Posts Tagged ‘direct patient care’

Talking Canadian Licensure With a Canadian

August 31, 2018

To her home the doc wants to go back

It took time, but she’s facing the fact

She has nought left to prove

So she decided to move

I told her she just needs to pack

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. After a month of part-time in northern Iowa, a new granddaughter, a friend’s funeral, a British Columbia reprise, and my 50th High School reunion, I’m back in Northwest Iowa.  Any identifiable patient information has been included with permission

I had a good long phone conversation with a Canadian national, a physician working in the States considering going back home, for a lot of reasons.

Right now she attends patients in a high-crime area with brutal heat and humidity, in the sunniest part of the sun belt. She loves teaching, and she loves medicine.

She talked about her aging parents in Ontario. She asked me about scope of practice and professional climate for docs seeking licensure in Canada.  And how to go about the process.

Honesty seized me. I couldn’t talk about her specialty or academic medicine at all. I could barely talk about big city medicine.  I told her how much I loved my spot in northern British Columbia and what huge hassles I’ve been through to work in Canada.

I couldn’t tell her what difficulties she’ll find getting licensure in Ontario, because Ontario is not British Columbia. After all, my Alaska license came easily, my Pennsylvania license did not.   She will not face the 5 months of ricocheting emails caused by hard-to-read signatures on 35-old-residency certificates, nor another 5 months of frustration caused by accidents of history in the development of Family Practice training.

She probably won’t face a 7-month dead-end with a private recruiter.

She won’t need a work permit because she’s Canadian, and she probably won’t need a physical.

We swapped bits of our backstories. I talked about how my curiosity got me north of the border to start with, but how the practice climate keeps me coming back.

We talked about how the insurance industry and government (under the guise of Medicare) used the Electronic Medical Record systems to steal the joy from medicine. We face rapidly expanding nets of regulations that demand more work but do nothing for patient care.

In the end, we agreed that we love the work despite the administrative hijacking.

When I hear American physicians whine, I tell them they can move, quit, go to Direct Patient Care (where the doc gets paid out of the patient’s pocket), keep whining, or just lay back and take it.

The Canadian internist arrived at the same narrow list of choices, and decided to move back home.

Limited Options: in the wake of Obamacare

October 1, 2015

What are they trying to prove?

With this Obamacare groove?

We have limited choice

And limited voice

If worst comes to worst, we can move.

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, and two weeks a month working Urgent Care in suburban Pennsylvania. I’m attending a medical conference in Denver.  Any patient information has been included with permission.

After lunch I sat in on a round table with a group trying to get out the message on a single payer system.  Our insurance companies currently take between 20% and 25% of our health care dollar and return nothing of value (physicians get 9%).  For every doctor we have two people employed by the insurance industry.  Doing away with the insurance companies would not cure all, but it could go a long way.  A doctor at the table made the comment that we already have a model for a single payer system in this country, TriCare, which gives medical care to Department of Defense, and the Veteran’s Administration.

Yet American doctors love to hate the single-payer Canadian system.

We all voiced frustrations with currently available Electronic Medical Record (EMR) systems.  Updates uniformly brought progressive loss of functionality.  The VA’s system, in use for decades with no updates, continues to function well.

I talked about my experience in New Zealand, a polite society with a very good medical system and a single, nation-wide EMR.  Socialized medicine, but ruled by reason.

Doctors in the US have seen their productivity fall by 25% since Obamacare; we spend increasing amounts of time keyboarding and jumping through regulatory hoops.  We devote more time to documenting the visit than we spend with the patient.  We have few options:  live with the way things are, move, find another line of work, or go to Direct Patient Care (DPC).

DPC means that the patient pays the doctor directly.  In concierge practices, a fixed yearly amount brings the doctor’s promise to limit the panel of patients to a fixed number and provide quick access with unlimited long appointments.

Other DPC docs perform primary care services, take cash only, and give the patient a receipt.  The patient can, if they choose, submit the bill to the insurance company.  Dealing with insurance requires one employee per doctor; elimination of insurance means lower overhead.  More than that, senseless time-sucking regulations can be ignored.

I hear doctors speak seriously about moving.  They would take a cut in pay to spend more time with patients and deal with a more reasonable system, even a single-payer system.

I want to work in Canada to experience it first-hand.  And when I come back, I might work locums for the Department of Defense and/or for the VA.