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B.C.'s doctor drought

Re: B.C.'s doctor drought

Postby Rwede » Dec 21st, 2017, 8:31 am

The Green Barbarian wrote:*removed*


Agree 100% with GB.

Dix and his 1990s gang of bozos are the reason BCers can't find a family doctor.

And to compound the problem, Dix and his 2017 gang of bozos are making BC unattractive for any doctors thinking about coming here to open a practice. Threats of higher taxation and punitive increases in things like carbon taxes chase away high income earners like doctors who are free to pick and choose the jurisdiction they want to do business in.
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Re: B.C.'s doctor drought

Postby Cactusflower » Dec 21st, 2017, 10:48 am

hobbyguy wrote:
If you look at my post, it is not an NDP issue, it is not a Liberal issue, it not a party/partisan issue at all. It is really a failure of all politicians to look at the long term and properly manage the system without interfering.

The only two politicians that I can think of, in the last 15-20 years, that have even made a serious effort to come to grips with the SYSTEM management problems are Rona Ambrose and Jane Philpott. Unfortunately neither is involved anymore. They may have ruffled some feathers, but feathers need to be ruffled, the status quo has been a downhill slide.


Thanks for that HG. Now perhaps we can get back to the topic at hand instead of trying to turn it into another anti-NDP soap-box derby. QK brought up the question as to why more immigrant doctors aren't brought into the system. I think we should pursue that, don't you?

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Re: B.C.'s doctor drought

Postby Queen K » Dec 21st, 2017, 11:01 am

I did but it's an old argument. There are language barriers involved sometimes and money issues. Mainly our government has to fully support foreign nationals while they try to cope with a new country and go back to school in a society that is expensive to live in if one is focused on quality of life. I don't know who decides who had merit to get into our medical system and who doesn't. Why are Drs selling cars? To supplement their tuition? That's crazy.


Rwede wrote:
The Green Barbarian wrote:or we could something he actually might respond to, and flood him with forged memos. Dix is a bonehead. What we should be focusing on is flooding the Weaver's email with requests to take down the NDP, and then we can start getting back to fixing the problems started by Dix and his gang of bozos in the 1990's.


Agree 100% with GB.

Dix and his 1990s gang of bozos are the reason BCers can't find a family doctor.

And to compound the problem, Dix and his 2017 gang of bozos are making BC unattractive for any doctors thinking about coming here to open a practice. Threats of higher taxation and punitive increases in things like carbon taxes chase away high income earners like doctors who are free to pick and choose the jurisdiction they want to do business in.


Ya know, we don't disagree on everything. This statement is one of those. I don't know how to fix it for just say, Doctors, but I do believe their could be some Dr.-only incentitves to assist them to come to remain practicing in Canada. How about student debt relief? Or better supplied hospitals in rural areas? And I don't mean supplies bought from the proceeds of Clearwater's thrift store, I mean government funded supplies. Let the thrift stores donate monies for smaller medical needs.
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Re: B.C.'s doctor drought

Postby hobbyguy » Dec 21st, 2017, 11:02 am

Rwede: Nope. I would love to trash the NDP, as I have zero respect for them, but in this case it has pretty near zero to do with the NDP.

It is a systems problem that has deep roots in the tensions between the federal and provincial governments, old fashioned "top down" hierarchical management, and demographic change that while very foreseeable has not been responded to.
We can have democracy in this country, or we can have great wealth concentrated in the hands of a few, but we can't have both. - Louis D. Brandeis

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Re: B.C.'s doctor drought

Postby seewood » Dec 21st, 2017, 11:09 am

As mentioned, there are doctors in our country that are not able to practice their profession due to a difference in standards.
OK , I get that but I might have mentioned this here in the past but why not have doctors that have come to our country do a series of equivalency exams perhaps, see where they are compared to North America standards. Once done, slot them into an upgrading program and bring them up to our standards and once competency has been achieved, have the new doctors trained to our standard do a 2-3 year stint in a rural setting. Controversial, but perhaps hold their passports so they don't zip to the states.. If they complete the 3 years, the tuition for the upgrade is forgiven?
I'm not really a fan of head hunting from other countries as the doctor shortage there is exacerbated. If they emigrate and get in by normal process try it and see what happens....
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Re: B.C.'s doctor drought

Postby hobbyguy » Dec 21st, 2017, 11:39 am

IF you re-qualified every doctor currently in Canada that is not practicing because of certification issues, it would have an impact, but not enough to solve the problem.

It is a careful and difficult balance to assure Canadians that physicians are properly qualified. Then you layer on professional organizations and academic regimes that are "protective of their fiefdoms", then you layer on governments that took the :easy way out" approach by trying to poach foreign doctors rather than have proper training regimes (I can not really blame some of our provincial governments, as the $$$ spent were, for a while at least and probably still, training doctors that would head south for the $$$).

The biggest barrier at the moment seems to be a lack of residency openings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868812/
http://calgaryherald.com/storyline/skilled-immigrants-wasting-their-talents-in-canada

"There’s a joke in Toronto that the best place to have a heart attack is in a cab because there’ll be a doctor driving that cab,” said Margaret Eaton, executive director of the Toronto Region Immigrant Employment Council.

In reality, fewer than one per cent of immigrant doctors drove taxis, according to the 2011 National Household Survey.

But almost half never get to practice medicine in Canada."

The question of "poaching" doctors from other countries is a difficult one in and of itself, and not without controversies.

Definitely not a simple issue.
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Re: B.C.'s doctor drought

Postby Cactusflower » Dec 21st, 2017, 12:39 pm

hobbyguy wrote:IF you re-qualified every doctor currently in Canada that is not practicing because of certification issues, it would have an impact, but not enough to solve the problem.

It is a careful and difficult balance to assure Canadians that physicians are properly qualified. Then you layer on professional organizations and academic regimes that are "protective of their fiefdoms", then you layer on governments that took the :easy way out" approach by trying to poach foreign doctors rather than have proper training regimes (I can not really blame some of our provincial governments, as the $$$ spent were, for a while at least and probably still, training doctors that would head south for the $$$).

The biggest barrier at the moment seems to be a lack of residency openings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868812/
http://calgaryherald.com/storyline/skilled-immigrants-wasting-their-talents-in-canada

"There’s a joke in Toronto that the best place to have a heart attack is in a cab because there’ll be a doctor driving that cab,” said Margaret Eaton, executive director of the Toronto Region Immigrant Employment Council.

In reality, fewer than one per cent of immigrant doctors drove taxis, according to the 2011 National Household Survey.

But almost half never get to practice medicine in Canada."

The question of "poaching" doctors from other countries is a difficult one in and of itself, and not without controversies.

Definitely not a simple issue.


Excellent links, HG, especially the second one. But the most interesting and informative part of that article comes after the story about the MacDonald's burger-flipping Brazilian pediatrician and your quote which ends with "But almost half never get to practice medicine in Canada."

After reading that, plus the summary of the first link, I'm convinced that our doctor shortage could be solved with some tweaking of the regulations set out by the regulatory bodies.
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Re: B.C.'s doctor drought

Postby Rwede » Dec 21st, 2017, 1:30 pm

*removed*


We've worked hard to have world class health care in this country. Diluting requirements and standards to remove responsibility from Dix and Horgan's putrid record on this file (now and in the past) is not the answer.
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Re: B.C.'s doctor drought

Postby hobbyguy » Dec 21st, 2017, 3:35 pm

Rwede wrote:
Cactusflower wrote:After reading that, plus the summary of the first link, I'm convinced that our doctor shortage could be solved with some tweaking of the regulations set out by the regulatory bodies.

*removed*

We've worked hard to have world class health care in this country. Diluting requirements and standards to remove responsibility from Dix and Horgan's putrid record on this file (now and in the past) is not the answer.


That will make a nice new avatar.

Nobody has said we should dilute standards. Just improve the mechanics of obtaining the certifications to meet the standards.

But as I have said, that is a small part of the issue. There still won't be enough doctors. You MIGHT pick up enough so that the problem of family physician shortages does not get worse for 2-3 years. That can be deduced from this report: https://www.cfms.org/files/meetings/sgm-2016/resolutions/16-_IMG_Backgrounder_Proposal.docx

In particular, family medicine is challenged. Anecdotally, there are graduates in other medical specialties that have trouble finding work in Canada. We don't know, as far as I can tell, how many of the IMG physicians stuck without Canadian certification that would qualify or want to go into family medicine. IF it follows the pattern of graduates, then only roughly 35-40% of those "stuck in limbo" would be family physicians - far short of "filling the gap".

Like it or not, the system model of physician front line care is not going to be able to cope.

Chronic care needs continue to rise, and are forecast to accelerate. Not only is there the fact that we will not have enough physicians to meet that growing need (we already don't), but cost and efficiency needs dictate we are going down an expensive rabbit hole if we focus on maintaining/improving the status quo.

Some of the products of our status quo system is just dumb. Here is my personal and simple case:

I have risk factors for developing glaucoma, so it makes sense to monitor my eyes for untoward developments.

1) getting an appointment with an ophthalmologist can be a lengthy wait, which indicates that there are not enough to go around
2) a visit to the ophthalmologist isn't cheap for the system, monitoring requires at least 2 visits per year

It took some convincing, but my care for that is now organized in a much more cost effective way:

1) the necessary additional test is added to my annual optometrist eye exam which I pay for, and that avoids an ophthalmologist visit
2) additional testing is scheduled with the optometrist at a lower cost to the system, and that avoids more ophthalmologist visits
3) test results are forwarded to the ophthalmologist and an exam every 4 years is done by him.

What that does, by thinking outside of the box just a little, is compress 8 ophthalmologist visits into 1, which both saves the system $$$ and frees up 7 ophthalmologist visit spots for patients who really need that specific attention.

The outcome, for me, as a patient, is every bit as good, and more convenient. IF the optometrist sees any sudden changes/reasons for concern, then it is back to the ophthalmologist.

The outcome for other patients is that it is easier to get an appointment with the ophthalmologist.

The outcome for the system is lower cost.

Win-win-win.

That simple example shows the kind of small changes that can be done if the SYSTEM is rationalized and modernized through better and more efficient management systems like Lean methodology that allow changes to come from the health care professionals.

What would that accomplish? Go back to my case. Let's throw some ballpark numbers at it:

1) assume an ophthalmologist can see 16 patients per day
2) assume that 20% of her/his patients are similar to me

220 working days x 16 = 3,520 patient visits.
3520 x .20 = 704 visits by patients like me.
15/16 of those 704 visits could be handled by the patients optometrist = 660 visits.
660/3,520 = 18.75% more ophthalmologist visits available.

So it is possible that that single item of rationalized care would improve patient access to ophthalmologist care by 18.75%, yet not one single additional ophthalmologist need be hired.

When you start thinking about those kinds of things, the possibilities are very large. How many patients with stable/under control blood pressure have to visit the doctor to get their meds renewed? etc. etc. How many other "ongoing" chronic conditions could be viewed as candidates for "team care"?

I honestly don't know, but what I do know is that when such thinking is applied in industry, the results can be very significant (and most industry settings are nowhere near as bureaucratic as our health care system has become). Yes, soft and human issues are subject such applications of system change, worker health and safety has improved dramatically through such methods.

IF I had to guess, we could improve our health care system by 25-30% just by getting the SYSTEM status quo out of the way of our dedicated health care professionals.

Part of that is how we perceive and measure things. MORE physician visits does not necessarily = better health care (especially if they are unnecessarily as I detailed above). Yet every single measurement study I have seen weights to number of physicians/capita, number of physician visits, etc. That is partly because WE view it that way.

What do WE really want? Health care when we need it, and reasonably close to where we are. IF we remove the unnecessary burdens on physicians, and we modernize the systems (tele-medicine etc.), then WE may find that WE do have enough doctors. I don't care if my health care comes from a doctor, a nurse practitioner, nurse, or other appropriate medical professional so long as it gets the job done.
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Re: B.C.'s doctor drought

Postby Cactusflower » Dec 21st, 2017, 4:43 pm

^^Would this be something that could aid patients like yourself and the optometrist and opthalmologist you mentioned?
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Re: B.C.'s doctor drought

Postby alanjh595 » Dec 21st, 2017, 5:12 pm

How does that address the wait times and the costs? Please try and stay on topic. This is a very sensitive issue for many of us.
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Re: B.C.'s doctor drought

Postby Cactusflower » Dec 21st, 2017, 6:20 pm

^^It appears to me that when a new and improved technology is approved it would stand to reason that steps would be taken to 'nip the problem in the bud' so to speak, eliminating the need for continued visits to monitor a problem which no longer exists.
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Re: B.C.'s doctor drought

Postby Omnitheo » Dec 21st, 2017, 9:31 pm

Cactusflower wrote:
hobbyguy wrote:
If you look at my post, it is not an NDP issue, it is not a Liberal issue, it not a party/partisan issue at all. It is really a failure of all politicians to look at the long term and properly manage the system without interfering.

The only two politicians that I can think of, in the last 15-20 years, that have even made a serious effort to come to grips with the SYSTEM management problems are Rona Ambrose and Jane Philpott. Unfortunately neither is involved anymore. They may have ruffled some feathers, but feathers need to be ruffled, the status quo has been a downhill slide.


Thanks for that HG. Now perhaps we can get back to the topic at hand instead of trying to turn it into another anti-NDP soap-box derby. QK brought up the question as to why more immigrant doctors aren't brought into the system. I think we should pursue that, don't you?


Lots are actually. Lots of South Africans especially. Every place I’ve worked at has had a wide ethnic range, with international doctors full of storied careers across the globe. Doctors come from all over the world to work here in Canada. While people on these forums moan and whine about immigrants, I’m celebrating the contributions they are making, and hard work they are doing for us and our country.
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Re: B.C.'s doctor drought

Postby dirtybiker » Dec 21st, 2017, 10:22 pm

Mine retired, been left in limbo ever since.

Not good !
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Re: B.C.'s doctor drought

Postby GracieD » Dec 27th, 2017, 4:24 pm

First of all Peachland has 2 new doctors coming in to Beach Medical and are taking new patients. Posted in a few places. My family doc is from S. Africa and I love him, but he is retirement age and cutting back on his hours. Scary. I personally know of a doctor from S. Africa who is a Psychiatrist, in order to practice here, must work side by side a BC licensed doctor for 6 weeks, do a rotation in other words and had to take retake 6 months of the same course they already had just too to qualify to work here. Why? why make them take it over. But if a doc graduates from some University in S. Africa and goes to England to specialize. Oh they are accepted here in BC no problem.??? something is wrong with the system.

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