits for injuries like that? Can we have some specifics?

Emergency rooms everywhere I know in Canada have access to MRIs that run more or less non-stop because the people who need them could be dying right now, not tomorrow. The MRIs that people are scheduled for work differently, and are "rationed" only because we have a shortage of technicians, as does the U.S. But if you arrive in emerg and need an MRI, you will get one immediately.

Well there's some 'truth' and then there's reality. Wait times are a problem in some places and in some areas. There is no doubt about that and it is a recognized problem.

However the reality is that in the US there are also problems with wait times, in some places and in some areas. I've gone through this sort of argument before and run into a couple of issue. The big one being that the tracking of how long people actually do wait for treatment is either not done, is really piecemail or is only done for particular ailments like the wait for knee surgaries. Which by the way are apparently more similar to Canada wait times for similar surgeries when all of the different factors and regions are taken into consideration. It is actually really hard to get direct comparisons of wait times in Canada because of the lack of tracking them in the US. However through discussion boards like this and through reading about cases there is a whole lot of anecdotal evidence of people experience long waits in the emergencies and long waits for operations. Here's the thing though. Since wait times are tracked here there is a wider spread recognition that they are a problem, people get pissed at them, we then have actual stats to back up anecdotal evidence and that creates the political will to actually do something about them.

So yeah lack of good stats leads to a lot of anecdotal evidence about how I or my relative in Canada had to godamn wait and the care sucked. Well logs in eyes and all that. For some reason and I know it's strange but I can't somehow believe that there haven't at least been a few people in the US who godamn had to wait and ended up with sucky care. :D

So here's my anecdotal evidence. My late Grandfather had heart pain, went to his HMO, waited 7 hours with chest pain and was sent home with a couple of pills for indigestion. Ended up he needed a heart valve replacement. He had insurance too but still ended up paying over ten thousand dollars in the costs that his insurance didn't cover when it was all said and done. Luckily he could afford it. So sucky care on both sides of the border. Check the box. The big difference is that on this side of the border someone like him would likely get to spend that ten thousand dollars on a big screen tv or a cruise to the Bahamas.

I also can't believe that no one in the US has been subject to the horrors of a doctor who can't speak english very well.(sarcasm) Why because just like Canada the US in order to deal with our mutual shortage is enacting programs and policies to try to attract said doctors. :D So yeah it's just BS with possibly a dose of sheer prejudice thrown in to make the story sound better and more horrible.

The whole monopoly insurance costs more then car insurance is just a complete load of crap. Canadians don't pay monthly insurance premiums in order to get coverage. It's not like car insurance at all. It differs between provinces and some do have small fees but they are based on incomes. If you don't have any income you pay nothing. The most I ever paid was forty bucks. Now I pay nothing. My monthly car insurance is around two hundred bucks. I'll pay more if I end up in an accident. If I get sick, get better and get sick again I will still pay nothing.

Canadians however can choose to supplement the basic care through a private insurance company but it's entirely voluntary. Basic coverage which everyone gets is done through taxes not a separate payment. The main difference between Canada and the US is that although some of all of our tax dollars go into the health care pot, everyone is covered no matter what. The care you get is also not related to whatever your individual insurance company decides to cover and there is no such thing as a 'pre-exisiting condition' that will deny you getting the insurance you need to just be able to afford to see a doctor. We also don't have to worry about changing or losing a jobs and losing access to the medical insurance it provides. In Canada someone might lose the extended benefits that some employers provide through private insurance but isn't in a position of losing access altogether. The fear of going bankrupt because one gets something horrible like cancer is also virtually non-existent.

Is the system perfect? Nope. It does have it's problems. However when you look at per capita numbers Canada spends about half the amount of money for universial coverage that the US spends per capita within it's system. You guys pay more through your taxes already but for some reason end up getting less if you look at society as a whole.

Yeah skdall. The whole 'rationing' argument is just so bogus. As if insurance companies don't ration their care. They depend on it. Reams of policy statements on whats covered and whats not. Many insurance companies 'ration' people right out of getting any care at all. That's the irony. We'll give you insurance but not if you have this and this or had that or that, or we will give you insurance but you have to pay way more money. Oh and hey if you do get really sick, we'll comb your past and make sure that you weren't lying to us and if we discover you did then DENY. You're on your own buddy. Of course from the companies perspective this is all quite 'rational'. It's just numbers and good business.

Health care and capitalism don't mix.

I promise you, if you arrive in emerg after vomiting bile for two days (as I have), you will be into an MRI immediately, as I was -- and I observed the way that department was working as they wheeled me along. It was 1 or 2 a.m., and patients from emerg were being streamed into it continuously.

\

Now, that's downtown Toronto. I realize that that won't happen in some parts of Canada where there isn't a hospital, maybe not even a resident doctor, although I know people who live in circs like that, and they usually have arrangements that get them flown out quite quickly to hospitals that can cope. I believe the provinces are required to set up such arrangements.

My doctor friends tell me that emergency departments here are nowhere near the horrorshows they've seen in the U.S., mainly because of the preventative aspect of our public healthcare. We don't have many young women turning up in the middle of the night, eg, suddenly bleeding from advanced cervical cancer, and we all know why that is. Uninsured victims of their system crowd U.S. emerg departments, put incredible pressure on them that we don't mainly have.

Emerg departments are for emergencies, though. I've done a lot of time in them, and they really do have to see to those in immediate danger of dying first.

remind wrote:

wow your monthly car insurance is 200.00 bucks Eliza?  Mine is 800.00 per year....of course should I lose my 40% discount by having an accident.

 

Drs do not  ask for MRI's if another diagnostic tool can do the job, equally as well, or better.

 

No matter what country you reside in...

Yep, that's about what I paid when I lived in BC. One of the joys to moving to another province that uses private insurance. I miss BC car insurance. :) It's so much easier to get too. You just go into one place, for one appointment and get everything done.

TM, what control would the CMA have over such matters? Isn't it up to the provincial bodies? And any GPs I know are horrified at their patient loads. They should pay them more and leave them more time per patient. They should be on salary. If they let GPs vote, I'll bet they'd pass that overwhelmingly. Don't know about the specialists.

Well, TM, I'll stick with my statement about provincial control - I could be wrong, but if so, why are there different qualifying standards in different provinces?

And yes, GPs are "free" to spend more quality time with fewer patients. Trouble is, two things then happen: 1. They have to refuse new patients, including family members of existing patients. 2. They are punished by earning less for doing better medicine.

So, I think the problem doesn't lie with GPs. Our politicians need to amend the system. It'll cost more money. Maybe the difference could be made up by reducing their fawning over Big Pharma.

G. Pie, all I said was that GPs who take fewer patients in order to spend more time, earn less. Surely you would agree with that. I know GPs (connected with the unions and CSST claims) whose annual earnings are pathetic (relatively speaking) for that very reason.

Was looking last year, at stats on GP's wages per year in BC, and  most made around 300,000 - 350,000.

And I agree with Tricia...the governments are not just at fault here, the  Royal College of Physicians and Surgeons of Canada and its provincial counterparts play a role too...

triciamarie wrote:

The problem is the Canadian Medical Association. Open up more spots in medical schools -- including cheap, short-term training for experienced doctors already qualified in other countries -- and the shortage disappears. Of course, that will make it more difficult for doctors to build the outrageous patient loads they so often prefer in a system that pays by the visit.

[url=http://conservativenannystate.org]US economist Dean Baker[/url] says that in his country the health care system could save $80 billion a year by simply allowing free labour markets for medical doctors alone. Baker says this number exceeds any savings estimates cited in big business-friendly NAFTA agreements for trade in commodities. Imagine the savings potential for lowering PSE tuition fees, he suggests.

Jack Layton said a couple of years ago that the feds just aren't listening when it comes to foreign trained doctors needing to do practicums in Canadian hospitals before they can be licenced in Canada. Like Baker describes the US conservative nanny state, I think Canada is also guilty of protecting jobs for the upper middle class. Licencing exams and other expensive red tape bureaucratic hurdles are problems, too. Very many of these foreign trained doctors unemployed or underemployed in Canada are internationally recognized for their skills except for the odd country like Canada. I think racism is an issue as well.

Quote:

Bill 37, adopted by the Quebec legislation on June 13, imposed a wage settlement and working conditions on medical specialists until 2010.

On Sept. 12, the Quebec Federation of Medical Specialists announced it will take the Charest government to court to contest the law's validity under the Quebec and Canadian charters of rights.

Under the imposed contract, Quebec's 8000 medical specialists receive a 2% wage increase in each of 4 years, leaving them on the bottom rung of the Canadian specialists' salary scale. The average gross annual income for a specialist in Quebec is $233 000 - $100 000 less than the national average.

The specialists' federation says the monetary package is disappointing, but it's what the federation calls the "extraordinary and punishing" nature of the decree that has pushed it to challenge the law's constitutionality. "It is an abuse of power and a breach of doctors' rights to freedom of association and freedom of expression," says Dr. Yves Dugré, the federation's president.  

(snip)

CMA's general council unanimously passed (with one abstention) a resolution in August, urging the association and its divisions to "staunchly oppose any form of coercive legislation in regard to the negotiation of working conditions and compensation of physicians."

TM, I'm talking about GPs and GPs only. That's where the urgent shortage is. Do you have earnings info for them that's different from mine? I do appreciate your disclaimer about gross earnings. They pay other people's salaries out of those, besides office expenses.

No one is talking about losing sleep. The fact remains that GPs are grossly overworked and underpaid. I know of no evidence that this is due to their own lobbying. In Québec, we are still feeling the effects of the late 1990s freeze on medical school entries and massive government financed early retirements of doctors and nurses - all aimed at budget cuts.

Canada must spend more on health care workers and less on drugs.

In 2001/2002:

Quote:

When the overhead estimates

are applied to the CIHI gross

billings, estimated 2001/02 average

net incomes (before taxes)

from fee-for-service payments

were $124 103 for family physicians

Unionist, the issue I believe we are discussing is the shortage of physicians. I have suggested that doctors generally benefit from a certain shortage of providers, because this supports their income levels. It is your view that family doctors are actually underpaid, as well as overworked. I don't consider $125 - 150K to be underpayment for what is effectively a government employee. If overwork is a problem then doctors absolutely have the ability to reduce their patient load, and earn less money. As to your point that this would mean that doctors could not treat the family members of their patients, well, there is usually some natural attrition going on too eh.

In many countries it is still seen as a calling to practice medicine. There is some altruism in the decision to enter the field. It's unfortunate that here it's so often viewed as a meal ticket.

I'm going to look into the question you raise about MD's incomes in Quebec.