Posts Tagged ‘Canadian medical system’

Speechless during a speech

February 20, 2018

I stood up to give a talk

And then a Canadian doc

Said “You may want to switch

To a province less rich.

It might be a bit of a shock.”

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. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. I’m taking some time off after a month of part-time (48 hours per week) work in northern Iowa. Any identifiable patient information has been included with permission.

I originally went to work in Canada to learn about the medical system first hand. Of course I want to share the knowledge, and I put together a half-hour lecture for the County Medical Society.

I managed to arrive at this late date without learning Power Point. But having adapted to 15 electronic medical record systems in the course of 3 years, I figured that putting together a PP presentation couldn’t be very difficult. And, indeed, in less than an hour I found myself creating slides and downloading images from the Internet.  My brother, an accomplished graphic artist, provided me with two illustrations.

American physicians do not want to hear that the current Canadian system is better for the doctors than the American system, especially not the ones who came from Canada. I hasten to say that the systems now are not what they were 20 years ago or even 10 years ago.

Still, a Canadian ex-pat pointed out that I had chosen Canada’s most prosperous province (which I hadn’t realized), and that least-prosperous Nova Scotia might have given me a different view-point.

Over the next 3 days, I talked to 3 American doctors far from burnout. Two of them, both in their 60s, have refused to acquire electronic medical record systems.  One refuses to take insurance.

A week and a half later, I gave a slightly different version of the same talk to first- and second-year medical students in Des Moines. The audience’s palpable idealism impressed me, and I pitched my presentation to those struggling with the basic sciences.  I advised them that burnout is a very real problem.

The early warnings about burnout happened early in my medical school career. The dean of the med school, in the first week, told us that if we didn’t take care of ourselves eventually we’d be of no use at all in the medical system.  I don’t think he could have foreseen the escalation of burnout now threatening the system, nor that it would come not from emotional exhaustion, but from frustration with electronic medical record systems and overreach by management and government.

Twenty minutes into my talk, my phone gave me a text chirp. I ignored it and kept talking.

At the end, I took questions. One of which, almost word for word, got asked at the County Medical Society meeting:  What one single, practical thing can be done to improve our system?

Go to a single level of service, I said, instead of the 5 that we have now.

I got four questions from the audience, three others on 3×5 cards, and five more as the students exited on their way to the next class, snagging leftover pizza.

Then I looked at my phone. My physician daughter had given birth to her second child, a daughter.

And then, for about five minutes, I was speechless.

It doesn’t happen often.



Why I Came, and Can I Fix the American System When I Get Back?

August 14, 2017

My reasons? I’ve got quite a few

I didn’t want to say I withdrew

My application

But my rationalization

Got me to work with the right crew.

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.

The patient (who gave me permission to write a good deal more about her than I have) asked why I came to British Columbia.

A lot of people ask me that question, and I truncate the truth, too complex for brevity. In no particular order:  I have a thick stubborn streak.  I had a tiger by the tail: see the project through or have to say that I’d withdrawn an application for licensure.  I wanted to spend more of my time taking care of patients and less time at meaningless but marginally lucrative mouse clicking.  I have a sense of adventure.  I wanted to know the truth behind what US doctors vilify and US liberals champion but neither have any experience or knowledge about.

There are more.

So I just said, “I wanted to know find out about the Canadian system.”

As I opened the door she asked, “So, when you get home, are you going to fix the American system?” I said, “No, but the first step is educating the American docs. And I’m not sure they’ll believe me.”

Actually, I don’t think the liberals will believe me, either.


Last night the smoke from the forest fires drifted into town. The dramatic evening sky progressed from intriguing to eerie.  Finally, darkness fell, thick and hard, two hours early.  The smell of smoke kept me from falling asleep.  This morning we watched the news for two hours to see how close the fires are.

We don’t want the fires to come this way. Too close and the town dies from lack of wood.  Much too close and the whole city goes up in flames.  I wouldn’t want to have to evacuate, and I don’t know which way we would go.

We’re seeing an increase respiratory problems from the smoke. Some people have come in from BC’s largest city, Prince George, because of air quality.


Last time I was on call, I saw 14 patients, and 3 diagnoses accounted for 13 of them: back pain, abdominal pain, and left facial pain. The only one not covered by those three complaints came in before the others, and left, cured.


Badly kept residency records, and Canadian license

November 17, 2015

On the list I’m making the checks,

I sent for my scores from the FLEX.

There’s loads of email

But the process could fail

On the training of the feminine sex.

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 included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, and working Urgent Care in suburban Pennsylvania. Any patient information has been included with permission.

I find myself in the process of applying for a Canadian license, specifically for British Columbia.

I want to experience the Canadian system first hand, and compare it to the realities of the current US system.  Then I want to write about it.

That Canada has a national electronic credential depository called makes sense.  I suppose I should have looked more carefully to find the SHARE DOCUMENTS button.  Today I found it and used it.

I don’t blame them for wanting letters from my employers for the last three years, documenting scope of practice and hours.  But how would that work if I had been self-employed during that time?  Actually, I was self-employed during that time; I got pay checks from the locum tenens agencies but as an independent contractor.  Positive they didn’t want me verifying myself, I sent emails off to the agencies.  All of them.

In the summer of 1979, I took a 3 day examination called the FLEX in downtown Denver, Colorado.  About 250 well-educated doctors came together in a cavernous hall.   All the other tests I’d taken up until then counted for nothing more than practice.  I remember that every 45 minutes or so I would have to put down my pencil and shut my eyes for 30 seconds so that I would start caring about the test again.

The Canadians want the original score from that test, and I suppose I can see their point.  I got that task done with a brief Internet search and a credit card outlay of $70.

The licensing process may very well fail on the faded records from my residency.  I had 18 weeks training in Obstetrics, but gynecology didn’t warrant any kind of mention.    And the College of Physicians and Surgeons of British Columbia wants to make sure I had adequate training.  Even though 90% of what I learned then is now incomplete, hopelessly out of date, or just plain wrong.

I spent a long morning on the phone and at the computer, making calls, leaving voice mails, asking for letters and certifications.  Without exception, the Canadians I talked to were polite, friendly, professional, and well-trained.  Their gentle reassurance carried the message that things would be fine, and my license will happen.

I keep an open mind.  If this adventure doesn’t work out, something else will.

I lunched with a colleague who works ER.  I picked his brain for stories of real major trauma.  While we talked about medications, management, techniques and tools, we couldn’t escape the discussion of drama, irony, and tragedy in the face of human bodies damaged by the inevitable truth of physical laws.