Speaking as a retired family physician and retired senior health care administrator…..
There are many other first world countries that deliver better health outcomes at lower aggregate costs, so I’m not convinced that we can argue that our system is underfunded.
We’ve been living for a very long time with government rationing of health care supply. They ration the supply of providers, through limits on class sizes and training opportunities. They limit the number of hospitals and beds. They limit the number of diagnostic machines. They limit the number of surgeries. They limit what drugs are covered through pharmacare. Everything is limited. The response to limited supply in the face of rising demand is increased costs.
I was a practicing physician. Doctors aren’t starving. Doctors from all over the world want to come here to work, but their opportunities are limited. Canadians who trained overseas, at their own expense, have to fight for an opportunity to train and practice in their own country. Some folks will incur huge additional costs to train as doctors overseas when they can’t get into a Canadian medical school. There’s no shortage of people who want to work here as doctors, but the opportunities are limited by government. Meanwhile, you earn exactly the same whether you are a bad doctor or a good doctor, so why try too hard?
I suspect the same is true for other providers. My wife was a nurse, trained in the days when it was a three year hospital-based training program. Nowadays, nurses are university-educated in a four year program, it graduate without the skills needed to look after patients from day 1, so they need an “apprenticeship” before they can do the work. We’ve limited the number of training spots, raised the costs, and graduate less capable people with higher expectations. At the same time, we’ve centralized health care, and unionized everything, so a nurse is a nurse is a nurse and they all earn the same, based on seniority not merit. We are so desperate to staff the hospitals that every nurse gets a job.
At the same time, because we’ve made it so hard to get into medical school and nursing school, we don’t fail anybody, even the ones who shouldn’t be there!
Want to make it work better? Restore the free market. Throw open the doors to training to anybody who is motivated and willing to pay for the chance. Graduate only those who prove their merit. Let them work where they can find opportunity, and charge what they deserve. Let private agencies open hospitals where there’s a need and run those hospitals efficiently. A bit of competition would reward the efficient and those who do their job well, while driving down overall costs.
At the same, drop the idea that the public purse will pay for everything. The original idea was to avoid people being bankrupted by catastrophic health care costs. We’ve completely lost the plot on that, and now we cover everything from soup to nuts, no matter what the value proposition might tell us.
I agree in principle that foreign healthcare workers (MD’s and Nurses) should be able to integrate into the Canadian system in an expedient manner. But how do we judge the level of training and if/how it fits the needs and expectations of Canadian healthcare? Can we develop a list of foreign educational institutions that can pass seamlessly into the Canadian system with little to no internship? That would be ideal in my opinion! But the thing is, I’ve noticed healthcare educational priorities differ from region to region, even within Canada. I’ve worked with highly technical practitioners in chronic care who are tone-deaf to the family-as-patient dynamic especially in pediatrics (with disastrous results), as well as low-quality practitioners who can do simple tasks for lower salaries but lack the clinical judgement to understand when a situation needs attention stat. I’ve got some horror stories but understand this discussion is beyond personal experience.
I am not a big fan of recruiting foreigners to staff our healthcare system. First, there are the issues you’ve mentioned in terms of determining whether their training is adequate. As well, there are significant cultural differences and linguistic barriers. Finally, many of the places we are recruiting from are not rich countries, and we are stealing their best and brightest.
All I said was that Canada is a place that people want to come to for work. In saying that, my point was that lots of Canadians also want to be healthcare workers in Canada, especially doctors, but they can’t because we’ve severely limited the number of spots in medical school and residency. They head off overseas, at great personal cost. We make it very hard for them to come back, so we lose a bunch of them to other countries. They have the motivation, they have the money, they are just as smart as the people we let in to Canadian medical schools, and they often turn out to be great doctors, but we drive them away. At the same time, we pretty well graduate everyone that we admit to medical school, even the ones who aren’t all that smart and the ones who lack any sort of ethics.
Case in point, Dalhousie admitted a guy a few years back who tried to pull off a big drug deal just before school started, in part to pay off some outstanding debts and in part to raise the money he needed for tuition. He had been a drug dealer all along. This was just a bigger deal than his usual. Something went wrong and the other guy ended up dead, although they’ve never recovered the body. Had the police not arrested the murderer and sent him off to prison, he most likely would have graduated from medical school. He got into med school even though he clearly had some serious ethical and moral deficiencies. Why? We have an elaborate system to choose who we let in, but it really does nothing. A lottery system would work just as well, assuming those entered into the lottery meet some basic criteria. And, once you are in, our medical schools almost never fail anyone, because they assume the selection process was so brilliant!
So, my point was that we need to train more Canadians in Canada:
- stop the ridiculous medical school admission process, which creates the impression of choosing “the best candidates” but does nothing of the sort
- open the doors to let more medical students in
- charge more for medical school, if necessary (a lot of interested people clearly have the money)
- flunk out the folks that aren’t as bright, or who don’t have the moral fibre or work ethic
- increase the number of residency spots and flunk out the folks that don’t measure up (you do no favours graduating people who can’t or won’t do the job they need to do)
- with more graduates, open up the market to a little competition (right now, you are guaranteed a job as a doctor no matter that you graduated at the bottom of your class, have no ethics, and lack any sort of drive to do your job! Talk about a recipe for mediocrity in the health care system!)
As I noted in my reply to Dean's comment, it would be great to collect ideas from experienced healthcare insiders. I'm not sure exactly what format that might take, but I'm sure it would be useful.
I'm not so sure there isn't enough money in the system. But I am sure that a lot of that money is wasted. I read somewhere that our ratio of managers to patients is ten times higher than Germanys, and their system is rated much higher than ours by the OECD. You also have people protecting their turf. My father-in-law was working in a hospital senior position when a new method of treating kidney stones was presented. It was less invasive. However the surgeons kicked up a fuss because they would lose out on the billing because the new procedure was done by radiologists. Turf wars. The OECD recognizes 28 or 30 health care systems that all rate better than Canada. And we rate just one step ahead of the US. So let's look at those other 28 systems and see what we can learn from them. And if we can improve the system, we might be able to attract more people to work in it.
It would be nice if we could somehow collect all the insider horror stories from people on the healthcare front lines. I would bet we could make something incredibly useful out of it (especially using the magic of AI).
Ok. Now you've got the gears in my mind turning...
I am, of an age, as used to be said. I was in my teens in the sixties and I do remember the introduction of medicare in Canada. In the case of my family it was welcomed as one of my brothers was habitually sick and in need of medical care, drugs, etc. I live and lived in Alberta but I also remember the Saskatchewan doctors' strike of 1962 as I was visiting a Saskatchewan friend that summer.
Okay I have stated my (non) bona fides; now to commentary.
First off, good on you to raise this topic, however I advise you to keep your head down for even mentioning the possibility of for profit medicine!
Second, it is my observation that the services covered by medicare have been expanding endlessly since the introduction of national medicare in 1966 (I think that is the year).
That second item is, I think the critical one in this discussion. Medical care coverage was pretty basic originally but is now much more comprehensive and comprehensive costs money. Lots and lots and lots of money. If we were to reduce medical coverage to the norm when medicare was introduced then costs would be much less but the available coverage would similarly be much less and Canadians would have to pay very substantially more out of pocket.
The point of all of this is that when we argue that medical care is "not what it used to be" and start looking for culprits, we should absolutely look in the mirror. The ever increasing demand for more, more, more medical services for "free" has stretched the system. Or, as Pogo (remember him?) said, "We have met the enemy and he is us."
It is quite simple. If we want "more," someone must pay for that "more" and it is we the taxpayer, whether through taxes or out of pocket. There is one incredibly important consideration in arguing that the rich should pay more: the problem with the rich is that there simply aren't enough of them to pay for what the non-rich want.
The lack of 'medical care' compared to someplace like the US, where people spend ungodly amounts of money on whatever toxic bullshit the FDA tells them they need, is why Canadians are healthier.
DON'T TRUST THE MEDICAL INDUSTRY!!! Their entire profit strategy is to make people chronically ill so they can harvest their incomes over lifetimes. You don't need vaccinations and they're bad for you, anyway. You don't need pills and injections to let you eat shitty corporate 'food products' without weighing 400 pounds. You don't need gene therapy for your sniffles. Eat healthy, natural food, and live a happy life. STAY AWAY FROM DOCTORS IF AT ALL POSSIBLE!!
Speaking as a retired family physician and retired senior health care administrator…..
There are many other first world countries that deliver better health outcomes at lower aggregate costs, so I’m not convinced that we can argue that our system is underfunded.
We’ve been living for a very long time with government rationing of health care supply. They ration the supply of providers, through limits on class sizes and training opportunities. They limit the number of hospitals and beds. They limit the number of diagnostic machines. They limit the number of surgeries. They limit what drugs are covered through pharmacare. Everything is limited. The response to limited supply in the face of rising demand is increased costs.
I was a practicing physician. Doctors aren’t starving. Doctors from all over the world want to come here to work, but their opportunities are limited. Canadians who trained overseas, at their own expense, have to fight for an opportunity to train and practice in their own country. Some folks will incur huge additional costs to train as doctors overseas when they can’t get into a Canadian medical school. There’s no shortage of people who want to work here as doctors, but the opportunities are limited by government. Meanwhile, you earn exactly the same whether you are a bad doctor or a good doctor, so why try too hard?
I suspect the same is true for other providers. My wife was a nurse, trained in the days when it was a three year hospital-based training program. Nowadays, nurses are university-educated in a four year program, it graduate without the skills needed to look after patients from day 1, so they need an “apprenticeship” before they can do the work. We’ve limited the number of training spots, raised the costs, and graduate less capable people with higher expectations. At the same time, we’ve centralized health care, and unionized everything, so a nurse is a nurse is a nurse and they all earn the same, based on seniority not merit. We are so desperate to staff the hospitals that every nurse gets a job.
At the same time, because we’ve made it so hard to get into medical school and nursing school, we don’t fail anybody, even the ones who shouldn’t be there!
Want to make it work better? Restore the free market. Throw open the doors to training to anybody who is motivated and willing to pay for the chance. Graduate only those who prove their merit. Let them work where they can find opportunity, and charge what they deserve. Let private agencies open hospitals where there’s a need and run those hospitals efficiently. A bit of competition would reward the efficient and those who do their job well, while driving down overall costs.
At the same, drop the idea that the public purse will pay for everything. The original idea was to avoid people being bankrupted by catastrophic health care costs. We’ve completely lost the plot on that, and now we cover everything from soup to nuts, no matter what the value proposition might tell us.
I agree in principle that foreign healthcare workers (MD’s and Nurses) should be able to integrate into the Canadian system in an expedient manner. But how do we judge the level of training and if/how it fits the needs and expectations of Canadian healthcare? Can we develop a list of foreign educational institutions that can pass seamlessly into the Canadian system with little to no internship? That would be ideal in my opinion! But the thing is, I’ve noticed healthcare educational priorities differ from region to region, even within Canada. I’ve worked with highly technical practitioners in chronic care who are tone-deaf to the family-as-patient dynamic especially in pediatrics (with disastrous results), as well as low-quality practitioners who can do simple tasks for lower salaries but lack the clinical judgement to understand when a situation needs attention stat. I’ve got some horror stories but understand this discussion is beyond personal experience.
Those are serious concerns. I would suggest that:
(1) Our desperate need for more professionals outweighs those potential problems.
(2) Many domestic graduates already share those issues (either because of personality issues or because they only came to Canada for med school).
(3) The market should (ideally) select high performing professionals for high demand roles.
None of those are complete answers, of course, but it's something to get us started.
Sorry David, but you sound like one of those business-oriented politicians or hospital administrators with no experience in the swamp.
I am not a big fan of recruiting foreigners to staff our healthcare system. First, there are the issues you’ve mentioned in terms of determining whether their training is adequate. As well, there are significant cultural differences and linguistic barriers. Finally, many of the places we are recruiting from are not rich countries, and we are stealing their best and brightest.
All I said was that Canada is a place that people want to come to for work. In saying that, my point was that lots of Canadians also want to be healthcare workers in Canada, especially doctors, but they can’t because we’ve severely limited the number of spots in medical school and residency. They head off overseas, at great personal cost. We make it very hard for them to come back, so we lose a bunch of them to other countries. They have the motivation, they have the money, they are just as smart as the people we let in to Canadian medical schools, and they often turn out to be great doctors, but we drive them away. At the same time, we pretty well graduate everyone that we admit to medical school, even the ones who aren’t all that smart and the ones who lack any sort of ethics.
Case in point, Dalhousie admitted a guy a few years back who tried to pull off a big drug deal just before school started, in part to pay off some outstanding debts and in part to raise the money he needed for tuition. He had been a drug dealer all along. This was just a bigger deal than his usual. Something went wrong and the other guy ended up dead, although they’ve never recovered the body. Had the police not arrested the murderer and sent him off to prison, he most likely would have graduated from medical school. He got into med school even though he clearly had some serious ethical and moral deficiencies. Why? We have an elaborate system to choose who we let in, but it really does nothing. A lottery system would work just as well, assuming those entered into the lottery meet some basic criteria. And, once you are in, our medical schools almost never fail anyone, because they assume the selection process was so brilliant!
So, my point was that we need to train more Canadians in Canada:
- stop the ridiculous medical school admission process, which creates the impression of choosing “the best candidates” but does nothing of the sort
- open the doors to let more medical students in
- charge more for medical school, if necessary (a lot of interested people clearly have the money)
- flunk out the folks that aren’t as bright, or who don’t have the moral fibre or work ethic
- increase the number of residency spots and flunk out the folks that don’t measure up (you do no favours graduating people who can’t or won’t do the job they need to do)
- with more graduates, open up the market to a little competition (right now, you are guaranteed a job as a doctor no matter that you graduated at the bottom of your class, have no ethics, and lack any sort of drive to do your job! Talk about a recipe for mediocrity in the health care system!)
As I noted in my reply to Dean's comment, it would be great to collect ideas from experienced healthcare insiders. I'm not sure exactly what format that might take, but I'm sure it would be useful.
I'm not so sure there isn't enough money in the system. But I am sure that a lot of that money is wasted. I read somewhere that our ratio of managers to patients is ten times higher than Germanys, and their system is rated much higher than ours by the OECD. You also have people protecting their turf. My father-in-law was working in a hospital senior position when a new method of treating kidney stones was presented. It was less invasive. However the surgeons kicked up a fuss because they would lose out on the billing because the new procedure was done by radiologists. Turf wars. The OECD recognizes 28 or 30 health care systems that all rate better than Canada. And we rate just one step ahead of the US. So let's look at those other 28 systems and see what we can learn from them. And if we can improve the system, we might be able to attract more people to work in it.
It would be nice if we could somehow collect all the insider horror stories from people on the healthcare front lines. I would bet we could make something incredibly useful out of it (especially using the magic of AI).
Ok. Now you've got the gears in my mind turning...
I am, of an age, as used to be said. I was in my teens in the sixties and I do remember the introduction of medicare in Canada. In the case of my family it was welcomed as one of my brothers was habitually sick and in need of medical care, drugs, etc. I live and lived in Alberta but I also remember the Saskatchewan doctors' strike of 1962 as I was visiting a Saskatchewan friend that summer.
Okay I have stated my (non) bona fides; now to commentary.
First off, good on you to raise this topic, however I advise you to keep your head down for even mentioning the possibility of for profit medicine!
Second, it is my observation that the services covered by medicare have been expanding endlessly since the introduction of national medicare in 1966 (I think that is the year).
That second item is, I think the critical one in this discussion. Medical care coverage was pretty basic originally but is now much more comprehensive and comprehensive costs money. Lots and lots and lots of money. If we were to reduce medical coverage to the norm when medicare was introduced then costs would be much less but the available coverage would similarly be much less and Canadians would have to pay very substantially more out of pocket.
The point of all of this is that when we argue that medical care is "not what it used to be" and start looking for culprits, we should absolutely look in the mirror. The ever increasing demand for more, more, more medical services for "free" has stretched the system. Or, as Pogo (remember him?) said, "We have met the enemy and he is us."
It is quite simple. If we want "more," someone must pay for that "more" and it is we the taxpayer, whether through taxes or out of pocket. There is one incredibly important consideration in arguing that the rich should pay more: the problem with the rich is that there simply aren't enough of them to pay for what the non-rich want.
The lack of 'medical care' compared to someplace like the US, where people spend ungodly amounts of money on whatever toxic bullshit the FDA tells them they need, is why Canadians are healthier.
DON'T TRUST THE MEDICAL INDUSTRY!!! Their entire profit strategy is to make people chronically ill so they can harvest their incomes over lifetimes. You don't need vaccinations and they're bad for you, anyway. You don't need pills and injections to let you eat shitty corporate 'food products' without weighing 400 pounds. You don't need gene therapy for your sniffles. Eat healthy, natural food, and live a happy life. STAY AWAY FROM DOCTORS IF AT ALL POSSIBLE!!