Posts Tagged ‘British Columbia’

The diversion of patients because of forest fires

July 12, 2017

The forest, it seems, is on fire.

And the wait can sure make me tire

When our referral facility

Has maxed capability

And my patients have problems most dire.

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.

As I write this, 183 wildfires rampage through the wilds of British Columbia. The smell of wood smoke permeates the air and a haze hangs over the nearby mountains.

We have been lucky during this last week of fires, with 3 days of solid, soaking rain. But with complex topography comes complex weather patterns, and nearby valleys have had no precipitation at all.

Yesterday I had call. I took care of people with problems in their skins, bones, throats, lungs, hearts, eyes, abdomens, fingers, toes, brains, ears, and genitals.  Two came in close together, with problems exceeding our facility’s capability.  I ordered blood work; I like to sound prepared when I speak to a doc in a referral center.  Then I waited.

And waited. When I got results back, I called the hospital in Prince George to speak to a couple of consultants and to formulate a plan, then I had the central ambulance dispatching service called.

Theoretically, the dispatch centralization makes sense; practically, however, it means a terrible delay in getting patients into the ambulance.

I had hoped to send both patients in the same vehicle to Prince George, but in the course of making arrangements I found out that the number of injuries coming in out of the forest fire had overwhelmed the schedule for sophisticated diagnostic tools, and couldn’t I please send the second patient to Dawson Creek?

It meant a longer delay for the second patient, but I agreed, and called the ER there with a bizarre, creepy history perfect for the opening of a horror movie.

Of course, in the hours between the arrival of those two patients and their departure, other patients came in for treatment.

At six I walked to the hotel to eat supper with Bethany. I had been continuously occupied for the previous 10 hours.  I wolfed my food, napped briefly, and walked back to the ER.

I started in on documentation, typing directly into the Electronic Medical Record. I continued between the patients who kept trickling in.  I ran into a surprising number of patients with back pain who adamantly spoke against narcotics (and I agreed with them).

I finished at ten, and returned to the hotel. I had attended 21 patients.  The emotional fatigue of waiting to transport those two critical patients far exceeded the physical tiredness.

And then I had no calls for the rest of the night.

Thursday last week I started to work

June 4, 2017

I took care of the patients I got

I gave a couple a shot

But for one of the rest

I’ll need quite the test.

The work just hit the spot.

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 started the day early, and lingered over breakfast while I watched a YouTube video about the underlying geology of northern British Columbia. The clash of tectonic plates has resulted in a coastal mountain range separated from the west edge of the Canadian Rockies by a central valley, everywhere scarred by the violence of glaciers.  All in all, I’m experiencing lovely scenery in an orderly, safe community where the children can walk unaccompanied to school.

Now 4 days into my Canadian adventure, I came to work this morning prepared for orientation in MOIS, the Electronic Medical Record (EMR) system (and my 15th in 30 months), but, alas, still lacking password sign on.

I took care of the latest, and hopefully last, couple of glitches in my bona fides. I did some email.  At the very last part of the morning, I started EMR training, which I followed by playing with the test patient named Mickey Mouse.  I knew immediately his birthdate was off, but finding citalopram (an antidepressant) on his med list came as no surprise.

When I came back from lunch, I had my first patient on my schedule.

I immediately fell back into my 3 question rhythm: Tell me about your problem.  Tell me more.  What else?

Though just starting on the learning curve for the EMR, and though I needed EMR coaching 5 times for 6 patients, this system seems easier to learn than most. Or maybe I have learned how to learn.

Two patients needed injections, three patients’ problems centered on their right leg. The last patient of the day turned out to be more complicated than anyone could have imagined, and will need follow-up and work-up.

To my surprise, the doctors here do their own injections, a job in the States uniformly delegated to RNs, LPNs, and, sometimes, Certified Medical Assistants. I have had to learn injection techniques on myself, as I take vitamin B12 shots into the muscle monthly, and Enbrel injections into the fat just under the skin every 5 days.

I took care of a total of 6 patients in the afternoon. Still clumsy with the EMR, I didn’t finish until 5:00PM, an hour after the clinic closed, but still a good deal earlier than what I’ve been doing for most of the last 40 years.

I thoroughly enjoyed myself.

 

 

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.

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.

 

 

 

 

Canada, rainbow’s end, and pheasant glass

May 12, 2015

In the evening I dove east in the rain
With a rainbow out over the plain
No matter what you’ve been told
At the end, there’s no gold,
But in fall, we just might have grain.

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 System (EMR) I can get along with. Just back from Nome, Alaska, I’m now in Grundy Center, Iowa.
I drove with the sun at my back, eastwards, from Sioux City towards Grundy Center, across flat farmland dotted with wind turbines. The dramatic clouds in front of me contrasted with the sunshine behind me, clarity against darkness. Bit by bit, a rainbow emerged against the backdrop, first at the north end, then at the south, and finally arched right across the sky.

I could not help but remember our train trip south across New Zealand, between assignments. Seven rainbows graced the skies that rainy day.

I picked New Zealand over Ireland in 2011 because of the medical licensure application. Ireland’s 84-page form brimmed with dense prose, indefinite antecedents and esoteric usage despite nominal English, after a week spent on the first 10 pages I gave it up as a bad bit of work, added it to recycling, and picked up New Zealand’s four-pager, which I completed in an under an hour.

Right now I’m working on a Canadian license. The paperwork so far has been reasonable to the point of unbelievability. In fact, I don’t believe it and I’m waiting for the full weight of bureaucracy to fall across my electronic desktop.

Trish, my recruiter, has guided me with patience and kindness. We mostly talk on her days working at home. In the US, recruiters work for agencies to place physicians where needed; the doc works as an independent contractor. The agency guarantees transportation, professional liability insurance, and housing. I can’t generalize for all Canada, but my recruiter puts doctors together with institutions in need. The professional then negotiates with the employer about rate, insurance, lodging, and transportation. In the end, the Canadian recruiter takes a much smaller piece of the pie. And doctors do their own negotiations.

In the beginning, I had no particular geographic aspirations. I even considered working in Quebec because I speak French (acquired, with Rosetta Stone, last year). Later I realized that the French spelling system with its archaic silent letters would threaten sanity maintenance in a medical environment.

Alberta, Manitoba, and Ontario slipped out of consideration, one by one, for different reasons.
So over the course of the last two months, my recruiter has helped narrow my focus from all of Canada to British Columbia, and I have entered the weird world of international licensure. Each province has its own license authority, just as every state in the Union does, but they have a degree of reciprocity.
Why Canada? Not chasing rainbows. I want to work in the Canadian system, which American doctors love to revile without understanding it. I don’t understand it either; I want to experience it first hand, and write about it. In all fairness, I’ve worked the American system for 33 years and I don’t understand it.

And I have all the rainbows I want, anywhere I go. I came over the crest of a hill, and the north end of the rainbow, always retreating at a fixed distance, shone against the brown and green of the Iowa fields germinating corn in the spring. No pot of gold, no leprechauns, just gleaming yellow, and a moment later, for a thrilling second, the south end of the rainbow popped up out of a gulley.

Then, WHAM, a hen pheasant died on my windshield.