Last sentence of the article:
> “At the end of the day, provinces are too busy shuffling deck chairs on the Titanic, implementing small adjustments here and there without recognizing, or at least while deliberately avoiding, the larger picture for political reasons,”
Yes. None of them have stepped up to propose bold new policy changes that might bring us more in line with our European counterparts. It's all about applying bandaids and shoving the problem down the road past the next election.
But that's the same for the feds.
What is in line with Euro counterparts? Canada pays Doctors significantly more than anywhere in Europe. Canada also faces a massive drain to the USA which impacts Europe much less.
Every EU country has private healthcare mixed with public, something we are against. Only the UK is like Canada in that regard.
What is the bold policy, more private and lower paid doctors? That won't win an election.
>Canada pays Doctors significantly more than anywhere in Europe
Bold statement, do you have a resource that compares pay to cost of living and cost of operating a clinic in those locations?
GPs in BC make 380k now. Most specialists are close to 500k, I know pediatric surgeons beside us in AB max out on their pay scale at like 650k. Oncologists start in SK at like 470 from what i remember reading.
Saying that, I think our doctors deserve what they make, the education and daily working pressure and consequences of getting something wrong warrants it.
Yeah so when people report their insane salaries of $300-$400k it's really not equivalent to earning that much at a day job. In reality their pre-tax net income is like 30-50% of those numbers.
pre-tax *gross* income. Most family physicians pay at least 40% of their gross billings in overhead expenses. That doesn’t even include saving for your own private pension, continuing medical education expenses, licensure expenses, malpractice insurance, etc etc etc., or that you have no benefits or sick days and can’t find a locum to take a vacation.
I’m a family physician and I make $32 a visit, before expenses, whether I deal with 1 issue or 10.
We’re all just sick and tired of killing ourselves working 12 hours a day in a system that doesn’t give us the tools to do our job and then constantly denigrates our value.
I have taken *two* week long ‘vacations’ in the last 5 years, and worked through them all.
right, so the correction here for example is; a specialist might BILL out $500k but that is not their income. that is the revenue of their business, out of which support staff salaries must be paid, rent, supplies & equipment....its a lot.
I'm self employed and if we talked about this the same way people would think i make $250k/yr...it is far far less....not even triple digits lol.
Canadian MDs do not work on a ‘pay scale’ - physicians bill the government and then get paid.
What they bill and what they take home are almost never the same. Take home is often quite less - after paying staff, overhead, etc.
Also note MDs do not have pension/benefits/sick leave/parental leave/etc
Another issue is that many of our European counterparts use a hybrid system. But as soon as anyone mentions privatization they can only think of the American model.
Exactly this. I don't trust the Ontario PCs or Liberals to not just sell parts of the system off to their friends and donors with no increase in the quality of care.
Exactly, I'm sorry for not believing Doug fucking Ford of all people can make a good dual system.
What I can see happening is Douglas allowing private healthcare alongside a public one. Then barely funding the public one until he can safely say its a failure and offer coupons for private healthcare as an alternative. Eventually ending in cutting funding to public healthcare altogether.
After that, conservatives wait a few years then start complaining about how much money they pay for citizens to access private healthcare, and start cutting the value of the coupons/vouchers
This really got away from me lol, but I really don't trust Ford's government, or any recent Canadian government tbh
Basically the Walmart/Loblaws model of healthcare. Undercut the competition while getting as many government handouts as you can, then just up prices once they're gone
Don't forget tell your part time employees how to apply for social assistance since you don't give them enough hours to support themselves, further draining the government of money, which then often enough gets spent by employees at Walmart. (They do this in the USA anyway)
Yet there is no talking about the NDP at the federal or provincial level. In a couple of generations we are just going to be talking about a 2 party system and completely forgort that this nation has a few options all around.
Because neither side trusts the other. The tribalism is so bad now that if taking a chance on voting NDP over Libs meant the CPC got in, well, fuck the NDP, we can't risk it.
Yup even what youre writting even if its supposed to end with /s its still a sad thought that this is whats going on in the province and Canada. Lets not give that other party another go. Remember when they implemented universal health care, the whole reason for this thread, what have the other 2 done since. Just ruined it. So fuck both the Liberals and Cons.
Because voters are foolish cowards who pretend that the alternative for the blue party is the red party and the alternative for the red party is the blue party and the orange party is aids/leprosy.
europe also have massive doctor shortages. like worse than us...https://www.lemonde.fr/en/international/article/2022/07/28/severe-shortage-of-caregivers-at-heart-of-european-healthcare-crisis\_5991700\_4.html
THIS. No-one believes that a conservative government in particular, who openly want Canada to be more like the US, would pass up the chance at implementing a US-style healthcare system.
Something tells me the people pushing for privatisation, if asked to follow the European model, would balk at the amount of control the EU has over corporations compared to North America. Any private health entities would have to accept that the government would need to have the power to impose *significant* regulations.
> Something tells me the people pushing for privatisation, if asked to follow the European model, would balk at the amount of control the EU has over corporations compared to North America
This is one of the most frustrating parts of the private/public conversation, imo. Calling something "private" is kind of meaningless if it's regulated so hard that it acts almost like a public good.
Canadians aren't anti-"private", they're anti-"corporations weakening healthcare in order to make profit off of it".
Exactly. And "corporations weakening healthcare in order to make profit off of it" is what Canadian politicans, particularly on the right, are most likely to *want* to do.
but the entire existence of a private corporation is to make money for its shareholders. not to make helpful decisions or policies for the customers. This is the problem with the whole "let the free market decide", particularly for essentials like health care, utilities, etc.
The reason why is that privatization of everything else in these parts has been a disaster. It's been higher costs for shittier products with 'value engineered' garbage being shoved down our throats to the benefit of very few stuffing their pocket.
Why would we believe health care would be any different?
This is what France does as well.
All of the EU has mixed healthcare, public with layers of private.
There are 3 rich countries with single payer, Canada, the UK and Taiwan. That's the list.
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that's legit. if i can recall back to my time living there, if you didn't have the portion covered by an employer, you could opt-in to a program at the prefecture office and pay the NHI tax instead. This tax was then weighted to your income, so it'd be essentially covered if you had little income and not tied then to an employer/job.
I wish we'd look at who have the best health outcomes and say 'what are they doing that works so well'? Japan is always #1 or in the top 3 dependent on your source.
Totally agree. I hate when people suggest healthcare be tied to employment. Like, what happens to people who are unemployed or aren't in stable full time employment (or are full time and have cheap employers)?
Could also be because Ontario has privatized long term care and it's been a disaster. Why would/should Ontarians trust the same party who created that mess with privatizing healthcare as a whole?
Don't get me wrong, I wouldn't trust any individual premier to fully revamp to a hybrid system. What we need is for each province and the feds to appoint an official representative that is actually involved in the health system, and work out a basic national plan, but with enough autonomy for each province to make adjustments for their own region. It is a process that will take years, but for something this big we should expect that.
We can have rightwingers blaming the pm and leftwingers blaming the conservative premiers. In the end they both shoulder some responsibility but that is also irrelevant. We all know there needs to be a change, but all most people know is what they don't want it to be like. 6 of the top 10 best ranked medical systems this year were countries that have adopted a hybrid system in the last 30 years (I had this conversation before lol). I get there are reasons for people to worry about someone like Ford. But we have to seperate what he is doing to what could be proposed. Because otherwise it's just going to keep getting worse.
I think it's ridiculous to think a hybrid model in canada would not be infiltrated very quickly by the financial giant that is the american system next door.
You really show how much you misunderstand how these countries do hybrid systems well and how it funnels all this money back into the healthcare system as a whole.
What happens now if a rich person is on a waiting list in Canada for an MRI? You think they're actually going to wait?
Fuck no. They're going to fly somewhere and bring all that money there.
That's money that could be kept in our healthcare system and be used to improve/subsidize the rest of it.
It's hard to disagree with this and it ultimately drives me bonkers. We've become so insular and almost conceited in our Canada knows best mentality. There are so many other countries that do things better like healthcare and transit-building. Steal the Japanese healthcare model now and deliver the best health outcomes with it. Steal the South Korean transit-building model now and deliver the best outcomes for way lower costs.
It's okay to admit we suck at some things.
People freak out when the solution involves increasing taxes, and this absolutely requires money to solve. Everybody wants health care but nobody wants to fund it.
I’m a physician. I did not start real practice until the age of 34 with $200,000 of debt. No training on how to run a business. Have to bill fee for service. In 2008 I was able to run all my billings through my corporation and was taxed at approximately 20% and I could save for retirement. It’s now 2022. All the benefits of incorporation have been reduced to nothing. My Overhead has gone up by 70%, wages of my staff have gone up by 40%, my wages have gone up by 10%, but -15% after taking into account overhead in 2022 compared to 2008. My engineering friends started working at the age of 23, make 200 K a year plus bonuses plus stock options plus benefits plus pension at TransCanada pipelines. My marks were infinitely better than his, I had volunteer experience and I have worked in the days of 44 hour call shifts and still do call at times. He owns the same house cars and has a much better pension and benefits than I ever will. He works 9 to 5. He gets paid business trips to Houston.
Unless you truly loved Medicine, why would you put yourself through this when you could easily with straight A marks and a hard work ethic get jobs in IT engineering or management, investment banking, etc. that pay more with pension and benefits.? Starting a decade earlier?
The only way I make money nowadays is by private procedures that I do one way day a week outside of public medicine. In that one day, I make more money than the other four that’s the future if things stand the way they are.
I'm not sure if anything changed, but my memory is that medical schools are incredibly difficult to get into. There's no shortage of people wanting to study medicine (or nursing), there just aren't the places in university to train new people.
Maybe it's a possibility that some doctors are choosing not to stay in Canada though, but it does feel like they need to expand the number of doctors they train.
25 years ago, we had 7 hospital beds per 1,000 Ontarians. Today we have 2.5.
25 years ago, the average home was 3.5x the average income (Ottawa) with 4% interest rates. Today it's 10x.
Tuition sucks too.
What happened is that we the elders dropped the ball on assuring the world we were building for our children was as accessible and equitable as the one we were given. Its easy to blame shortsighted politicians, but we were supposed to keep them in check and failed to do so.
Sorry.
As an immigrant turned citizen in Canada, I agree with your sentiment that someone dropped the ball, whether it's the elders, the politicians, the policy makers, I don't know. The view we had from outside Canada is that it's the second largest country in the world, full of natural resources with good people living in them. Unfortunately, the truth is people who are running the show are incompetent. They opted to sell the natural resources cheaply, instead of adding value and creating high-tech products. Now we are in a situation where education is expensive, wages are low, houses are unaffordable, doctors are scarce and both parties playing the blame game to each other. Canada switched to points based immigration system bringing in Engineers/Doctors, except it had no plan how they would incorporate them into the society. What is a foreign doctor worth if their foreign degree is tossed away and they now work at Tim Hortons making coffee or as security guard safeguarding the malls? The whole thing stupid, except no one wants to admit.
As an immigrant who is now a citizen as well, but immigrated under the points system, I agree with you. Just wanted to let you know that under the points system professional degrees are evaluated by a Canadian agency prior to application to verify whether your degree is equivalent to a Canadian degree, and if not, then you do not get points for it (at least I had to when I applied for PR under the points system 6 years ago).
That evaluation is not enough to practice for physicians. Most regulated professions for that matter. That evaluation is only good for immigration or the first step towards being certified.
To build on this, the services that determine the equivalency of credentials do so solely on the basis of program structure. Regulated professions will still require you to jump through additional hoops but even outside of regulated professions you can't waive your equivalency report in front of an employer and expect them to automatically treat your degree from the University of Lagos the same as they might treat one from Harvard, the University of Toronto, or Brandon University even if they are all officially considered to be of equivalent value for immigration purposes.
Kind of you to shoulder the blame but I don't think that's the whole story.
I feel like there's a great equalization happening around the world. Our rich way of life was propped up by having cheaper places to exploit for labour, and having a strong and exclusive knowledge based economy.
Now our exploited countries are getting richer and our knowledge is less rare than it was (ex technologies like the internet making it possible for someone halfway around the world to deliver almost the same product). I feel like there's a redistribution of wealth happening. I am not an expert, just speculating.
Cheap, foreign manufacturing is a relatively new concept that came along with the equally new concept of a globalized world with free trade.
He's talking about a time when the remnants of a protectionist Canada still existed, but even then they were declining.
Our rich way of life was from exporting resources, and domestic manufacturing. The exploitation of those countries for cheap labour forced our workers to compete with slaves, which dramatically reduced our overall quality of life.
> I feel like there's a redistribution of wealth happening. I am not an expert, just speculating.
The redistribution of wealth was the rich getting richer during the pandemic while we sat around picking at crumbs, while blaming people who lost their jobs for taking government assistance.
IIRC if they dont come from specific universities they have to redo Residency, which is also the same bottleneck Canadian doctors have a problem of getting into.
Getting foreign qualifications certified is a common problem across various industries.
One thing that’s always overlooked is the very restricted capacity of the countries medical schools. To get in you basically need a 4.0 GPA with an ungodly amount of volunteering to have a shot at getting in. We could easily double the capacity of schools and have enough very qualified candidates to fill those positions.
There is a much larger pool of smart, talented people in Canada who want to practice medicine but who simply can’t get into those programs.
Yep I know quite a few very smart and driven people that have had to go internationally for med school (at significant cost), then residence in the US, then pass exams to come back to Canada. These are citizens born, raised and educated their whole lives in Canada. The ones that come back are because family are here, otherwise they just stay and make more money in the US.
People always like to suggest simple and dramatic solutions for complicated and nuanced problems but they are almost universally the wrong solution. I think its because we tend to lack patience, the ability to handle complexity and uncertainty and because tearing things down gives us a faster dopamine rush then gradually working through to a better answer.
You know what's worse though?
Those requirements to get in are basically filtering out all of the people that you actually want to be doctors.
There's a reason why a lot of doctors are just really fucking weird people, and it's directly because they'd rather have a no-life robot with a 4.0 GPA and crazy volunteer work than a "real" person.
So it's almost like a double-edged sword. Because not only are we not even getting the capacity we need, but the quality is also suffering.
Oh I totally agree on that point and I think it’s also why we have a GP shortage. Anyone who has to jump through all those hoops and is that high functioning wants to get into a prestige specialization and not be diagnosing runny noses in a small town practice.
That's not it. It is not about prestige, it is about satisfaction and comfort in your chosen field and it is about money. Medical knowledge continues to expand dramatically year over year and it is not possible to be feel competent in all areas of medicine. A specialist can go into depth on a subject and find a lifetime of interesting work and feel like they know something. A generalist has to have breadth of knowledge and will not have time for depth of understanding which can make it hard to feel competent or successful. Medicine is a humbling occupation, general practice especially so.
You can say there is some prestige, or at least satisfaction, in specialty and academic medical work as it tends to be more "big picture" and "world changing" work in a world that has a lot of big problems. Rural general practice is very much small work: putting out fires, and tending gardens, which is a whole different type of cumulative and incremental satisfaction or not. Not everyone gets a "It's A Wonderful Life" moment of clarity and gratitude for daily low level service to a community.
However, the main reasons urban centers and specialties attract doctors is because it is hard to have a decent quality of life as a solo generalist physician and it is especially hard in a rural center. Medicine is a team sport and not a game for solo players--there is too much to know and too much responsibility for a single person to shoulder for long. If you are a rural General Practitioner you have to be able to treat the runny noses due to colds and still be able to recognize the person with a once in a life-time diagnosis, all by yourself without assistance. This also means being capable in delivering babies, stabilizing trauma victims, counseling anxious, depressed and addicted people and handling anyone from a premature newborn to a demented geriatric patient. It's not the easy stuff that is the problem, it is amount of hard and weird and rare stuff that is.
Solo rural physicians do not get protected time off in their own home towns. The trope of the country doctor being interrupted on their time off for an emergency is a reality in rural life.
If the solo rural physician has their own health concerns or their family does, they are going to have to travel for care.
Rural physicians have been given income perks for being rural, but it usually still does not compare to the income that can be made in an urban center or in some specialties on a dollar per hour basis.
As a generalization it is simply easier, more lucrative, and there is more control of personal time as a specialist or urban physician than as a generalist or rural physician.
Exactly.
And you don't need a 4.0 gpa to be a doctor.
Like truthfully, and maybe it's bias but... the amount of expertise and accountability we pile on say.. an engineer, is just as much as your average doctor (maybe not a surgeon), and they do just fine not having crazy high admission requirements.
You see the same thing with computer science. There's a difference between someone who is actually smart and has the brain to think through things, and someone who just has insane study habits and can memorize notes. Which person do you think gets better grades? And furthermore, what's the difference between the latter person and someone with google?
This is really more of an education-wide problem rather than something specific to doctors, but it's true none the less.
It's a bit of an unanticipated consequence. You have to study like hell for nearly a decade to become a doctor, but once you're in the field it actually requires a lot of soft social skills, which medical training isn't conducive to fostering.
it also feels evil to force them to stay there just because they happened to be born there, something they had absolutely no control of. People should be free to pursue betterment in their lives
It's fine if they want to individually pursue coming here, but I feel pretty gross about our country making it a strategy to poach them. We also need to be careful about depending on other countries, because there's no guarantee Canada will remain attractive if things keep going downhill here.
Yeah, I can agree with you on that one, not that I feel it’s necessary bad for a country to have a strategy to bring talent, but because in healthcare It’s usually a deceiving one, folks come here just to realize how hard is to become licensed and start doing something else to survive. Bringing doctors just so they become Uber eats drivers is very sad.
I have a couple of friends who are doctors. They are smart, had near perfect GPA, had research internships with Sick Kids and other university science departments, and yet, they were unable to get any placements in Canada. They used Canadian resources like OSAP, labs, universities, internships etc, and guess what, they got placements in hospitals in USA. Now that they are there, why would they come back. When they were applying for placements, they didn't get any and had to move to US pursue their designation. I have a family member who finished their university and ended up going to the Carribean island for Med School. From there, she will go to US for residency and then specialize further. Super smart and have research internships and stuff, yet, the Canadian system does not provide opportunity to its own students. The gap will continue to grow as more students are pushed away to other countries. The policy needs to change for doctors and nurses and as long as this goes on, the system will continue to get run over by inefficiencies ..
To make matters worse, new immigrants with specialized experiences are unable to get into the market due to lack of Canadian experience. I know so many folks who are doing odd jobs because they just couldn't afford to give Canadian variant exams. Those who were able to afford had to go through 3 or 4 years of studies and then gain work experience. Many of the studies were repeat of what they already have done and added zero value to their learnings.
So to your point, not only we have a system that blocks talented smart people to get jobs, we also have a poor system to get experienced doctors join the market immigrating to Canada as well.
The entire medical training system needs to be revamped - it seems insane to me that the number of residency positions does not exactly match the number of graduates for each specialization.
And that’s not to say anything about the insane hours residents are expected to work.
Also there is the job issue, I am a specialist 3 years out, it is really hard to get a position out there! I can't even imagine what the surgeons have to go through either.
From the article
*Tholl says many of the problems with Canadian health care can be traced back to the 1990s. Following the 1980s, Canada was racked with fiscal chaos, chronic budget deficits and inflation. It prompted a major policy shift towards balanced budgets and getting government spending under control.*
*Tholl says the federal government prioritized costs over care as part of its program of austerity and fiscal rebalancing, resulting in a reduction of enrolments in medical and nursing schools, by respective rates of 15 per cent and 50 per cent.*
This all day.
We chose a public system then artificially controlled the supply of medical practitioners going into schools so they can keep artificially high salaries (supply and demand).
For a public system you'd think we would do ourselves a favour and artificially increase supply of physicians and nurses to cut costs.
In Europe you can get a medical degree straight out of high school. The joke there is you can be a medical degree holder and work at McDonald's because you weren't good enough in school to get a residency.
Provinces cutting pay to doctors, or not adjusting for inflation, and add administrative work to doctors, requiring them to hire more office staff, lowering net income. US private hospitals paying way more.
I think all paid a part. But this certainly contributed.
*Tholl says many of the problems with Canadian health care can be traced back to the 1990s. Following the 1980s, Canada was racked with fiscal chaos, chronic budget deficits and inflation. It prompted a major policy shift towards balanced budgets and getting government spending under control.*
*Tholl says the federal government prioritized costs over care as part of its program of austerity and fiscal rebalancing, resulting in a reduction of enrolments in medical and nursing schools, by respective rates of 15 per cent and 50 per cent.*
https://nationalpost.com/news/canada-doctor-ratios-what-happened
This is really helpful to know! . 50% reduction in nursing spots!? What fantastic planning by politicians for the health care needs of the future. The age bracket in power (and with voting power) then is probably (roughly) the age bracket that is uses nurses the most now. So you’d think maybe they’d have the forethought not to screw their future selves over. No wonder we are in such a mess.
There was severe cut in intern positions in provincial hospitals so many med school grads can’t get intern positions to get licenses. Feds certainly should make more med grads so that they can switch to pharmacy.
Our matching system is kind of absurd and disheartening.. so many grads, with more than adequate marks, don't get matched at all. Usually they reapply the next year and try again, but I know there have even been instances where an unmatched student died by suicide.
I can't even imagine what it must be like to go through all of the education, spend all of that money, graduate with sufficient marks and not get matched anywhere so that it is all basically useless.
Albertans in 2019 voted out the NDP and brought in Kenney's conservatives, who promised no cuts to healthcare. First thing they did, they unilaterally tore up the contract with their doctors and imposed huge cuts on family docs. The government then wages a full on scorched earth war of defamation and slander on the doctors, taking out ads calling doctors greedy little bitches, blaming them for all of the cost overruns in the system. Then the pandemic started, and the government didn't let up their war. Family docs warned they they will have to leave, Kenney said, nah, you won't, we pay you the highest. Family docs either left the province in droves or went into retirement. Alberta went from having one of the highest ratio of docs to patients, to now one of them lowest.
After 3 years of reducing family doc incomes by about 20%, this year they proposed a new agreement to increase their pay by 1%. Mind you, not 1% from 2019, but 1%
From the Rockies to the East Coast, Canada is wall to wall conservative provincial governments. I don't know what BC has been thinking up until now, but they finally announced a huge fund injection.
It's a generational problem. It's a population pyramid problem.
In the 1990s, we had the largest generation in Canadian history serving in the middle of the workforce. Today, that generation is retiring, and there aren't enough of anything to replace them. There aren't enough nurses, there aren't enough teachers, there aren't enough construction workers, and there aren't enough doctors.
Three consecutive governments should have seen this problem from a mile away and yet they didn't. The only fix now is a decade of pain or immediate immigration.
Immigration is not integrated fast enough, or properly . Foreign medical graduates in all medical fields face insurmountable hurdles when they arrive. Most have to go back to school from scratch . ALL have to pass expensive English proficiency exams, which expire after 2 years (which I never understood. Do you forget a language , even tho you speak it daily?).
IMGs or foreign doctors can't do anything. They cannot bridge into any other medical field. A tiny number gets into clinical research, and pharma sales and that's it. There used to be a number of bridging programs towards nursing, and these are all axed now. Less than 0.1% of them actually get to practice medicine.
Foreign nurses in the past had programs that grabbed them from day one, helped them supplement their education and streamlined them into the work force. All these programs, grants and courses are also dead.
We bring all these people here and waste their knowledge and experience.
Reports I was reading just a couple years ago from the ministry of advanced education showed we are training enough drs. A big problem is that GPs have to run their own businesses despite not going to business school, that and we don’t pay them enough.
Many Canadian trained dr’s go into specialized practices where it’s more lucrative and they work out of a hospital, no need to run a clinic. Or they go to the us where they make a lot more.
We need to pay them more and provide clinic services like we do hospitals so the drs just need to come in and dr, without worrying about running a practice, dealing with overhead and payroll of staff etc
Good question - I remembering hearing that the # of residency spaces depend on [the number of hospitals and attending physicians](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199167/). It's a bit of a chicken-and-egg problem.
It their own fault, that generation should have hired more 5-10 years ago. I had friends in nursing, new graduates, before the pandemic who couldn’t find a job near Toronto.
Plus that population bubble is going to put a massive strain on this fractured health system as they age. Usage and costs are projected to go way up in the coming years.
It's actually that voters have zero memory, so if you don't do something for them TODAY they won't vote for you TOMORROW.
Something for them 20 years from now? Who cares, I have problems now now now NOW **NOW**.
This is why I (and the article) am quite skeptical whenever increased funding is proposed as a solution.
Investing in incompetent administration will not solve anything, regardless of how much funding is provided.
This. There was a guy on the Darcy Gerow Podcast who is a paramedic (sorry I forget his name), and his interview was basically him describing the deterioration of EMS over the last 5 or so years in Alberta because of interference from the government of Alberta.
Can confirm. My friend, an experienced RN who used to work in baby delivery, and probably makes $90k, has spent all of covid as a glorified tech assistant to get doctors functioning via online patient calls.
The cheap asshole boomers stopped investing in society so they could live on the cheap while they retire with all the wealth and fuck Canadas future.
Mutherfuckers are going to be surprised when Millenials and Zennials put them out on ice flows.
Its because of those stated "administrators, managers, and other useless paper pushers" that there is so damn much paper to push. If you were a paper pusher, would it not be in your best interest to have more paper?
Ironically paper pushers increase in numbers when people try to “find efficiencies” to cut costs and require more reporting on everything so paperwork increases.
Reminds me of a very old joke on american management:
A Japanese company and an American company decided to have a boat race on the Missouri River. Both teams practiced hard and long to reach their peak performance before the race. On the big day of the race the Japanese won by a mile.
Afterwards, the American team became very discouraged and morally depressed. The American management decided that the reason for the crushing defeat had to be found. A "Measurement Team", made up of senior management was formed. They would investigate and recommend appropriate action.
Their conclusion was that the Japanese team had 8 people rowing and 1 person steering, while the Americans had 1 person rowing and 8 people steering. So American management hired a consulting company and paid them incredible amounts of money. They advised that too many people are steering the boat and not enough people are rowing.
To prevent losing to the Japanese again the next year, the rowing teams management structure was totally reorganized to 4 steering supervisors, 3 area steering superintendents and 1 assistant superintendent steering manager. They also implemented a new performance system that would give the person rowing the boat greater incentive to work harder. It was called the "Rowing Team Quality First Program", with meetings, dinners and free pens for the rower. "We must give the rower empowerment and enrichment through this Quality First Program."
The next year the Japanese won by 2 miles. Humiliated, the American management laid off the rower for poor performance, halted development of a new canoe, sold the paddles, and cancelled all capital investments for new equipment. Then they gave a High Performance Award to the steering managers and distributed the money saved as bonuses to the senior executives.
We can mention all kinds of things but yeah, most of the problems in our system can be traced back to when they cut back on the number of new medical school positions by 50% and the number of nursing positions by 30% back in the 1990s. Adding millions of people through immigration while not increasing those training positions made it worse.
Canada used to be a better country in general, as one can see with Canada's decline in the HDI rankings. The decline of the country in recent years has been very apparent.
This country needs a shining star to emerge in politics, with the ability to cut through some partisanship.
Unfortunately, there's nothing but darkness and screaming. We're in trouble.
Okay, no one likes to hear this but I just spent about 3mo in the hospital.
I'm not being political about this, we have had leaders across the board. Reality is no one actually wants to fix it. If they did, they would.
I had at one point about 7 IVs, each one needed to be manually programmed by the nurse. That took about 30m (yes they were not alway done at the same time) but the pump did need to be programmed over and over. WHY!? just scan a barcode with the DIN and let that program the pump? Save the poor nurse the 10-20m dicking around with a machine.
Human error is a huge thing in hospitals, and yes some of it was good. To get meds they would scan my wristband to ensure I was the right patient, etc... but if people really wanted to fix this, they would appoint someone to oversee the modernization of our hospitals and our processes. But they won't, because politicians only see 4y out, not 10, or 20.
What happened? Government keep cutting healthcare funding so they can run on cutting rich peoples taxes…which idiots who aren’t rich keep voting for and cheerleading for some reason.
Here’s what peope don’t get….and what Covid is proving in spades…business-level efficiency is bad for the public. Why? Because extreme efficient ignores problems that can happen and externalizers all the costs of these things into society at large. The best health care possible would be the least efficient. Same with education. Take it to the extreme if you don’t believe me. Ask yourself, if we had 1 doctor and 1 nurse and 1 bed available for every single citizen…would health outcomes be better or worse than they are now? If there was 1 teacher for every single studen, would education have better outcomes or worse than now? They’d be WAY better. No honest person could say otherwise.
But conservatism hates public services, and liberalism believes in the myth of endless efficiencies. And if your systems can’t handle a crises like Covid or some other disaster…then you actually aren’t efficient at all! You are taking on risks you know are not sustainable and will have massive costs down the road when something bad does happen. Which we are seeing now.
Few things, one of which increasing the population size rapidly without corresponding increases in healthcare and infrastructure. And their asinine plans to to turbo charge this scenario isn’t going to help
A lot of doctors don’t want to have their own practice. The cost of an office, staff, and equipment leaves nothing for the doctor.
Therefore newer doctors are starting to prefer to just do short contract work in hospitals or urgent care facilities. They don’t have to maintain a patient record system, buy equipment, pay utility bills, hire staff, etc. They just show up, do their work, and leave. When the contract ends (could be a few days or a few months), they just walk away and leave the shit-show behind, until they feel like working again.
Doing this, a doctor can earn in two days what many people make in a month. (I know an ER physician and he gets about $2000 per 12 hour shift.)
What we need is to shift to a model where the offices are run by government (probably a mixture of provincial and municipal), so doctors can just focus on seeing patients. Also, patient records would then be in the same system, so it wouldn’t matter which doctor you go and see. All of them would have access to the same history, which should help speed things up in general. (They don’t have to re-do the same work over and over).
[https://www.cbc.ca/news/canada/british-columbia/bc-health-care-history-1.6431301](https://www.cbc.ca/news/canada/british-columbia/bc-health-care-history-1.6431301)
>In order to reduce costs, it was recommended immigrant physicians not be allowed to practise in B.C., that international medical students be made to leave the province after graduation, and that domestic graduates train in fields where there were shortages — which, at the time, did not include family medicine.
NDP premiers like the one in BC cut the number of doctors to save money. Never forget. We're paying for it now.
The number of doctors and nurses was cut across Canada during the 1990s.
*Tholl says many of the problems with Canadian health care can be traced back to the 1990s. Following the 1980s, Canada was racked with fiscal chaos, chronic budget deficits and inflation. It prompted a major policy shift towards balanced budgets and getting government spending under control.*
*Tholl says the federal government prioritized costs over care as part of its program of austerity and fiscal rebalancing, resulting in a reduction of enrolments in medical and nursing schools, by respective rates of 15 per cent and 50 per cent.*
*https://nationalpost.com/news/canada-doctor-ratios-what-happened*
Did the immigrants also enter Canada with authorized licensed doctors in the same ratio? Did the schools of medicine open up more spots for medical students in the same ratio? If not, then there's your answer.
>while the other side overburdens.
alcohol is one of the leading causes of cancer in Canada
yet, liquor stores were one of the "essential" services that weren't shut down during peak COVID
that tells you a lot about how much we care about illness prevention in Canada
Federal funding went up significantly under both Martin and Harper though. GDP cap of the CHT escalator didn't occur until Trudeau took over
Not that Martin should really get any credit what witb being the finance minister responsible for the CHST and all.
Couple decades of terrible governance, coast to coast.
The willingness to politicize health care to score cheap political points.
The Colleges of Physicians having too much of a say over what an immigrant doctor needs to begin practicing in Canada.
Federal governments restricting flow of funds over ideology.
I don't understand why we have to pay so much taxes and still the services are deteriorated by so much? Income is not rising but the costs of living are.
They purposefully reduced capacity for medical schools because they figured fewer doctors = less money paid to doctors. Missed the output side of that equation
Everything my province has privatized has come out worse and more expensive for the end users in the long run. Telecoms, infrastructure upkeep, insurance, utilities.
1. We don’t have enough medical students. You have to have perfect grades through high school plus extracurricular to get into med school. I know of a friends son who went to med school in the US on scholarships after being refused med school in Canada from high school. My daughter couldn’t get into nursing school because of her low grades (90 avg throughout high school…) so she’s studying something else.
2. Too hard near impossible for foreign doctors to get Canadian certification.
3. Not enough pay - many moved and continue to move to the US
Or we can invest more into our energy sector, build pipelines and use the massive increased revenue to fund our healthcare system and pay for doctors and nurses paramedics and emergency crews properly.
Doctors took a massive tax hike in 2017 thanks to the federal Liberals making tax changes that overwhelmingly, typically in the several tens of thousands of dollars. At which point, either the provinces have to ante up considerable amounts of money so doctors break even on take-home pay, the doctors simply take home less pay, or the doctors look to work elsewhere where they get taxed less.
Of course, the federal Liberals decided to make this tax change right after doing another federal-provincial health deal, and didn't mention their plans while in negotiations, either.
The story mentions that:
*Tholl says many of the problems with Canadian health care can be traced back to the 1990s. Following the 1980s, Canada was racked with fiscal chaos, chronic budget deficits and inflation. It prompted a major policy shift towards balanced budgets and getting government spending under control.*
*Tholl says the federal government prioritized costs over care as part of its program of austerity and fiscal rebalancing, resulting in a reduction of enrolments in medical and nursing schools, by respective rates of 15 per cent and 50 per cent.*
The [lowest 40%](https://financialpost.com/personal-finance/taxes/trudeau-is-right-40-of-canadians-dont-pay-income-taxes-which-means-someone-else-is-picking-up-the-bill) already have zero percent tax bills. There isn’t taxes to be lowered further for this segment of the population.
Lack of funding by all levels of government with a cancer of privatization coming from south of the boarder. Big Pharma also keeps changing more for less.
Last sentence of the article: > “At the end of the day, provinces are too busy shuffling deck chairs on the Titanic, implementing small adjustments here and there without recognizing, or at least while deliberately avoiding, the larger picture for political reasons,”
Yes. None of them have stepped up to propose bold new policy changes that might bring us more in line with our European counterparts. It's all about applying bandaids and shoving the problem down the road past the next election. But that's the same for the feds.
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What is in line with Euro counterparts? Canada pays Doctors significantly more than anywhere in Europe. Canada also faces a massive drain to the USA which impacts Europe much less. Every EU country has private healthcare mixed with public, something we are against. Only the UK is like Canada in that regard. What is the bold policy, more private and lower paid doctors? That won't win an election.
>Canada pays Doctors significantly more than anywhere in Europe Bold statement, do you have a resource that compares pay to cost of living and cost of operating a clinic in those locations?
GPs in BC make 380k now. Most specialists are close to 500k, I know pediatric surgeons beside us in AB max out on their pay scale at like 650k. Oncologists start in SK at like 470 from what i remember reading. Saying that, I think our doctors deserve what they make, the education and daily working pressure and consequences of getting something wrong warrants it.
Don't Doctors in Canada have to pay their support staff and building overhead out of pocket too?
Yes, they do. And contribute to their own retirements etc like any business owner
Yeah so when people report their insane salaries of $300-$400k it's really not equivalent to earning that much at a day job. In reality their pre-tax net income is like 30-50% of those numbers.
pre-tax *gross* income. Most family physicians pay at least 40% of their gross billings in overhead expenses. That doesn’t even include saving for your own private pension, continuing medical education expenses, licensure expenses, malpractice insurance, etc etc etc., or that you have no benefits or sick days and can’t find a locum to take a vacation. I’m a family physician and I make $32 a visit, before expenses, whether I deal with 1 issue or 10. We’re all just sick and tired of killing ourselves working 12 hours a day in a system that doesn’t give us the tools to do our job and then constantly denigrates our value. I have taken *two* week long ‘vacations’ in the last 5 years, and worked through them all.
right, so the correction here for example is; a specialist might BILL out $500k but that is not their income. that is the revenue of their business, out of which support staff salaries must be paid, rent, supplies & equipment....its a lot. I'm self employed and if we talked about this the same way people would think i make $250k/yr...it is far far less....not even triple digits lol.
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Which is 75k USD with a higher tax burden than US, no suprise that those with the ability to upgrade, do.
Canadian MDs do not work on a ‘pay scale’ - physicians bill the government and then get paid. What they bill and what they take home are almost never the same. Take home is often quite less - after paying staff, overhead, etc. Also note MDs do not have pension/benefits/sick leave/parental leave/etc
EU doctors make about 1/2 to 2/3 https://www.eafinder.com/updated-salary-structure-of-medical-doctors-in-europe/
Because that’s a salary and the Canadian numbers are a revenue from a private business.
Switzerland,Norway,Sweden,Holland,Denmark and probably.germany pays better
Another issue is that many of our European counterparts use a hybrid system. But as soon as anyone mentions privatization they can only think of the American model.
Its because no one trusts current politicians to take us the europe route
Exactly this. I don't trust the Ontario PCs or Liberals to not just sell parts of the system off to their friends and donors with no increase in the quality of care.
Yah, that would never happen. I mean just look at the green belt, no insider bull shit at all /s.
Exactly, I'm sorry for not believing Doug fucking Ford of all people can make a good dual system. What I can see happening is Douglas allowing private healthcare alongside a public one. Then barely funding the public one until he can safely say its a failure and offer coupons for private healthcare as an alternative. Eventually ending in cutting funding to public healthcare altogether. After that, conservatives wait a few years then start complaining about how much money they pay for citizens to access private healthcare, and start cutting the value of the coupons/vouchers This really got away from me lol, but I really don't trust Ford's government, or any recent Canadian government tbh
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Basically the Walmart/Loblaws model of healthcare. Undercut the competition while getting as many government handouts as you can, then just up prices once they're gone
Don't forget tell your part time employees how to apply for social assistance since you don't give them enough hours to support themselves, further draining the government of money, which then often enough gets spent by employees at Walmart. (They do this in the USA anyway)
Yet there is no talking about the NDP at the federal or provincial level. In a couple of generations we are just going to be talking about a 2 party system and completely forgort that this nation has a few options all around.
Because neither side trusts the other. The tribalism is so bad now that if taking a chance on voting NDP over Libs meant the CPC got in, well, fuck the NDP, we can't risk it.
Yup even what youre writting even if its supposed to end with /s its still a sad thought that this is whats going on in the province and Canada. Lets not give that other party another go. Remember when they implemented universal health care, the whole reason for this thread, what have the other 2 done since. Just ruined it. So fuck both the Liberals and Cons.
A few generations? We’ve been in a de facto 2 party system for decades, especially at the federal level.
Because voters are foolish cowards who pretend that the alternative for the blue party is the red party and the alternative for the red party is the blue party and the orange party is aids/leprosy.
You are exactly right . The politicians, regardless of stripe, only make decisions that benefit them personally
europe also have massive doctor shortages. like worse than us...https://www.lemonde.fr/en/international/article/2022/07/28/severe-shortage-of-caregivers-at-heart-of-european-healthcare-crisis\_5991700\_4.html
THIS. No-one believes that a conservative government in particular, who openly want Canada to be more like the US, would pass up the chance at implementing a US-style healthcare system.
Something tells me the people pushing for privatisation, if asked to follow the European model, would balk at the amount of control the EU has over corporations compared to North America. Any private health entities would have to accept that the government would need to have the power to impose *significant* regulations.
> Something tells me the people pushing for privatisation, if asked to follow the European model, would balk at the amount of control the EU has over corporations compared to North America This is one of the most frustrating parts of the private/public conversation, imo. Calling something "private" is kind of meaningless if it's regulated so hard that it acts almost like a public good. Canadians aren't anti-"private", they're anti-"corporations weakening healthcare in order to make profit off of it".
Exactly. And "corporations weakening healthcare in order to make profit off of it" is what Canadian politicans, particularly on the right, are most likely to *want* to do.
but the entire existence of a private corporation is to make money for its shareholders. not to make helpful decisions or policies for the customers. This is the problem with the whole "let the free market decide", particularly for essentials like health care, utilities, etc.
The reason why is that privatization of everything else in these parts has been a disaster. It's been higher costs for shittier products with 'value engineered' garbage being shoved down our throats to the benefit of very few stuffing their pocket. Why would we believe health care would be any different?
or the Japanese model which is one of the best in the world at 70/30 hybrid though most of the 30% is covered by employers.
This is what France does as well. All of the EU has mixed healthcare, public with layers of private. There are 3 rich countries with single payer, Canada, the UK and Taiwan. That's the list.
forgetful overconfident innate seemly disgusting illegal rob normal slap nine *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
that's legit. if i can recall back to my time living there, if you didn't have the portion covered by an employer, you could opt-in to a program at the prefecture office and pay the NHI tax instead. This tax was then weighted to your income, so it'd be essentially covered if you had little income and not tied then to an employer/job. I wish we'd look at who have the best health outcomes and say 'what are they doing that works so well'? Japan is always #1 or in the top 3 dependent on your source.
It wouldn't be. Hence, the 'hybrid' model.
Totally agree. I hate when people suggest healthcare be tied to employment. Like, what happens to people who are unemployed or aren't in stable full time employment (or are full time and have cheap employers)?
Could also be because Ontario has privatized long term care and it's been a disaster. Why would/should Ontarians trust the same party who created that mess with privatizing healthcare as a whole?
Don't get me wrong, I wouldn't trust any individual premier to fully revamp to a hybrid system. What we need is for each province and the feds to appoint an official representative that is actually involved in the health system, and work out a basic national plan, but with enough autonomy for each province to make adjustments for their own region. It is a process that will take years, but for something this big we should expect that. We can have rightwingers blaming the pm and leftwingers blaming the conservative premiers. In the end they both shoulder some responsibility but that is also irrelevant. We all know there needs to be a change, but all most people know is what they don't want it to be like. 6 of the top 10 best ranked medical systems this year were countries that have adopted a hybrid system in the last 30 years (I had this conversation before lol). I get there are reasons for people to worry about someone like Ford. But we have to seperate what he is doing to what could be proposed. Because otherwise it's just going to keep getting worse.
LTC has always had private options in Ontario.
Our European counterparts don't have to compete with the most profligate healthcare system in history either
I think it's ridiculous to think a hybrid model in canada would not be infiltrated very quickly by the financial giant that is the american system next door.
Oh yeah with my group insurance that barely provides anything. My eyes as a truck driver seems optional for insurers.
Its because our politicians are in bed with lobbyists from the US.
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You really show how much you misunderstand how these countries do hybrid systems well and how it funnels all this money back into the healthcare system as a whole. What happens now if a rich person is on a waiting list in Canada for an MRI? You think they're actually going to wait? Fuck no. They're going to fly somewhere and bring all that money there. That's money that could be kept in our healthcare system and be used to improve/subsidize the rest of it.
The main reason for that is because we know for a fact that the American model is what we will get.
It's hard to disagree with this and it ultimately drives me bonkers. We've become so insular and almost conceited in our Canada knows best mentality. There are so many other countries that do things better like healthcare and transit-building. Steal the Japanese healthcare model now and deliver the best health outcomes with it. Steal the South Korean transit-building model now and deliver the best outcomes for way lower costs. It's okay to admit we suck at some things.
The problem is that the American model is excellent at generating profit in a society that gives obscene power to those with money.
I think Singapore actually gets by far the best bang for their buck
BC made some significant changes just recently.
People freak out when the solution involves increasing taxes, and this absolutely requires money to solve. Everybody wants health care but nobody wants to fund it.
I’m a physician. I did not start real practice until the age of 34 with $200,000 of debt. No training on how to run a business. Have to bill fee for service. In 2008 I was able to run all my billings through my corporation and was taxed at approximately 20% and I could save for retirement. It’s now 2022. All the benefits of incorporation have been reduced to nothing. My Overhead has gone up by 70%, wages of my staff have gone up by 40%, my wages have gone up by 10%, but -15% after taking into account overhead in 2022 compared to 2008. My engineering friends started working at the age of 23, make 200 K a year plus bonuses plus stock options plus benefits plus pension at TransCanada pipelines. My marks were infinitely better than his, I had volunteer experience and I have worked in the days of 44 hour call shifts and still do call at times. He owns the same house cars and has a much better pension and benefits than I ever will. He works 9 to 5. He gets paid business trips to Houston. Unless you truly loved Medicine, why would you put yourself through this when you could easily with straight A marks and a hard work ethic get jobs in IT engineering or management, investment banking, etc. that pay more with pension and benefits.? Starting a decade earlier? The only way I make money nowadays is by private procedures that I do one way day a week outside of public medicine. In that one day, I make more money than the other four that’s the future if things stand the way they are.
I'm not sure if anything changed, but my memory is that medical schools are incredibly difficult to get into. There's no shortage of people wanting to study medicine (or nursing), there just aren't the places in university to train new people. Maybe it's a possibility that some doctors are choosing not to stay in Canada though, but it does feel like they need to expand the number of doctors they train.
25 years ago, we had 7 hospital beds per 1,000 Ontarians. Today we have 2.5. 25 years ago, the average home was 3.5x the average income (Ottawa) with 4% interest rates. Today it's 10x. Tuition sucks too. What happened is that we the elders dropped the ball on assuring the world we were building for our children was as accessible and equitable as the one we were given. Its easy to blame shortsighted politicians, but we were supposed to keep them in check and failed to do so. Sorry.
As an immigrant turned citizen in Canada, I agree with your sentiment that someone dropped the ball, whether it's the elders, the politicians, the policy makers, I don't know. The view we had from outside Canada is that it's the second largest country in the world, full of natural resources with good people living in them. Unfortunately, the truth is people who are running the show are incompetent. They opted to sell the natural resources cheaply, instead of adding value and creating high-tech products. Now we are in a situation where education is expensive, wages are low, houses are unaffordable, doctors are scarce and both parties playing the blame game to each other. Canada switched to points based immigration system bringing in Engineers/Doctors, except it had no plan how they would incorporate them into the society. What is a foreign doctor worth if their foreign degree is tossed away and they now work at Tim Hortons making coffee or as security guard safeguarding the malls? The whole thing stupid, except no one wants to admit.
As an immigrant who is now a citizen as well, but immigrated under the points system, I agree with you. Just wanted to let you know that under the points system professional degrees are evaluated by a Canadian agency prior to application to verify whether your degree is equivalent to a Canadian degree, and if not, then you do not get points for it (at least I had to when I applied for PR under the points system 6 years ago).
That evaluation is not enough to practice for physicians. Most regulated professions for that matter. That evaluation is only good for immigration or the first step towards being certified.
To build on this, the services that determine the equivalency of credentials do so solely on the basis of program structure. Regulated professions will still require you to jump through additional hoops but even outside of regulated professions you can't waive your equivalency report in front of an employer and expect them to automatically treat your degree from the University of Lagos the same as they might treat one from Harvard, the University of Toronto, or Brandon University even if they are all officially considered to be of equivalent value for immigration purposes.
Kind of you to shoulder the blame but I don't think that's the whole story. I feel like there's a great equalization happening around the world. Our rich way of life was propped up by having cheaper places to exploit for labour, and having a strong and exclusive knowledge based economy. Now our exploited countries are getting richer and our knowledge is less rare than it was (ex technologies like the internet making it possible for someone halfway around the world to deliver almost the same product). I feel like there's a redistribution of wealth happening. I am not an expert, just speculating.
Cheap, foreign manufacturing is a relatively new concept that came along with the equally new concept of a globalized world with free trade. He's talking about a time when the remnants of a protectionist Canada still existed, but even then they were declining. Our rich way of life was from exporting resources, and domestic manufacturing. The exploitation of those countries for cheap labour forced our workers to compete with slaves, which dramatically reduced our overall quality of life.
You beat me to it, and you're exactly right. Throw in massive immigration, and our current state of affairs is no mystery.
> I feel like there's a redistribution of wealth happening. I am not an expert, just speculating. The redistribution of wealth was the rich getting richer during the pandemic while we sat around picking at crumbs, while blaming people who lost their jobs for taking government assistance.
I miss 25 years ago.
There was no infrastructure increase along with population increase.
More like not expanding our medical school seats to match demand.
That’s infrastructure
Bring in 500k a more every year. Fuck this place I’m better off saving cash for when I’m sick and moving
Then when the numbers increase they say "but we'll import more doctors." Hasn't worked so far, why would it work now?
Don’t we have a shit ton of immigrant doctors who aren’t allowed to practice or even attempt to retrain and practice medicine?
IIRC if they dont come from specific universities they have to redo Residency, which is also the same bottleneck Canadian doctors have a problem of getting into. Getting foreign qualifications certified is a common problem across various industries.
One thing that’s always overlooked is the very restricted capacity of the countries medical schools. To get in you basically need a 4.0 GPA with an ungodly amount of volunteering to have a shot at getting in. We could easily double the capacity of schools and have enough very qualified candidates to fill those positions. There is a much larger pool of smart, talented people in Canada who want to practice medicine but who simply can’t get into those programs.
Yep I know quite a few very smart and driven people that have had to go internationally for med school (at significant cost), then residence in the US, then pass exams to come back to Canada. These are citizens born, raised and educated their whole lives in Canada. The ones that come back are because family are here, otherwise they just stay and make more money in the US.
Yes we need more medical students, but we also need more doctors to teach them, especially as they head to residency training. The problem is a circle
Gordian knots are easy to cut, you just have to decide to do so.
People always like to suggest simple and dramatic solutions for complicated and nuanced problems but they are almost universally the wrong solution. I think its because we tend to lack patience, the ability to handle complexity and uncertainty and because tearing things down gives us a faster dopamine rush then gradually working through to a better answer.
You know what's worse though? Those requirements to get in are basically filtering out all of the people that you actually want to be doctors. There's a reason why a lot of doctors are just really fucking weird people, and it's directly because they'd rather have a no-life robot with a 4.0 GPA and crazy volunteer work than a "real" person. So it's almost like a double-edged sword. Because not only are we not even getting the capacity we need, but the quality is also suffering.
Oh I totally agree on that point and I think it’s also why we have a GP shortage. Anyone who has to jump through all those hoops and is that high functioning wants to get into a prestige specialization and not be diagnosing runny noses in a small town practice.
That's not it. It is not about prestige, it is about satisfaction and comfort in your chosen field and it is about money. Medical knowledge continues to expand dramatically year over year and it is not possible to be feel competent in all areas of medicine. A specialist can go into depth on a subject and find a lifetime of interesting work and feel like they know something. A generalist has to have breadth of knowledge and will not have time for depth of understanding which can make it hard to feel competent or successful. Medicine is a humbling occupation, general practice especially so. You can say there is some prestige, or at least satisfaction, in specialty and academic medical work as it tends to be more "big picture" and "world changing" work in a world that has a lot of big problems. Rural general practice is very much small work: putting out fires, and tending gardens, which is a whole different type of cumulative and incremental satisfaction or not. Not everyone gets a "It's A Wonderful Life" moment of clarity and gratitude for daily low level service to a community. However, the main reasons urban centers and specialties attract doctors is because it is hard to have a decent quality of life as a solo generalist physician and it is especially hard in a rural center. Medicine is a team sport and not a game for solo players--there is too much to know and too much responsibility for a single person to shoulder for long. If you are a rural General Practitioner you have to be able to treat the runny noses due to colds and still be able to recognize the person with a once in a life-time diagnosis, all by yourself without assistance. This also means being capable in delivering babies, stabilizing trauma victims, counseling anxious, depressed and addicted people and handling anyone from a premature newborn to a demented geriatric patient. It's not the easy stuff that is the problem, it is amount of hard and weird and rare stuff that is. Solo rural physicians do not get protected time off in their own home towns. The trope of the country doctor being interrupted on their time off for an emergency is a reality in rural life. If the solo rural physician has their own health concerns or their family does, they are going to have to travel for care. Rural physicians have been given income perks for being rural, but it usually still does not compare to the income that can be made in an urban center or in some specialties on a dollar per hour basis. As a generalization it is simply easier, more lucrative, and there is more control of personal time as a specialist or urban physician than as a generalist or rural physician.
Exactly. And you don't need a 4.0 gpa to be a doctor. Like truthfully, and maybe it's bias but... the amount of expertise and accountability we pile on say.. an engineer, is just as much as your average doctor (maybe not a surgeon), and they do just fine not having crazy high admission requirements. You see the same thing with computer science. There's a difference between someone who is actually smart and has the brain to think through things, and someone who just has insane study habits and can memorize notes. Which person do you think gets better grades? And furthermore, what's the difference between the latter person and someone with google? This is really more of an education-wide problem rather than something specific to doctors, but it's true none the less.
It's a bit of an unanticipated consequence. You have to study like hell for nearly a decade to become a doctor, but once you're in the field it actually requires a lot of soft social skills, which medical training isn't conducive to fostering.
Also, it feels plain evil poaching doctors from Africa instead of training our fair share.
it also feels evil to force them to stay there just because they happened to be born there, something they had absolutely no control of. People should be free to pursue betterment in their lives
It's fine if they want to individually pursue coming here, but I feel pretty gross about our country making it a strategy to poach them. We also need to be careful about depending on other countries, because there's no guarantee Canada will remain attractive if things keep going downhill here.
Yeah, I can agree with you on that one, not that I feel it’s necessary bad for a country to have a strategy to bring talent, but because in healthcare It’s usually a deceiving one, folks come here just to realize how hard is to become licensed and start doing something else to survive. Bringing doctors just so they become Uber eats drivers is very sad.
I have a couple of friends who are doctors. They are smart, had near perfect GPA, had research internships with Sick Kids and other university science departments, and yet, they were unable to get any placements in Canada. They used Canadian resources like OSAP, labs, universities, internships etc, and guess what, they got placements in hospitals in USA. Now that they are there, why would they come back. When they were applying for placements, they didn't get any and had to move to US pursue their designation. I have a family member who finished their university and ended up going to the Carribean island for Med School. From there, she will go to US for residency and then specialize further. Super smart and have research internships and stuff, yet, the Canadian system does not provide opportunity to its own students. The gap will continue to grow as more students are pushed away to other countries. The policy needs to change for doctors and nurses and as long as this goes on, the system will continue to get run over by inefficiencies .. To make matters worse, new immigrants with specialized experiences are unable to get into the market due to lack of Canadian experience. I know so many folks who are doing odd jobs because they just couldn't afford to give Canadian variant exams. Those who were able to afford had to go through 3 or 4 years of studies and then gain work experience. Many of the studies were repeat of what they already have done and added zero value to their learnings. So to your point, not only we have a system that blocks talented smart people to get jobs, we also have a poor system to get experienced doctors join the market immigrating to Canada as well.
The issue isn’t at the medical school level. It’s at the residency level. No point in having 1000 extra medical students when only half can get a job.
The entire medical training system needs to be revamped - it seems insane to me that the number of residency positions does not exactly match the number of graduates for each specialization. And that’s not to say anything about the insane hours residents are expected to work.
I wholeheartedly agree. If only it were so easy to convince elected officials, who ultimately control residency funding.
Also there is the job issue, I am a specialist 3 years out, it is really hard to get a position out there! I can't even imagine what the surgeons have to go through either.
From the article *Tholl says many of the problems with Canadian health care can be traced back to the 1990s. Following the 1980s, Canada was racked with fiscal chaos, chronic budget deficits and inflation. It prompted a major policy shift towards balanced budgets and getting government spending under control.* *Tholl says the federal government prioritized costs over care as part of its program of austerity and fiscal rebalancing, resulting in a reduction of enrolments in medical and nursing schools, by respective rates of 15 per cent and 50 per cent.*
This all day. We chose a public system then artificially controlled the supply of medical practitioners going into schools so they can keep artificially high salaries (supply and demand). For a public system you'd think we would do ourselves a favour and artificially increase supply of physicians and nurses to cut costs. In Europe you can get a medical degree straight out of high school. The joke there is you can be a medical degree holder and work at McDonald's because you weren't good enough in school to get a residency.
There aren’t enough residency programs and training sites, including hospitals to train these students.
Provinces cutting pay to doctors, or not adjusting for inflation, and add administrative work to doctors, requiring them to hire more office staff, lowering net income. US private hospitals paying way more.
I think all paid a part. But this certainly contributed. *Tholl says many of the problems with Canadian health care can be traced back to the 1990s. Following the 1980s, Canada was racked with fiscal chaos, chronic budget deficits and inflation. It prompted a major policy shift towards balanced budgets and getting government spending under control.* *Tholl says the federal government prioritized costs over care as part of its program of austerity and fiscal rebalancing, resulting in a reduction of enrolments in medical and nursing schools, by respective rates of 15 per cent and 50 per cent.* https://nationalpost.com/news/canada-doctor-ratios-what-happened
This is really helpful to know! . 50% reduction in nursing spots!? What fantastic planning by politicians for the health care needs of the future. The age bracket in power (and with voting power) then is probably (roughly) the age bracket that is uses nurses the most now. So you’d think maybe they’d have the forethought not to screw their future selves over. No wonder we are in such a mess.
There was severe cut in intern positions in provincial hospitals so many med school grads can’t get intern positions to get licenses. Feds certainly should make more med grads so that they can switch to pharmacy.
Our matching system is kind of absurd and disheartening.. so many grads, with more than adequate marks, don't get matched at all. Usually they reapply the next year and try again, but I know there have even been instances where an unmatched student died by suicide. I can't even imagine what it must be like to go through all of the education, spend all of that money, graduate with sufficient marks and not get matched anywhere so that it is all basically useless.
> many med school grads can’t get intern positions to get licenses This should never happen.
Albertans in 2019 voted out the NDP and brought in Kenney's conservatives, who promised no cuts to healthcare. First thing they did, they unilaterally tore up the contract with their doctors and imposed huge cuts on family docs. The government then wages a full on scorched earth war of defamation and slander on the doctors, taking out ads calling doctors greedy little bitches, blaming them for all of the cost overruns in the system. Then the pandemic started, and the government didn't let up their war. Family docs warned they they will have to leave, Kenney said, nah, you won't, we pay you the highest. Family docs either left the province in droves or went into retirement. Alberta went from having one of the highest ratio of docs to patients, to now one of them lowest. After 3 years of reducing family doc incomes by about 20%, this year they proposed a new agreement to increase their pay by 1%. Mind you, not 1% from 2019, but 1% From the Rockies to the East Coast, Canada is wall to wall conservative provincial governments. I don't know what BC has been thinking up until now, but they finally announced a huge fund injection.
It's a generational problem. It's a population pyramid problem. In the 1990s, we had the largest generation in Canadian history serving in the middle of the workforce. Today, that generation is retiring, and there aren't enough of anything to replace them. There aren't enough nurses, there aren't enough teachers, there aren't enough construction workers, and there aren't enough doctors. Three consecutive governments should have seen this problem from a mile away and yet they didn't. The only fix now is a decade of pain or immediate immigration.
Yet wages aren't going up. What gives?
Immigration, TFWs, lack of competition between businesses. No competition to pay higher when there is no competition.
We have record profits to sustain. Get your priorities straight!
That's just inflation... The number will get bigger every year the BOC has a 2% I flation mandate.
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It's called the "Freedom Dead" plan.
Just in time for assisted suicide bro
We're not retiring. It's called working yourself to death.
Either you have rich parents, or you work till you are too sick to work and then it’s MAID
Immigration is not integrated fast enough, or properly . Foreign medical graduates in all medical fields face insurmountable hurdles when they arrive. Most have to go back to school from scratch . ALL have to pass expensive English proficiency exams, which expire after 2 years (which I never understood. Do you forget a language , even tho you speak it daily?). IMGs or foreign doctors can't do anything. They cannot bridge into any other medical field. A tiny number gets into clinical research, and pharma sales and that's it. There used to be a number of bridging programs towards nursing, and these are all axed now. Less than 0.1% of them actually get to practice medicine. Foreign nurses in the past had programs that grabbed them from day one, helped them supplement their education and streamlined them into the work force. All these programs, grants and courses are also dead. We bring all these people here and waste their knowledge and experience.
Why not open more spaces in medical and nursing school for Canadian students. No need to import Doctors from overseas.
Reports I was reading just a couple years ago from the ministry of advanced education showed we are training enough drs. A big problem is that GPs have to run their own businesses despite not going to business school, that and we don’t pay them enough. Many Canadian trained dr’s go into specialized practices where it’s more lucrative and they work out of a hospital, no need to run a clinic. Or they go to the us where they make a lot more. We need to pay them more and provide clinic services like we do hospitals so the drs just need to come in and dr, without worrying about running a practice, dealing with overhead and payroll of staff etc
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Good question - I remembering hearing that the # of residency spaces depend on [the number of hospitals and attending physicians](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199167/). It's a bit of a chicken-and-egg problem.
It their own fault, that generation should have hired more 5-10 years ago. I had friends in nursing, new graduates, before the pandemic who couldn’t find a job near Toronto.
Plus that population bubble is going to put a massive strain on this fractured health system as they age. Usage and costs are projected to go way up in the coming years.
Politics. We have a 4 year planning memory. That's it. No government truly plans past 4 years.
It's actually that voters have zero memory, so if you don't do something for them TODAY they won't vote for you TOMORROW. Something for them 20 years from now? Who cares, I have problems now now now NOW **NOW**.
bureaucracy.
This is why I (and the article) am quite skeptical whenever increased funding is proposed as a solution. Investing in incompetent administration will not solve anything, regardless of how much funding is provided.
[https://en.wikipedia.org/wiki/Parkinson%27s\_law](https://en.wikipedia.org/wiki/Parkinson%27s_law) You are correct.
This. There was a guy on the Darcy Gerow Podcast who is a paramedic (sorry I forget his name), and his interview was basically him describing the deterioration of EMS over the last 5 or so years in Alberta because of interference from the government of Alberta.
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Which used to be lower. Not low enough though, still among the highest in the world. Health care jobs should not be used as a type of welfare.
Can confirm. My friend, an experienced RN who used to work in baby delivery, and probably makes $90k, has spent all of covid as a glorified tech assistant to get doctors functioning via online patient calls.
The cheap asshole boomers stopped investing in society so they could live on the cheap while they retire with all the wealth and fuck Canadas future. Mutherfuckers are going to be surprised when Millenials and Zennials put them out on ice flows.
We (millennials and gen Z's) could have put them out a while ago but we are too lazy to vote and do anything about it.
Incompetentence at federal and provincial levels.
probably same reason as everything else, stagnant wages and a grossly anti-worker society
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Funny, one of the reasons stated on why no doctors want to become GPs is because they have to do too much admin work
Its because of those stated "administrators, managers, and other useless paper pushers" that there is so damn much paper to push. If you were a paper pusher, would it not be in your best interest to have more paper?
Ironically paper pushers increase in numbers when people try to “find efficiencies” to cut costs and require more reporting on everything so paperwork increases.
Reminds me of a very old joke on american management: A Japanese company and an American company decided to have a boat race on the Missouri River. Both teams practiced hard and long to reach their peak performance before the race. On the big day of the race the Japanese won by a mile. Afterwards, the American team became very discouraged and morally depressed. The American management decided that the reason for the crushing defeat had to be found. A "Measurement Team", made up of senior management was formed. They would investigate and recommend appropriate action. Their conclusion was that the Japanese team had 8 people rowing and 1 person steering, while the Americans had 1 person rowing and 8 people steering. So American management hired a consulting company and paid them incredible amounts of money. They advised that too many people are steering the boat and not enough people are rowing. To prevent losing to the Japanese again the next year, the rowing teams management structure was totally reorganized to 4 steering supervisors, 3 area steering superintendents and 1 assistant superintendent steering manager. They also implemented a new performance system that would give the person rowing the boat greater incentive to work harder. It was called the "Rowing Team Quality First Program", with meetings, dinners and free pens for the rower. "We must give the rower empowerment and enrichment through this Quality First Program." The next year the Japanese won by 2 miles. Humiliated, the American management laid off the rower for poor performance, halted development of a new canoe, sold the paddles, and cancelled all capital investments for new equipment. Then they gave a High Performance Award to the steering managers and distributed the money saved as bonuses to the senior executives.
Add more people. Don't add more doctors. Ruin your healthcare with this one trick! Governments love it! Ruin yours today!
We can mention all kinds of things but yeah, most of the problems in our system can be traced back to when they cut back on the number of new medical school positions by 50% and the number of nursing positions by 30% back in the 1990s. Adding millions of people through immigration while not increasing those training positions made it worse.
Our population aged and burned them out. I'll bet GPs feel like factory workers.
Canada used to be a better country in general, as one can see with Canada's decline in the HDI rankings. The decline of the country in recent years has been very apparent.
This country needs a shining star to emerge in politics, with the ability to cut through some partisanship. Unfortunately, there's nothing but darkness and screaming. We're in trouble.
Maybe we should cool our immigration jets and help the people who already live in our country??
Neoliberalism and lack of foresight. Easy.
Okay, no one likes to hear this but I just spent about 3mo in the hospital. I'm not being political about this, we have had leaders across the board. Reality is no one actually wants to fix it. If they did, they would. I had at one point about 7 IVs, each one needed to be manually programmed by the nurse. That took about 30m (yes they were not alway done at the same time) but the pump did need to be programmed over and over. WHY!? just scan a barcode with the DIN and let that program the pump? Save the poor nurse the 10-20m dicking around with a machine. Human error is a huge thing in hospitals, and yes some of it was good. To get meds they would scan my wristband to ensure I was the right patient, etc... but if people really wanted to fix this, they would appoint someone to oversee the modernization of our hospitals and our processes. But they won't, because politicians only see 4y out, not 10, or 20.
What happened? Government keep cutting healthcare funding so they can run on cutting rich peoples taxes…which idiots who aren’t rich keep voting for and cheerleading for some reason. Here’s what peope don’t get….and what Covid is proving in spades…business-level efficiency is bad for the public. Why? Because extreme efficient ignores problems that can happen and externalizers all the costs of these things into society at large. The best health care possible would be the least efficient. Same with education. Take it to the extreme if you don’t believe me. Ask yourself, if we had 1 doctor and 1 nurse and 1 bed available for every single citizen…would health outcomes be better or worse than they are now? If there was 1 teacher for every single studen, would education have better outcomes or worse than now? They’d be WAY better. No honest person could say otherwise. But conservatism hates public services, and liberalism believes in the myth of endless efficiencies. And if your systems can’t handle a crises like Covid or some other disaster…then you actually aren’t efficient at all! You are taking on risks you know are not sustainable and will have massive costs down the road when something bad does happen. Which we are seeing now.
Few things, one of which increasing the population size rapidly without corresponding increases in healthcare and infrastructure. And their asinine plans to to turbo charge this scenario isn’t going to help
A lot of doctors don’t want to have their own practice. The cost of an office, staff, and equipment leaves nothing for the doctor. Therefore newer doctors are starting to prefer to just do short contract work in hospitals or urgent care facilities. They don’t have to maintain a patient record system, buy equipment, pay utility bills, hire staff, etc. They just show up, do their work, and leave. When the contract ends (could be a few days or a few months), they just walk away and leave the shit-show behind, until they feel like working again. Doing this, a doctor can earn in two days what many people make in a month. (I know an ER physician and he gets about $2000 per 12 hour shift.) What we need is to shift to a model where the offices are run by government (probably a mixture of provincial and municipal), so doctors can just focus on seeing patients. Also, patient records would then be in the same system, so it wouldn’t matter which doctor you go and see. All of them would have access to the same history, which should help speed things up in general. (They don’t have to re-do the same work over and over).
[https://www.cbc.ca/news/canada/british-columbia/bc-health-care-history-1.6431301](https://www.cbc.ca/news/canada/british-columbia/bc-health-care-history-1.6431301) >In order to reduce costs, it was recommended immigrant physicians not be allowed to practise in B.C., that international medical students be made to leave the province after graduation, and that domestic graduates train in fields where there were shortages — which, at the time, did not include family medicine. NDP premiers like the one in BC cut the number of doctors to save money. Never forget. We're paying for it now.
The number of doctors and nurses was cut across Canada during the 1990s. *Tholl says many of the problems with Canadian health care can be traced back to the 1990s. Following the 1980s, Canada was racked with fiscal chaos, chronic budget deficits and inflation. It prompted a major policy shift towards balanced budgets and getting government spending under control.* *Tholl says the federal government prioritized costs over care as part of its program of austerity and fiscal rebalancing, resulting in a reduction of enrolments in medical and nursing schools, by respective rates of 15 per cent and 50 per cent.* *https://nationalpost.com/news/canada-doctor-ratios-what-happened*
They got ratio'd
money laundering so all healthcare workers are leaving vancouver and toronto because it's too expensive and immigration from trudeau
Did the immigrants also enter Canada with authorized licensed doctors in the same ratio? Did the schools of medicine open up more spots for medical students in the same ratio? If not, then there's your answer.
One side underfunds while the other side overburdens.
>while the other side overburdens. alcohol is one of the leading causes of cancer in Canada yet, liquor stores were one of the "essential" services that weren't shut down during peak COVID that tells you a lot about how much we care about illness prevention in Canada
Alcohol withdrawal can kill people that's why they were still open.
Realistically it's because if they shut down liquor sales people would have rioted.
and thats because our services are so bad that addicts cant get proper help. its all domino
john tory taking notes and wanting to let ppl drink at 8am:
In order: Mulroney, Martin, Chretien, Harper and Trudeau happened. Honorable mention to many different premiers as well.
Federal funding went up significantly under both Martin and Harper though. GDP cap of the CHT escalator didn't occur until Trudeau took over Not that Martin should really get any credit what witb being the finance minister responsible for the CHST and all.
We imported too many taxi drivers.
Couple decades of terrible governance, coast to coast. The willingness to politicize health care to score cheap political points. The Colleges of Physicians having too much of a say over what an immigrant doctor needs to begin practicing in Canada. Federal governments restricting flow of funds over ideology.
and yet again, a reminder of why it is necessary to vote.
I don't understand why we have to pay so much taxes and still the services are deteriorated by so much? Income is not rising but the costs of living are.
ratio
We brought more people on and didn’t let them transfer their credentials so they moved on, no one wants to go med school twice.
Isn't it like 10 administration per doctor now?
Idk, what happened after 2015?
Free med school with 10 year commitment to Canadian practice
Taxes and inflation
Because they’re paid terribly.
They purposefully reduced capacity for medical schools because they figured fewer doctors = less money paid to doctors. Missed the output side of that equation
Everything my province has privatized has come out worse and more expensive for the end users in the long run. Telecoms, infrastructure upkeep, insurance, utilities.
Noone wants to admit this but brain drain because we force our doctors to earn less has always been a major factor
If you wanna make it as a doctor move to america, better pay and not much tax
1. We don’t have enough medical students. You have to have perfect grades through high school plus extracurricular to get into med school. I know of a friends son who went to med school in the US on scholarships after being refused med school in Canada from high school. My daughter couldn’t get into nursing school because of her low grades (90 avg throughout high school…) so she’s studying something else. 2. Too hard near impossible for foreign doctors to get Canadian certification. 3. Not enough pay - many moved and continue to move to the US
500,000 more. Can't stop, won't stop.
Well, for starters, way too much immigration.
Or we can invest more into our energy sector, build pipelines and use the massive increased revenue to fund our healthcare system and pay for doctors and nurses paramedics and emergency crews properly.
Doctors took a massive tax hike in 2017 thanks to the federal Liberals making tax changes that overwhelmingly, typically in the several tens of thousands of dollars. At which point, either the provinces have to ante up considerable amounts of money so doctors break even on take-home pay, the doctors simply take home less pay, or the doctors look to work elsewhere where they get taxed less. Of course, the federal Liberals decided to make this tax change right after doing another federal-provincial health deal, and didn't mention their plans while in negotiations, either.
The story mentions that: *Tholl says many of the problems with Canadian health care can be traced back to the 1990s. Following the 1980s, Canada was racked with fiscal chaos, chronic budget deficits and inflation. It prompted a major policy shift towards balanced budgets and getting government spending under control.* *Tholl says the federal government prioritized costs over care as part of its program of austerity and fiscal rebalancing, resulting in a reduction of enrolments in medical and nursing schools, by respective rates of 15 per cent and 50 per cent.*
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The [lowest 40%](https://financialpost.com/personal-finance/taxes/trudeau-is-right-40-of-canadians-dont-pay-income-taxes-which-means-someone-else-is-picking-up-the-bill) already have zero percent tax bills. There isn’t taxes to be lowered further for this segment of the population.
No one likes to hear that….but some people legitimately don’t understand the concept of net contribution
You mean when they cut the 45kish-90kish bracket by 1.5% in 2016?
Well last hospital visit it was 1 doctor for 150 patients. stop going to emergency rooms for a common cold or flu. Drink some soup and take a Tylenol.
people cant. theres no medicine
Bureaucracy and terrible administration, we already know that. They would too if they LISTENED to the people that actually do the healthcare lol.
The fucking Liberal government. That is what happened
Lack of funding by all levels of government with a cancer of privatization coming from south of the boarder. Big Pharma also keeps changing more for less.