Archive for the ‘Canada’ Category

June 25, 2017

They come in, right off the street

The problem it seems, is the feet

And then when the pain

Makes them complain

Orthotics just can’t be beat.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I have really bad ankles. I started with flat feet as a child, and things haven’t gotten better in the last 60 years.  Now I wear stiff hiking boots with orthotics you can, literally, drive nails with.  They keep me going.

A fair number of my patients, no matter where I go, come in with foot problems.

Most “ingrown” toenails result from people cutting a corner of the big toenail too short, temporarily relieving the pain but setting themselves up for worse problem when the nail grows out, cutting into the flesh. More than half the time the original problem stems from shoes functionally too small.  I tell people to keep their nails trimmed.  With a flair of showmanship I predict I’ll find a hole worn in their shoe lining from the big toenail, then I tell them to file a bevel into the end of the nail, making it both more flexible and easier to trim when it grows out.

Those with plantar fasciitis start the first step of the day OK, then the pain hits. But it gets better as the day wears on.  At the end of the day, they might sit and relax for 20 minutes but when they stand up they face excruciating pain.  I teach them stretching exercises, encourage them to lose weight, and advise new footwear.

Most WalMarts have a Dr. Scholl’s display; those orthotics (shoe inserts) can be the first step away from the pain. But if they don’t work, I recommend the podiatrist, or, sometimes, the orthotist, a person who does nothing but make orthotics.

The patient gave me permission to say that when I told her to take off her shoes and stand up, her arches sagged to the floor. They looked just like mine.

Then I talked about how I felt the first day I put my feet into the solid inserts. I walked away with a gait 30 years younger, my back straighter.

 

Dislocated thumbs and warmth in the ER

June 24, 2017

To the ER the injuries come,

So I just took hold of the thumb

Yes, dislocated

But a technique underrated

Includes no drugs to make the hand numb

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Over the years I’ve learned at least 8 different ways to put a dislocated shoulder back into place (medicalese: reduce the subluxation).   My favorite remains the one I learned in the parking lot of the hospital on my last day of residency.  I met one of the emergency docs coming in as I was going out for the last time.  He told me he’d learned the technique that involved no drugs, bandages, tape, buckets of sand, or force, and he showed it to me.  I use it to this day.

It failed only once, when in another clinic in another city a very muscular young man suffered a dislocated shoulder in the course of an electrical injury.

Last night, on call, for the first time in my career I faced a patient with a dislocated thumb (the patient gave permission to include a good deal more information than I have). I looked at the x-ray, I reviewed the anatomy, and put together a plan.  But I’d never done one before so I felt I should at least speak with someone with more experience before I tried it.  I put out a call to a consultant orthopedist and I waited.

And I waited.

One of my colleagues who had done several of the procedures, just back from an ambulance run came striding through. I told him the plan, and he gave me the nod.

I had the patient give me the thumbs up sign. I grasped the digit, and we started to chat.  As the patient relaxed, I took the weight of the hand, and, eventually, the arm.  After 5 minutes, supporting the forearm with my other hand, I let go.  Using patience and gravity, the thumb had slid back into place, with no drugs, no violence, and no clunk.

Just the way I like it.

_*_*_*

Injured people rarely come into the ER alone. Some of my patients have problems so difficult to look at that you wouldn’t see them in a horror movie.   The visual impact can jar friends and relatives into free displays of affection.  But during a recent night on call, I witnessed a kiss so astounding that the warmth flooded the ER and so memorable I had to comment on it.  I kept doing what I had to do, thinking all the while that so much love must make a difference in the healing process.

 

Trying to figure out what “call” means

June 21, 2017

When my weekend came to an end

A patient off we did send

With findings so rare

It gave us a scare

And help we needed to mend. 

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

 

People can use the same word and mean different things, different words to mean the same thing, or even the same word in different contexts to mean different things.

Doctors use the term “call” when talking about coverage after hours and on weekends, but what does that word “call” really mean?

In Utgqiavik, the town formerly known as Barrow, it never meant anything other than 12 hours. I have been places where holiday call meant ten times that.  Depending on the location, weekend call might start on Friday or Saturday morning.  Or it could include staffing a Saturday clinic.  Sometimes it meant ER coverage only.  For a couple of decades I had to field calls from nursing homes, patients, ERs and hospital inpatient units as well as obstetrical duties.  For one former employer, if I drew the duty, I could count on sprinting between hospitals to admit patients till midnight, and a minimum of one phone call every 45 minutes requiring critical decision-making.

In New Zealand, when I worked for a North Island outfit, “call” meant staying overnight in the clinic.

On one particularly memorable assignment, it meant nothing other than having my name on a calendar slot. I had protested the marginal cell coverage at my dwelling.  Administration told me not to worry, in the event of a disaster the Sheriff knew where he could find me.

I write this while on weekend call. Sunday morning dawned very early and very clear.

During my 23 years in private practice, the docs wouldn’t talk about how the weekend went until afterwards. The same superstitious factors leading to that custom led to the many Emergency Rooms that banned the “Q word” (quiet).

What does weekend call mean here? Starts at 8:00AM Friday, ends at 8:00AM Monday, followed by a day off.

Now post call, I can say I cared for 3 people who, for one reason or another, didn’t have a chart in the local electronic Medical Record. I never cared for more than 12 people in one 24 hour period.  Several times, on the verge of leaving for the apartment, I asked people on the way in if they had come for emergency services.

At the end, a patient arrived with an extremely rare problem, so serious I called a colleague for help, and ended up riding in the ambulance to the medical center.

Learning about forestry

June 12, 2017

Out here we’ve got poplars and pines,

And recently we’ve got a few mines

But who pays the fees

To cut down the trees

Where too many beetles have dined.

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Western Canada in general, and this area of British Columbia in particular, has a lot of trees; many of them currently dead, killed by the mountain pine beetle.

In the normal course of events, those pine beetles attack the mature trees in a stand. With a decreased ability to fight the invader and the fungus it carries, those trees quickly die and fall, and make room for the new generation.

A century of fire suppression increased the proportion of old trees. Because smoke kills pine beetle larvae, the number of reproducing insects increased.  All this at a time when warmer winters led to improved insect survival, and drier summers to impair sap production, further lowering the trees’ resistance.

The dead trees still have commercial value.

So a lot of standing timber, living or dead, with a conscientious government, can mean a lot of potential revenue, which, in turn, means a lot of work for foresters. And, indeed, I’m taking care of a lot of patients in the industry.

Some work on the supply side, mostly from the side of the government. They do what they can to maintain the health of the forest.

Forestry techs are the ones who go out on foot to find the harvestable trees. I have just begun to find out what their work involves.

On the private side, a lot of contractors operate in this area. One person estimated 25 outfits logging around here, but the number would depend on how one defined “around here.”  A logging camp will have between 25 and 100 employees, living 2 to 15 hours from town.  They operate year round.

I have found out about another genre of forestry worker, the person who, interfacing with the government, negotiates the complex of regulations so that the contractor can extract the resources.

I’ve talked with some of them. Their expertise has become vital to the industry.  One said, “Forestry isn’t rocket science.  It’s way more complicated than that.”

I have yet to meet up with another group of workers, the tree planters. Vital to the continuation of the timber product industry, they only work in the summer.

I want to know more about their work; forestry is an immense, complicated industry. I’ve lived surrounded by wood and wood products all my life.  I’m just beginning to find out how they happen.

 

 

Metric ambivalence and slices of Canadian life

June 5, 2017

Out here where it’s too north for wheat,

People use both meters and feet

The confusion rebounds

Between kilos and pounds

But can Celsius make Fahrenheit delete?

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Canada officially uses the metric system, but, unlike New Zealand, they have a lot of ambivalence. Today, at the grocery store (the town has a very good one) we bought things by the ounce, pound, gram, kilo, fluid ounce, quart, milliliter, cc and liter. Carpenters use 2×4’s, plywood comes in 6’x8’sheets.  Most everyone uses Celsius to talk about the weather (even I know my favorite metric temp is 18), but when I ask about fever, half the people answer in Fahrenheit.  One patient described an involuntary loss in pounds, but all the clinic scales weigh in kilograms.  Almost no one knows their height in meters, but they do know their height in feet and inches.   People talk about their cars’ mileage in kilometers per liter, but don’t recognize the linguistic dissonance until I point it out.

At one point this last week I sat with the patient while waiting for a staffer to bring some documentation. The patient told me about an American TV game show, where contestants were asked how safe they feel in their homes, and some didn’t feel safe at all.  The patient asked, “Are things really that bad in the US?  Are people really that fearful?”  I said that it all depends on the place.  I had just finished 14 weeks in a small town in Iowa where people leave their houses and cars unlocked despite the presence of a prison in the town.  On the other hand the big cities have their high crime zones.  “How safe do you feel,” I asked, “In Vancouver?”

Gasoline runs a little over a dollar a liter here, which comes to $3.17 per gallon at current exchange rate. Quite inexpensive compared to New Zealand, and very reasonable considering the distance it must be trucked to get here.  The country has no posted speed limit higher than 100 kilometers per hour (about 62.3 MPH).  Because I take speed limits seriously, as I have no wish to get another international speeding ticket (I had one in New Zealand), I get great mileage in the small Korean car I rented.  But I get passed a lot.

Cigarettes here run $12/pack, a little less than twice the price in Iowa. The national rate of smoking in the US dropped to 16% two years ago, in Canada it’s now 15%.  Still, more than half of last week’s patients smoke.

A surprisingly large majority consumes no alcohol, and almost no one uses marijuana. At least, that’s what they tell me.  And I believe them.

 

Uncertainty usually strikes at least twice

November 2, 2016

Only a second was I left perplexed

And then with the changes I flexed

I know what to do

When the plans all fall through

I ask, What shall we do next?

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor.  Just back from a Canada moose hunt, I’ve worked a couple of days in northern Iowa, and I’m taking a few days off.  Any identifiable patient information has been included with permission.

I have been working on practicing in Canada for 20 months. Six weeks ago I thought I was within 2 months, then 3 weeks ago learned that my case would have to go through immigration because I have no plans to immigrate.  And that their review would take 6 months.

OK, I know how to deal with uncertainty. Bethany and I talked for about 10 minutes, with the unspeakable luxury of discussing, Where shall we go next?

If I had the chance to tell me as a teenager what life would look like 50 years in the future, I would not have believed me saying that such freedom could exist in the real world. We decided on interior Alaska for the winter.  And I decided I wanted to work for the Veterans’ Administration, because they have been so very good to me.

I got on the net, I plugged my headphones into my cell, and I started the process. VA facilities run shorthanded chronically, but the one in Fairbanks no longer works with agencies.  And they are willing to work with me directly.

Over the next couple of days I got emails from several people in the institution with a far warmer and friendlier tone than I expected.

Last week I started the credentialing process. I put in a mere 7 hours, finishing yesterday with a trip to FedEx.

Because I cut the agency out, I’ll have to arrange my own housing and vehicle.

Tonight I talked with a man who specializes in selling cars to seasonal Alaska workers and buying them back when the jobs are done. I’ll wait till things have firmed up till I start contacting real estate agents and other housing mavens.

Yesterday I learned that that my putative Canadian gig had found permanent recruits and wouldn’t need me.

Uncertainty, part of the human condition, runs rampant in the locum tenens business, and struck again in less than a week. Yet from experience I know if something falls through, I generally end up having a better time with my second, third or fourth choice than I would have with my first.

I got out my 3×5 cards and started making notes as I cruised Googlemaps and Wikipedia.

I read stuff to Bethany, and we talked. She doesn’t want to go anywhere reachable only by small plane or snow machine, or that has under 1000 people.  I, in turn, define my professional zone of comfort as less than 2 hours from the nearest surgeon.

We have to have indoor exercise facilities for both of us, internet access, and at least one grocery store. Nice options would include a cinema, indoor archery range, and recreational fishing.  I would like to walk to work, and Bethany would like to be able to get work as a teacher.

We’re looking forward to the next adventure.

 

 

Reverse Snowbirds

October 19, 2016

North we are planning to go

For the experience, not for the dough

If we prefer cold to heat

Can Alaska be beat?

We’ll wait for the dark and the snow.

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor.  I just returned from a moose hunt in Canada.  Any identifiable patient information has been included with permission. 

Yesterday featured a volley of emails and phone calls to Canada.

American liberals love the Canadian medical system; American doctors love to hate the Canadian system. Neither side understands it.  I want to experience it firsthand.  To that end I’ve been working on getting a Canadian license.

Rural areas in both the US and Canada face terrible shortages of medical personnel. Even doctors willing to work in small communities have to overcome enormous hurdles for licensure if they come from out of the country.  In the US, physicians and other skilled workers from other countries bring diversity to the hinterlands.

I wouldn’t bring much diversity to Canada.

After quite a saga, I’ve gotten to the point of talking with a facility in northern British Columbia. They need me, I’d like to work for them, but I have no intention of immigration (though the social fallout from the election could change that).  After I get a formal job offer, the facility needs to file a Labour Market Impaction Application (LMIA) with Immigration.

Yesterday I learned that a realistic time frame for having Immigration review the LMIA and act on it would be six months. I had planned a mid-January start date.

So Bethany and I sat at the table and asked, Where do we want to go?

It took about ten minutes to decide to go back to Alaska, where we have had such wonderful experiences. And, because the window would come smack in the middle of the winter, we decided on the interior, far from the moderating effects of the ocean, where we’ll face cold more intense than Barrow.  Bethany specified she didn’t want to get in a small plane to get there.

I put several items on my original walkabout agenda back in 2010, among them the Veterans’ Administration, because they’ve been so good to me. I let my fingers do the walking through the Internet.

I introduced myself to the clinic manager and asked if she needed any locums. The sunshine in her voice radiated through my cell phone when she said “Yes.”

I specified the agencies I’ve worked with, emailed my CV, and set up a phone interview with the Chief of Staff.

On the phone today I found out that they need me enough to consider working around the lack of authority to make a contract for a locum tenens.

I usually say yes to 6 assignments for every one that actually happens, and I have come to embrace the uncertainty.

Hearing loss and moose hunt

October 15, 2016

There’s a ringing I have in my ears

I sure hope that it clears

Perhaps on its own

Or with prednisone

For deafness is one of my fears

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor.  I just returned from a moose hunt in Canada.  Any identifiable patient information has been included with permission. 

We first spotted the moose on a hill about 170 yards from the lakeshore. He moved just before I pulled the trigger.  The guide started to call, and the moose came to us, his antlers swinging at the level of the boreal forest tree tops.

With my crosshairs on the bull’s sternum, I pulled the trigger when the distance closed to 60 yards, and my ears started to ring.

Age-related hearing loss runs in my family. My mother and her mother needed hearing aids before they reached my age.  But neither of them stood in front of the drummer playing sax for an R and B band, hung out in discos, nor had anything to do with firearms.  I could still hear bats at the age of 26, but the highs gradually faded.  I started hunting in my 30’s and after the first few years of firearms use I got conscientious about hearing protection.  Later I bought occlusive hearing aids with a limiter circuit, so I could hear a pheasant taking off or a deer approaching, but nothing louder than 85 db would transmit to my ears.  The devices worked fine hunting pheasants in January.

But they failed to protect my ears from the blast of a 7mm Remington Magnum.

The death of an animal, even a mouse in a trap, always hits me spiritually. I have never killed a moose before, and when he crumpled he left a palpable hole in my universe.

When the moose stopped moving I found my hearing had fled.

Over the next couple of days my hearing improved. As soon as I got home I contacted the audiologist.  He found I’d lost 20 db on the left and 10 on the right.   He adjusted my hearing aids and talked to me about vitamins.

Luckily, I’d already ordered an electronic stethoscope.

The next day I went for acupuncture. But on a physician’s social media site, I posted a question about treatment for acute noise-induced hearing loss.  More than one doc said it served me right for killing such a majestic creature, a thought I had already had.  But a few mentioned steroids.

I never self-prescribe; I called my ENT, and I started steroids today.

I hope they work. I’m not done listening.

Aging truckers and doctors

October 13, 2016

In the land of the poplar and spruce

I saw the eagle, the crow and the goose

I cooled my seat

While they processed the meat

That came from a 30-inch moose

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor.  I just returned from a moose hunt in Canada.  Any identifiable patient information has been included with permission. 

 

I went moose hunting in Manitoba, and shot a young bull at about 60 yards. (For the firearms enthusiasts, I used 175 grain bullets in a Weatherby Vanguard 7mm Remington Magnum.)  To paraphrase Jose Ortega y Gassett, eating justifies the kill, the kill justifies the hunt.  I really had no idea of the enormity of the northern Canadian wilderness.

I drove north out of Sioux City through Winnipeg to Thompson, about 16 hours. Past Thompson, one can drive east or west but no further north.  An hour by float plane put me onto a lake where the living moose have seen humans only for two weeks last year.

The camp consisted of a wall tent with a wood floor, big enough to sleep two hunters and a guide comfortably.

We hunted by boat, cruising the shore line. I shot the third moose we saw, three days into the hunt.  After that we took care of the meat, went fishing, and loafed.  With no internet, I didn’t post anything though I continued to write.

After the hunt I stayed in Thompson getting the meat processed and frozen. In the Days Inn that Saturday I struck up a conversation with a married trucking couple.  They drive separate rigs together in Canada, and his engine needed work for a day or two.

They love their work, but, in his early 60’s, he’s looking forward to retiring. Over-regulation has robbed the job of much joy.  He finds it no longer feasible to drive in California because a drop of oil onto a white sheet of paper results in a fine and in turning back at the border.  That state stringently enforces emission rules, mostly in the form of expensive inspection stickers.  Log books, now electronic, can no longer be juggled.  While Canada permits a solo driver 13 driving hours per day, the US only permits 10, and he finds it difficult to make driving in the States profitable.

He could diagnose and fix almost anything wrong with a truck made before 1995, but since then computers have taken over the engines. A mechanic needs certification, with a week update training every 2 months.

I sympathized. Doctors, I said, have seen regulation erode earning potential.  Clinical improvement justifies about 10% of those regulations, and the rest just take more time.  Recertification, a hot button issue, occupies more time and energy than it deserves.

Both fields have changed markedly in the course of our careers. The older generation, voting with their feet, is retiring earlier than they had intended because of the problems.

But autonomous big rig trucks will replace human drivers in the next 20 years. Every society needs doctors.  At least for the foreseeable future.

 

Faded Signatures: 4 Months to BC License.

December 6, 2015

They might think that I’ve misstated

Or perhaps I’m just overrated

This back-and-forth trial

For a license denial

Because the ink at the bottom has faded.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer  and fall included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, and working Urgent Care in suburban Pennsylvania. Right now I’m in Virginia for the holiday.  Any patient information has been included with permission.

This afternoon I got a call from the British Columbia recruiting agency, and my learning continues.  As it turns out, they have plenty of docs trying to come in and get jobs in coastal BC. Any installation trying to get a locum tenens doctor has to do a great deal of documentation before they get approval, worse if that doc comes from another country.  The bureaucratic hoops seem insurmountable.  But when I told her I planned to go to the northern, interior part of BC her voice audibly brightened.  I might stand a chance, but, in all honesty she said, it will probably be at least 4 months.

I learned that each Canadian province has its own Electronic Medical Record system, and if I don’t get my BC license, Alberta might be easier.

And I explained I might have a problem getting a license.

Last night I received an email from the Canadian website where I’ve sent my credentials.  They want a better copy of my residency certificate.

After 4 years of medical school, a physician who wants to practice goes to post-graduate training, or residency.  Non-surgical specialty training generally runs 3 years, surgical specialties like cardio-thoracic or ophthalmology take 5 to 7.  At the end of my term in Casper, Wyoming, I received a paper certificate mounted on wood and protected by laminated plastic.

The Canadian agency in charge of vetting my credentials so they can be reviewed by other agencies said that they’d looked at the copy of my residency certificate, and they couldn’t read two of the three signatures at the bottom.

My email back to them noted that the certificate had been faded by exposure to fluorescent light for 26 years and sunlight for 23 of those years. The signatures weren’t very legible to start with, and I couldn’t do better than the professionally-made copy I’d sent.

In the 21st Century, due diligence demands verification of all credentials.  The hours of investigation easily justifies the Source Verification Request fee I’ve already paid.  They should not just take my word for it.

I still face the hurdle of poor documentation of my gynecologic training during residency.

But I have a tiger by the tail.  Every application I fill out asks if I’ve ever been denied a license or if I’ve ever withdrawn an application.  So far I’ve answered, in honesty, “no.”  Withdrawing an application reflects badly on me.  But license denial because of an illegible signature doesn’t.