Health care system needs to be reformed - NOW!

[Sir Bandelot]

we've had this discussion before, foreign MDs are not certified in Canada because they are not qualified...they must pass the same rigorous requirements that canadian MDs must go through... we are only now beginning to hear about those MS patients requiring follow up treatment/surgery in canada at our expense of botched surgical procedures in foreign hospitals...

There used to be a system that recognized the training standards of health care professionals coming from other countries, especially from Commonwealth nations and in particular Britain. This standard was set and recognized by medical associations within the countries. It allowed for the employment of medical professionals from these countries. But in the last 10 years, this has been dropped. A very lengthy and expensive evaluation process has been put in its place. The CMA and government have made it quite difficult to make it through this process.

Not saying we should railroad through doctors but it seems that it should be easier for a doctor from the UK or USA to be eligible to work in Canada, after a reasonable assessment of their credentials and history, etc. Instead the system is made so that the applicant has to write medical exams (which is fine) and go through residency again, which should be reasonable for a short time, and sign a contract indicating that they will agree to work in remote areas where there are little or no medical services available. Can't imagine why anyone who's gone through medical school in a developed western country would want to go to Nunavut and try to set up a practice there. Even getting medical supplies and support services is really difficult there. A better model would be to ship people to the big city when they need medical help. I know they do that already to some extent. But at the same time, there are shortages of medical support in the big cities, too.

[dre]

we've had this discussion before, foreign MDs are not certified in Canada because they are not qualified...they must pass the same rigorous requirements that canadian MDs must go through... we are only now beginning to hear about those MS patients requiring follow up treatment/surgery in canada at our expense of botched surgical procedures in foreign hospitals...

No thats simply not true. They dont get certified in many cases because the certification process can take as long as SEVEN YEARS, and even doctors that DO get certified cannot get residency slots.

we are only now beginning to hear about those MS patients requiring follow up treatment/surgery in canada at our expense of botched surgical procedures in foreign hospitals...

Yup theres horror stories in every system including ours. Malpractice, mistakes, etc. What we are also hearing though is that medical tourism is one of the fastest growing industries world wide, with over 50 countries now naming it as a major industry, and scrambling to increase quality and build trust among westerners with a great deal of success.

We should be working with these countries to harmonize standards, and strengthen the accreditation process to increase portability, and we should improve our ability to identify good doctors and get them working easily and quickly. Ontario for example decided that it was in the public interest to fast track certification for doctors trained in certain countries and with certain levels of experience. The reasoning behind it being that a cardiologist thats been in business for ten years already in another country with healthcare standards similar to our own dont need a 7 year long accreditation process, and they attempted to alleviate the doctor shortage by fast tracking these doctors through a 6 month residency. The problem is... theres no slots. Canadian and US doctors get inserted into the slots ahead of these experienced and qualified candidates who would put 1/4 as much strain on the residency system, so they have had to suspend the program... a program which have easily and quickly put thousands of new doctors into the system.

[Sir Bandelot]

Case in point:

As a physician considering immigrating to (or recently arrived in) Ontario you must learn how to obtain a license to practice medicine in this province. This is called registration. You will need to look at your circumstances honestly and take the following factors into consideration:

• There is no guarantee that you will receive registration to practice in Ontario.
  
• The process for obtaining a training or assessment position and receiving registration to practice is complex, and will take time.
  
• You will have to be very committed, personally and financially.
  
• You will have to sign a Return-of-Service Agreement. This means that you will have to promise to practice in an underserviced community in Ontario, where there is a shortage of doctors.
  

http://www.health.gov.on.ca/english/providers/project/img/img_brochure.pdf

Seems written to discourage, more than encourage.

Edited August 25, 2011 by Sir Bandelot

[wyly]

No thats simply not true. They dont get certified in many cases because the certification process can take as long as SEVEN YEARS, and even doctors that DO get certified cannot get residency slots.

Yup theres horror stories in every system including ours. Malpractice, mistakes, etc. What we are also hearing though is that medical tourism is one of the fastest growing industries world wide, with over 50 countries now naming it as a major industry, and scrambling to increase quality and build trust among westerners with a great deal of success.

We should be working with these countries to harmonize standards, and strengthen the accreditation process to increase portability, and we should improve our ability to identify good doctors and get them working easily and quickly. Ontario for example decided that it was in the public interest to fast track certification for doctors trained in certain countries and with certain levels of experience. The reasoning behind it being that a cardiologist thats been in business for ten years already in another country with healthcare standards similar to our own dont need a 7 year long accreditation process, and they attempted to alleviate the doctor shortage by fast tracking these doctors through a 6 month residency. The problem is... theres no slots. Canadian and US doctors get inserted into the slots ahead of these experienced and qualified candidates who would put 1/4 as much strain on the residency system, so they have had to suspend the program... a program which have easily and quickly put thousands of new doctors into the system.

ya it is true, I'm in touch on a regular basis with MDs and mrs wyly is in upper management of medical financials my info from the source is very good, unless you're an MD your info is not better than mine....it's not up to Canada harmonize standards it's up to other countries to meet our standards...

residency requirements are part of the training required of Canadian MDs, it's a dangerous assumption to make with patients lives that other countries meet our standards on their say so...I know of a foreign MD who was let go after less than 6 months of beginning work on his certification here, his knowledge was judged as no better than a third year Canadian med student, surprisingly this was someone who was a practicing MD in Israel...

I've just switched MDs from a Canadian to a Middle eastern immigrant, he went through all the requirements and I've confidence in his ability because of that...

[wyly]

Seems written to discourage, more than encourage.

I'd say it was meant to inform potenial MDs that certification is not an automatic process.

[Sir Bandelot]

it's not up to Canada harmonize standards it's up to other countries to meet our standards...

Other countries no longer recognize Canada's standards either. It would benefit all parties if there was some kind of standard. There used to be. I remember when the announcement came that we had lost our accreditation in the UK. It was in or around 2001.

I know of a foreign MD who was let go after less than 6 months of beginning work on his certification here, his knowledge was judged as no better than a third year Canadian med student, surprisingly this was someone who was a practicing MD in Israel...

Not too surprising really. Incompetence exist in all professions. No doubt you will find some amongst our own Canadian-made doctors too.

[dre]

ya it is true, I'm in touch on a regular basis with MDs and mrs wyly is in upper management of medical financials my info from the source is very good, unless you're an MD your info is not better than mine....it's not up to Canada harmonize standards it's up to other countries to meet our standards...

residency requirements are part of the training required of Canadian MDs, it's a dangerous assumption to make with patients lives that other countries meet our standards on their say so...I know of a foreign MD who was let go after less than 6 months of beginning work on his certification here, his knowledge was judged as no better than a third year Canadian med student, surprisingly this was someone who was a practicing MD in Israel...

I've just switched MDs from a Canadian to a Middle eastern immigrant, he went through all the requirements and I've confidence in his ability because of that...

ya it is true, I'm in touch on a regular basis with MDs and mrs wyly is in upper management of medical financials my info from the source is very good, unless you're an MD your info is not better than mine....it's not up to Canada harmonize standards it's up to other countries to meet our standards...

I DO respsect your opinion and I think youre being honest with me. But this is argumentum ad veracundium and I dont find it compelling. Especially when Im reading stuff like this...

Therefore, the majority of immigrant doctors have to complete a residency here. Foreign doctors will only be considered after Canadian-trained graduates have found residency positions. They can compete in the second round—for the leftovers. The competition is stiff. In 2003, 625 international graduates competed. Only 67—about ten percent—found a position.

Those are doctors that PASSED all the exams. Less than 1/10th of them got put to work in our system, and it absolutely was NOT because they are unqualified.

There are more than 600 internationally trained doctors in Alberta right now, and somewhere between 150 and 300 of them have passed all their exams and are waiting for a residency spot.

Theres a serious shortage of family physicians, yet hundreds of doctors that have passed all their exams are just sitting there unable to get a residency slot. Many of them will never get one, and eventually be forced to pursue other careers.

Edited August 25, 2011 by dre

[Michael Hardner]

Not saying we should railroad through doctors but it seems that it should be easier for a doctor from the UK or USA to be eligible to work in Canada,

Or India... I'm sure in a country 30X the size of Canada there are plenty of qualified doctors who would love to work for $100K a year.

[Michael Hardner]

Theres a serious shortage of family physicians, yet hundreds of doctors that have passed all their exams are just sitting there unable to get a residency slot. Many of them will never get one, and eventually be forced to pursue other careers.

I've never heard this before... and it seems ridiculous to me that this could happen.

[wyly]

Theres a serious shortage of family physicians, yet hundreds of doctors that have passed all their exams are just sitting there unable to get a residency slot. Many of them will never get one, and eventually be forced to pursue other careers.

but now we're getting back to my original point Funding...there is a finite number of spots open for residency, those Canadians who have also passed their exams get first chance, others go to foreign students who are leaving canada to practice in their own countries afterward, this helps those countries retain MDs and subsidizes our medical training as those governments pay much much higher tuition than our med students...

giving finite residency spots to foreign MDs ahead of our own will not alleviate our MD shortage you'll just create a an uproar by denying canadians the right to residency...it will only improve if governments allocate more funding for hospital expansion and residency training...if that's what you support I'm in agreement...

[wyly]

I've never heard this before... and it seems ridiculous to me that this could happen.

if there only 10 spaces for residency and we have 10 canadians to fill those spots then everyone else has to wait...space is not unlimited...

[wyly]

Or India... I'm sure in a country 30X the size of Canada there are plenty of qualified doctors who would love to work for $100K a year.

if they can pass all canadian certification/exams and find an opening in residency sure...

[dre]

Or India... I'm sure in a country 30X the size of Canada there are plenty of qualified doctors who would love to work for $100K a year.

Yeah. Thats why it would make sense to sit down with a country like India thats trying to build medicine into a national industry, and tell them what kinds of standards we required in order to approve portability of both patients, and medical resources between their country and ours. The studies I have seen on patient outcomes suggested they are already very close.

[wyly]

Not saying we should railroad through doctors but it seems that it should be easier for a doctor from the UK or USA to be eligible to work in Canada, after a reasonable assessment of their credentials and history, etc. Instead the system is made so that the applicant has to write medical exams (which is fine) and go through residency again, which should be reasonable for a short time, and sign a contract indicating that they will agree to work in remote areas where there are little or no medical services available. Can't imagine why anyone who's gone through medical school in a developed western country would want to go to Nunavut and try to set up a practice there. Even getting medical supplies and support services is really difficult there. A better model would be to ship people to the big city when they need medical help. I know they do that already to some extent. But at the same time, there are shortages of medical support in the big cities, too.

I'm told there ís leeway given for "star" candidates, internationally recognized MDs as leaders in their field...

[wyly]

Not too surprising really. Incompetence exist in all professions. No doubt you will find some amongst our own Canadian-made doctors too.

which was the comment made by one of my MD friends...not his exact words but the best I can recall-"we make our system as tough as possible to weed out our incompentent MDs but some still get through, lowering our standards for foreign MDs would only allow more to slip by the screening process"...

[dre]

but now we're getting back to my original point Funding...there is a finite number of spots open for residency, those Canadians who have also passed their exams get first chance, others go to foreign students who are leaving canada to practice in their own countries afterward, this helps those countries retain MDs and subsidizes our medical training as those governments pay much much higher tuition than our med students...

giving finite residency spots to foreign MDs ahead of our own will not alleviate our MD shortage you'll just create a an uproar by denying canadians the right to residency...it will only improve if governments allocate more funding for hospital expansion and residency training...if that's what you support I'm in agreement...

I would look at the whole 6-7 year process a foreign doctor has to go through in order to practice here, and see if theres ways to streamline it without unacceptable risk. Everything Iv read says its a bureaucratic nightmare. I would then relieve strain on the residency system by fast tracking slots for established foreign doctors and reducing their residence requirements to 6 months for them. And absolutely... I would try to alleviate that bottleneck... fund more slots. But you have to go BIG. We need to saturate the market in order to drive down costs enough.

I would also have an open mind to adjusting our standards and attempting to harmonize some of them with other similar countries. Its very hard to accept that quality is not the absolute panacea in healthcare but it really isnt. You need to balance quality with accessibility and affordability, and if your certification regime results in scarcity that damages the system as a whole.

Id also look at changing the way certification works and who controls it... and try to get rid of the blatant conflict of interest. The medical assocations currently represent their membership, and are in charge of negotiating rates with each province. The group doing these things SHOULD NOT be the same group thats controlling certification because that puts in their hands the valve that controls flow, which allows them to manipulate their negotiations with the government.

giving finite residency spots to foreign MDs ahead of our own will not alleviate our MD shortage

It would if we fast-tracked foreign applicants who qualified for a shortened 6 month residency system (these are doctors with established careers and good records and credentials). This would increase the ammount of professionals added to the marketplace for each x number of residency slots.

Edited August 25, 2011 by dre

[wyly]

fast tracking residencies will cause deaths, there is a reason why it's in place, it's not there to piss people off or to protect MD jobs and wages...

[Guest Derek L]

That's funny, because I just looked outside, and it wasn't happening here, either. Why is the US the only industrialized country without a universal system? Why do you assume that means they made the better choice, when they're the only ones?

I never said that......I'm in favour of having both public and private options…..

[bush_cheney2004]

Some believe that health care is a basic human right, in an advanced society. Straight teeth and eyeglasses are not...

Basic human rights only apply to "advanced societies"? Interesting dichotomy....

[Sir Bandelot]

Basic human rights only apply to "advanced societies"? Interesting dichotomy....

It's not a human right in yours?

[bush_cheney2004]

It's not a human right in yours?

No...health care is not a right...not even in yours.

[wyly]

It would if we fast-tracked foreign applicants who qualified for a shortened 6 month residency system (these are doctors with established careers and good records and credentials). This would increase the ammount of professionals added to the marketplace for each x number of residency slots.

and let's not forget residents are practicing MDs so what's the point of fast tracking anyways...

[Sir Bandelot]

and let's not forget residents are practicing MDs so what's the point of fast tracking anyways...

But it's not quite the same as a general practitioner who can make decisions alone. Someone else needs to oversee the resident.

[Michael Hardner]

fast tracking residencies will cause deaths, there is a reason why it's in place, it's not there to piss people off or to protect MD jobs and wages...

Still, it could be good if at least one of the major stakeholders in this morass had a fire lit under them.

[wyly]

But it's not quite the same as a general practitioner who can make decisions alone. Someone else needs to oversee the resident.

I've had residents with no one surpervising them, I'm sure they consult later but still while I was being seen by a resident his mentor/supervisor was off somewhere seeing someone else...