Hasten registration of foreign trained medical professionals

[SpankyMcFarland]

1 hour ago, ExFlyer said:

3. My daughter has worked in 4 very remote communities in NWT and was the only medical professional there. She did lots of things because a doctor was not close and used the internet and video conferencing with doctors to do procedures.  So, effective communications has been there for a long time.

4. Most (almost all) remote (northern) communities are only staffed by nurses now

6. I am quite sure the public is fully aware of lack of medical professionals in their community.  There is one community after another on the news every day saying their doctors moved or quit.

It is not the university classrooms that are costly and time consuming, it is the internships that must be carried out in large accredited hospitals. 4 or more years after university classroom and expensive  laboratory time.

Ontario is already paying tuition for nurses and healthcare workers. 

I think you need to get some current information.

"Government provides free tuition to medical students to practice in underserviced areas. Toronto, July 24–The Ontario government will provide $4 million for free tuition and location incentives to new doctors willing to practice in underserviced areas, health and long-term care minister Elizabeth Witmer announced today " .

"government funds and student fees still make up the largest proportion of revenue together, at 46 per cent and 30 per cent respectively, while private/corporate funds makeup 24 per cent."

"Today, the Government of Ontario announced new funding to expand medical education and strengthen the health care system province wide. The move will support the creation of new undergraduate and postgraduate seats"

Many stations in my province have been staffed by nurses for decades so I am well aware of that. The point is that this doctorless state is coming for many more communities, bigger ones, if current trends are not interrupted. All I can tell you is that the efforts by govt in my province are failing, and well publicized initiatives don’t change that underlying trajectory. In my town a generation of locally trained GPs is disappearing and is being replaced by a smaller and more transient cohort, mainly of IMGs. We have attracted very few Canadian grads in recent years. The general news on the availability of GPs in Canada is also bleak. What should be done about all that? Should nothing more be done?

BTW an assignment in medical school where one works with a team is better termed an elective rather than an internship to avoid confusion with the traditional post-graduate training year after medical school.

 

Edited August 19, 2022 by SpankyMcFarland

[ExFlyer]

11 hours ago, SpankyMcFarland said:

Many stations in my province have been staffed by nurses for decades so I am well aware of that. The point is that this doctorless state is coming for many more communities, bigger ones, if current trends are not interrupted. All I can tell you is that the efforts by govt in my province are failing, and well publicized initiatives don’t change that underlying trajectory. In my town a generation of locally trained GPs is disappearing and is being replaced by a smaller and more transient cohort, mainly of IMGs. We have attracted very few Canadian grads in recent years. The general news on the availability of GPs in Canada is also bleak. What should be done about all that? Should nothing more be done?

BTW an assignment in medical school where one works with a team is better termed an elective rather than an internship to avoid confusion with the traditional post-graduate training year after medical school.

 

Done.

You have no more points.

[SpankyMcFarland]

50 minutes ago, ExFlyer said:

Done.

You have no more points.

I’ve lead that to others to judge. Last night on CBC’s The National it was the crisis for paramedics in Ottawa and the shortage of nurses in Ontario. Do you really believe the situation in health care is fine and dandy? Clearly you disagree with my perspective, so set out what you think and what you propose. Do you talk to foreign doctors and listen to their perspective on licensure? In my own long experience of recruiting specialist physicians, there was virtually no correlation between licensure eligibility and clinical competence. Despite the many roadblocks, I had four long-term IMG (for anyone else reading - international medical graduates, i.e. foreign graduates) colleagues, all fantastic. However, we missed out on a lot of other excellent people and our ability to recruit IMGs has been even more seriously hampered in recent years. 

Edited August 19, 2022 by SpankyMcFarland

[ExFlyer]

32 minutes ago, SpankyMcFarland said:

I’ve lead that to others to judge. Last night on CBC’s The National it was the crisis for paramedics in Ottawa and the shortage of nurses in Ontario. Do you really believe the situation in health care is fine and dandy? Clearly you disagree with my perspective, so set out what you think and what you propose. Do you talk to foreign doctors and listen to their perspective on licensure? In my own long experience of recruiting specialist physicians, there was virtually no correlation between licensure eligibility and clinical competence. Despite the many roadblocks, I had four long-term IMG (for anyone else reading - international medical graduates, i.e. foreign graduates) colleagues, all fantastic. However, we missed out on a lot of other excellent people and our ability to recruit IMGs has been even more seriously hampered in recent years. 

I never once said the situation is fine and dandy or even acceptable. I have only addressed your position and comments.

I disagree with your solutions and reasoning.

I have only said, repeatedly, that there should be no short cuts for foreign health care professionals. That they must be accredited and licensed the same as any and every Canadian health care professionals.

You just kept on about the associations and where their offices are.

 

[SpankyMcFarland]

4 minutes ago, ExFlyer said:

I never once said the situation is fine and dandy or even acceptable. I have only addressed your position and comments.

I disagree with your solutions and reasoning.

I have only said, repeatedly, that there should be no short cuts for foreign health care professionals. That they must be accredited and licensed the same as any and every Canadian health care professionals.

You just kept on about the associations and where their offices are.

 

Short cuts? Good Lord, nobody is suggesting that. You should find out a bit more about the endless hoops any foreign doctor has to jump through to become licensed in a Canadian province these days. It is so absurdly involved that it deters good candidates. We are in an international competition for a limited pool of high quality IMGs and we are not doing as well as we could. They have many other options. 

[ExFlyer]

3 minutes ago, SpankyMcFarland said:

Short cuts? Good Lord, nobody is suggesting that. You should find out a bit more about the endless hoops any foreign doctor has to jump through to become licensed in a Canadian province these days. It is so absurdly involved that it deters good candidates. We are in an international competition for a limited pool of high quality IMGs and we are not doing as well as we could. They have many other options. 

You seemed to.

You seemingly want to make it easier.

It takes the time it takes. It takes our doctors 7 or 8 years. If unsatisfactory, then they can take those other options.

To me, there are processes , standards, rules and regulations for a reason. All medical professionals must abide by them, foreign or domestic. No exceptions.

That is my stand.

I was a lowly aircraft mechanic that had rules, regulations and standards to abide by. When in the US, I had to comply with theirs and get licensed, and in Europe they had them too and I had to comply and get licensed. I got no shortcuts. Not as critical as health care but, if I made mistakes, people could perish too.

Edited August 19, 2022 by ExFlyer

[myata]

2 hours ago, SpankyMcFarland said:

I’ve lead that to others to judge. Last night on CBC’s The National it was the crisis for paramedics in Ottawa and the shortage of nurses in Ontario. Do you really believe the situation in health care is fine and dandy?

Two points:

1. Yes it's exactly "fine and dandy" as seen from the top. If anything minor problems, and quick fixes for only a few extra megabucks (a trifle). And back to the business as usual, the normal state of affairs.

14 hours ago, SpankyMcFarland said:

The general news on the availability of GPs in Canada is also bleak. What should be done about all that? Should nothing more be done?

2. To stop and buck a deteriorating trend, an essential change is often needed. Passes and promises, on their own, don't change anything. Throwing megabucks blindly without even trying to understand the problem and possible solutions only to fix the status quo for a tad longer is no solution.

We have major issues in all of these areas:

- sufficiency of adequately trained professional resources

- access to stable and enjoyable employment

- quality and efficiency of delivery of care

- access to care.

And they all seem to converge on outdated, entrenched organization and management system that doesn't see any need to change and adapt, and sees any meaningful change as a threat to its default, entrenched position. Obviously, the longer this situation persist, the more difficult, longer and more expensive the eventual reform will be to the society. But yet again: who is looking and who is thinking? Those who were supposed to see and initiate and execute the change are also the least interested, quite the contrary.

[SpankyMcFarland]

Retention of IMGs isn’t just about pay. There are many other lifestyle factors involved. Here’s an example of a Newfoundland town that’s trying to address one of those key issues:

 

Quote

The central Newfoundland town of Gander is working with its local Muslim community to establish the town's first mosque — and to retain Muslim doctors.

Gander Mayor Percy Farwell and Dr. Mohamed Barasi, director of the Central Newfoundland Islamic Community, said Wednesday they hope a mosque will encourage Muslim doctors to stay in the region.

Farwell says there are several internationally trained Muslim doctors working in Gander, and in the past, the town has had difficulties convincing them to stay. While he applauds the provincial government's efforts to attract international medical graduates, he said communities in need of their expertise have an important role in retaining them.

 

Quote

Barasi said a local mosque would serve a critical need for Muslims in Gander, as well as those in nearby communities.

"If you're a Muslim doctor working in Newfoundland, an international graduate — after two years or three years, if you're able to go to Ontario, saying you got the same money, you'll go to Ontario," Barasi said. "You'll find a lot of mosques there, and you can go to the mosque in person instead of staying home. You can practise your religion in person."

 

https://www.cbc.ca/news/canada/newfoundland-labrador/gander-mosque-doctors-1.6554703

 

Edited August 19, 2022 by SpankyMcFarland

[SpankyMcFarland]

Here’s a simple scenario for anyone to think about. You’re the new Health Minister in NL and this is your first question: 

Journalist: 25% of people in Newfoundland and Labrador have no GP. What is your plan to deal with this? 

I don’t know about other provinces but down here I haven’t seen detailed, granular league tables similar to those CIHI produces for health parameters on how we are doing with recruitment and retention by health region, community size, IMG/FMG, age cohort, gender, specialty etc. that are updated in real time. Trends would be a lot easier to spot then. Instead we limp along until a big loss of doctors somewhere is noticed by some member of the public and the minister has to make reassuring noises. It’s a bit like coastal erosion. Actually, in my health region the figures are even worse: 37% don’t have a GP! I’d like to say this can’t go on but that would ignore where things seem to be headed. 
 

Some research in Canada suggests that rural electives by FP residents increase the likelihood of rural recruitment. However, our local experience with this has been disappointing. We’re not succeeding there. 

 

Edited August 19, 2022 by SpankyMcFarland

[SpankyMcFarland]

5 hours ago, ExFlyer said:

You seemed to.

You seemingly want to make it easier.

It takes the time it takes. It takes our doctors 7 or 8 years. If unsatisfactory, then they can take those other options.

To me, there are processes , standards, rules and regulations for a reason. All medical professionals must abide by them, foreign or domestic. No exceptions.

That is my stand.

I was a lowly aircraft mechanic that had rules, regulations and standards to abide by. When in the US, I had to comply with theirs and get licensed, and in Europe they had them too and I had to comply and get licensed. I got no shortcuts. Not as critical as health care but, if I made mistakes, people could perish too.

I want to make the process easier, not the standards of clinical skill required. There’s a lot of needless delay and duplication even when applying to one province. What’s needed changes greatly as a doctor matures. A young foreign graduate should be carefully looked at in every aspect and their med school training is important. With an older specialist decades into a career, time has a way of revealing what is up in terms of both character and competence. Have they stayed in just a few jobs, have they published, what’s the general feeling about them in their specialty? These were the guys we were looking for, people ready to lead and put down roots. 
 

We have a lot to learn from the airline industry on QA and we’re only starting with Just Culture in medicine. 

Edited August 19, 2022 by SpankyMcFarland

[myata]

In the course of training and early practice a medical professional learns a massive array of skills. The problem is not only to know but being able to actually perform procedures to at least the minimal standard of quality (and that would be minimal standard of service, not necessarily a great one).

If we wanted to ensure that minimal standard, what kind of organization and resources would have to be invested into verification process? How comprehensive and long should it be? Would this entirely individual process be more efficient than training them here? Or would it be just a rubberstamp to streamline and facilitate and whatever happens?

The problem is not that we don't know the answer, we don't know how to obtain one confidently. With another multi-million tax paid studies subcontracted somewhere, would we get that answer?

Edited August 20, 2022 by myata

[SpankyMcFarland]

9 hours ago, myata said:

In the course of training and early practice a medical professional learns a massive array of skills. The problem is not only to know but being able to actually perform procedures to at least the minimal standard of quality (and that would be minimal standard of service, not necessarily a great one).

If we wanted to ensure that minimal standard, what kind of organization and resources would have to be invested into verification process? How comprehensive and long should it be? Would this entirely individual process be more efficient than training them here? Or would it be just a rubberstamp to streamline and facilitate and whatever happens?

The problem is not that we don't know the answer, we don't know how to obtain one confidently. With another multi-million tax paid studies subcontracted somewhere, would we get that answer?

Sure, that’s a problem. There’s a risk giving any doctor a licence. This applies to home-grown graduates, Canadians who go abroad to train, and outright foreigners. Disturbed and dangerous medical students and trainees slip through the cracks all over the world - indeed, we had two examples of that in Newfoundland some years ago. There’s also a non-zero risk in renewing any doctor’s licence. What about older docs, both Canadian and foreign-trained, an area that is deserving of considerably more scrutiny? Most of us must have heard of doctors who were past their best but still hanging on. 

With all that said, the risk with foreign doctors is intrinsically much higher than with CMGs. Their range of training is enormously varied, with national standards in some countries virtually non-existent. The only way to eliminate all risk from foreign trained MDs is to exclude them completely from the system. If we allow them in, it’s going to cost a lot of money to assess them properly and some bad apples will still get through. There’s no denying that; there have been some terrible incidents. It’s up to Canadians to decide whether the risk is worth it and how much we should spend to try to bring it down to an acceptable level. 
 

 

 

Edited August 20, 2022 by SpankyMcFarland

[ExFlyer]

14 hours ago, SpankyMcFarland said:

Sure, that’s a problem. There’s a risk giving any doctor a licence. This applies to home-grown graduates, Canadians who go abroad to train, and outright foreigners. Disturbed and dangerous medical students and trainees slip through the cracks all over the world - indeed, we had two examples of that in Newfoundland some years ago. There’s also a non-zero risk in renewing any doctor’s licence. What about older docs, both Canadian and foreign-trained, an area that is deserving of considerably more scrutiny? Most of us must have heard of doctors who were past their best but still hanging on. 

With all that said, the risk with foreign doctors is intrinsically much higher than with CMGs. Their range of training is enormously varied, with national standards in some countries virtually non-existent. The only way to eliminate all risk from foreign trained MDs is to exclude them completely from the system. If we allow them in, it’s going to cost a lot of money to assess them properly and some bad apples will still get through. There’s no denying that; there have been some terrible incidents. It’s up to Canadians to decide whether the risk is worth it and how much we should spend to try to bring it down to an acceptable level. 
 

 

 

What are you saying now??

Don't let foreign doctors in?

To take the time and effort to asses them?

You were the one that wanted to make the process easier in previous discussion.

 

[SpankyMcFarland]

4 hours ago, ExFlyer said:

What are you saying now??

Don't let foreign doctors in?

To take the time and effort to asses them?

You were the one that wanted to make the process easier in previous discussion.

 

Hold on. As you know from your own industry, risk is ubiquitous and cannot be fully eliminated. The airline industry has done a far better job than health care on examining every single element in flying planes to see where that risk is and to reduce it. We have only just started to be as rigorous and systematic as you have been.

What I am saying is that risk in medicine goes with the territory. If I decide to see my doctor today, the risk starts with me getting in the car and driving to the clinic. When he sees me he may miss something that eventually harms me or he may actually do something that harms me. That’s the bargain we all sign up to when we see a doctor no matter where our doctor comes from. My new GP happens to be foreign trained but I count myself lucky to have anybody in view of the fact that 37% of people in my health region don’t. 
 

So is there is a non-zero risk seeing any doctor. In my previous post, I was merely conceding that there are added risks with foreign trained physicians over and above those with our own CMGs (and Canadians who train abroad, a special category of FMGs who have already received much of their education in Canada). One big problem with FMGs is that they have highly variable training and it’s entirely up to Canadians to decide how to manage this extra risk. An extreme position would be to eliminate the risk entirely by banning FMGs. This would have the benefit of removing the possibility of some of the incidents we have seen with FMGs but it would also carry a significant cost. For example, I would lose my doctor. For me the risk of undiagnosed illness would then shoot up. I’m simply not prepared to to spend my days in the ER, wasting the valuable time of ER staff, for chronic medical conditions, nor should I have to do this in a developed country. So I believe some sort of middle course is sensible - FMGs have a role to play in our health care. If we are going to continue to allow FMGs in, I would merely suggest that there should be some shift in emphasis to focus more on  current skills, especially with experienced physicians. That’s just my random, internet crazy person opinion. 

Edited August 21, 2022 by SpankyMcFarland

[SpankyMcFarland]

Here’s the reality of health care on an island near me:

Quote

We’ve heard about the shortage of family doctors in Canada and a second crisis of understaffed emergency rooms across the country. But what happens when your emergency doctor is your family doctor?

On Fogo, a tiny island with 2,200 people just off the northern coast of central Newfoundland, the family-doctor shortage and emergency-room crisis aren’t two problems — they’re one and the same.

For the first time in centuries, Fogo Island, with its 17-bed hospital, has no family doctor, leading to an urgent call for temporary doctors — known as “locums” — to help close the gap. Earlier this summer, I answered that call.

 

Quote

The doctor I took over for, Daniel Hewitt, looked exhausted when I arrived. In addition to keeping office hours during the day, he’d been on call for the emergency room 24/7 for the past week — and I was about to do the same.

A week might sound like a long time to be on call, but staff told me their last family doctor, Tarik Abulbida, had been on call nearly every day for an entire year before leaving in June, before Hewitt arrived.

On call for an entire year! And when you send somebody to the local hospital, you’re the guy you’re sending the patient to. I’m amazed the doctor stayed so long under such conditions. 
 

Another of my bugbears - our health hub ‘system’. 
 

Quote

Instead of seeing a doctor, Fogo Islanders either have to leave the island or access Health Hubs — the region’s virtual-care solution for those without a family doctor. According to Central Health, the regional health authority to which Fogo belongs, the phone service is staffed seven days a week by physicians in Gander and Grand Falls-Windsor.

However, Shea criticizes the Health Hubs as inadequate to address the current gaps in care.

“So they only book one week [at a time] and it gets blocked up within the first 20 minutes. If you don’t get in, they won’t take an appointment for the next week. You’ve got to phone in Monday morning the following week and then, possibly, it’ll be blocked up again before you get through,” he says.

https://www.cbc.ca/newsinteractives/features/two-week-stint-on-fogo-island

Edited August 21, 2022 by SpankyMcFarland

[myata]

18 hours ago, SpankyMcFarland said:

With all that said, the risk with foreign doctors is intrinsically much higher than with CMGs. Their range of training is enormously varied, with national standards in some countries virtually non-existent. The only way to eliminate all risk from foreign trained MDs is to exclude them completely from the system.

Very good points. The problem is, with the system we have, we cannot even have confident inputs for an intelligent decision. What is the cost / time of having training and skills of a foreign professional verified to the level of confidence of Canadian one? Obviously these a necessary inputs for any intelligent decision. We come up with a solution before or even without being able to check if it makes sense. How smart is that?

[SpankyMcFarland]

23 minutes ago, myata said:

Very good points. The problem is, with the system we have, we cannot even have confident inputs for an intelligent decision. What is the cost / time of having training and skills of a foreign professional verified to the level of confidence of Canadian one? Obviously these a necessary inputs for any intelligent decision. We come up with a solution before or even without being able to check if it makes sense. How smart is that?

My own personal risk analysis is simple. I know the foreign institution where my doctor trained and I know I’m far better off with a doctor than without a doctor. For the country, it’s a far more difficult thing to figure out. What I would contend is that, one way or another, every Canadian deserves timely access to medical expertise. As the article on Fogo mentions, we have health hubs here for those without FPs that you have to phone into to get an appointment. Needless to say all the spots go rapidly in the morning once the lines are open and you can bet your bottom dollar that those most in need often aren’t nimble enough to get those spots. Even a Neanderthal like myself can see that technology could help with this particular problem. We run golf clubs better than this, for crying out loud!

Edited August 21, 2022 by SpankyMcFarland

[ExFlyer]

5 hours ago, SpankyMcFarland said:

Hold on. As you know from your own industry, risk is ubiquitous and cannot be fully eliminated. The airline industry has done a far better job than health care on examining every single element in flying planes to see where that risk is and to reduce it. We have only just started to be as rigorous and systematic as you have been.

What I am saying is that risk in medicine goes with the territory. If I decide to see my doctor today, the risk starts with me getting in the car and driving to the clinic. When he sees me he may miss something that eventually harms me or he may actually do something that harms me. That’s the bargain we all sign up to when we see a doctor no matter where our doctor comes from. My new GP happens to be foreign trained but I count myself lucky to have anybody in view of the fact that 37% of people in my health region don’t. 
 

So is there is a non-zero risk seeing any doctor. In my previous post, I was merely conceding that there are added risks with foreign trained physicians over and above those with our own CMGs (and Canadians who train abroad, a special category of FMGs who have already received much of their education in Canada). One big problem with FMGs is that they have highly variable training and it’s entirely up to Canadians to decide how to manage this extra risk. An extreme position would be to eliminate the risk entirely by banning FMGs. This would have the benefit of removing the possibility of some of the incidents we have seen with FMGs but it would also carry a significant cost. For example, I would lose my doctor. For me the risk of undiagnosed illness would then shoot up. I’m simply not prepared to to spend my days in the ER, wasting the valuable time of ER staff, for chronic medical conditions, nor should I have to do this in a developed country. So I believe some sort of middle course is sensible - FMGs have a role to play in our health care. If we are going to continue to allow FMGs in, I would merely suggest that there should be some shift in emphasis to focus more on  current skills, especially with experienced physicians. That’s just my random, internet crazy person opinion. 

The title of this thread by you is "Hasten registration of foreign trained medical professionals"

I have insisted that there is a process and procedures for Canadians to be licensed and certified and foreign should be no less.

You argued that for a while and am glad that you now see there should be no "hastening" for foreign medical personnel and that they must be verified no less than Canadian staff, no matter how long it takes.

Now ,the issue of shortages on places all across the country, well, that is something that becomes personal decisions of the doctors and medical personnel.  Whatever incentives (bribes) that are being offered do not seem enough and a permanent solution, short of mandated rural service, is not evident.

Edited August 21, 2022 by ExFlyer

[myata]

3 hours ago, SpankyMcFarland said:

We run golf clubs better than this, for crying out loud!

And there's a reason for that. And it's quite obvious too. Why bother changing anythin when it works so nicely for everyone, level CEO up? Anywhere and in pretty much every aspect of public service it's that way already. No can't improve anything without some / many megabucks and only for a short interval before the next crisis.

Here in Ontario awhile back they introduced regional health networks or something like. Supposed to work better but here's the problem - implemented and managed by the same venerable bureaucracy. So for three or so / more years I've been receiving quarterly letters with a cheerful message: no can't find you a doctor but trying hard. An epitome, and we'll have it everywhere, the question is only the time getting there: three years; none, zero service. And a monthly letter, instead of service. Paid for by your tax dollars. And why not? Why couldn't it work like that? The best of possible solutions: nobody has to move a finger.

[SpankyMcFarland]

11 hours ago, ExFlyer said:

The title of this thread by you is "Hasten registration of foreign trained medical professionals"

I have insisted that there is a process and procedures for Canadians to be licensed and certified and foreign should be no less.

You argued that for a while and am glad that you now see there should be no "hastening" for foreign medical personnel and that they must be verified no less than Canadian staff, no matter how long it takes.

Now ,the issue of shortages on places all across the country, well, that is something that becomes personal decisions of the doctors and medical personnel.  Whatever incentives (bribes) that are being offered do not seem enough and a permanent solution, short of mandated rural service, is not evident.

1. Title by me? One thing I hope we can agree on is that I did not start this thread. The title is not mine. 

2. If what I wrote was interpreted as arguing for no regulations or lax regulations on FMGs entering Canada then I didn’t do a good job. I would never argue for that. Most FMGs would welcome a more stringent and more expensive process that delivered a swifter decision one way or the other with less paperwork. If they already live in Canada and some minor deficiency is noted, e.g. a surgeon didn’t get enough training in their internship fifteen years ago in something that is considered vital now, then it should be possible to do a few weeks of training in Canada to sort that out. At the moment it often isn’t. 

3. We are a developed country which should be able to provide access to timely medical care to everybody. How exactly that is done is up to Canadians and their governments. We’ve been through some of the options, which will probably be needed in combination, and they all come with their own costs and benefits. One of those options is more FMGs - which we can accept or reject. However, the basic principle that everybody should get basic care in this country should be non-negotiable. We can’t admit defeat on that and in the next breath have the gall to claim we have universal medical care and look down our noses at the Americans. 

 

 

 

Edited August 22, 2022 by SpankyMcFarland

[eyeball]

2 hours ago, SpankyMcFarland said:

 

3. We are a developed country which should be able to provide access to timely medical care to everybody. How exactly that is done is up to Canadians and their governments.

It doesn't matter how developed we are if the relationship between Canadians and our governments remain as they are.

Trust and the lack thereof in government is at the heart of the issue. We need to deal with the issue of trust first before we can ever hope to effectively tackle any problem we face as a nation.

Personally I think our governments trust us even less than we trust them.

 

[SpankyMcFarland]

I think one of the problems I have with the way we assess FMGs is that it doesn’t fully reflect the modern world, esp. with doctors who have been qualified for a decade or two. We live in an age where knowledge becomes obsolete faster than ever and is no longer restricted in its distribution. I can listen to better lectures online any day of the week than I ever heard in medical school or in my residency. Judging the experienced doctor more on their individual skills and knowledge is expensive and inconvenient but I think it’s worth the trouble. Just my opinion. 

Edited August 22, 2022 by SpankyMcFarland

[SpankyMcFarland]

In the current environment, I have serious concerns about my province moving to a rigorous national standard on all matters licensing. Given the highly uneven playing field in Canada with regard to pay, conditions and the allure of the big city, I can’t see how we will compete with the likes of Ontario under this new regime. One set of national standards would be good in a genuinely unitary state but in our fractured country it will lead to even more brain drain. It’s like a heavyweight telling a bantamweight to fight fair. There’s only one possible outcome. 

Edited August 22, 2022 by SpankyMcFarland

[myata]

8 hours ago, eyeball said:

Trust and the lack thereof in government is at the heart of the issue. We need to deal with the issue of trust first before we can ever hope to effectively tackle any problem we face as a nation.

Not just trust, but the detachment. Look it's complete, accomplished the detachment meter is at 99.9%. They have no clue about the realities of the country; they don't need to; and they can't care less to find out. They have their own, different and separate reality, in which smiling beaver is hugging a dancing mountie. With an obscene, unjustifiable in any sane place multiple of a median income in the country paycheck. They think that one wise word from their wise tower will do magic in the reality (no exaggeration) and have no interest in finding out the actual results. There's no connection to the reality. No meaningful feedback of any kind. How can you fix that conundrum? With what $$$$$$ money?

[SpankyMcFarland]

Doug Ford met the Maritime premiers on the health care crisis:

https://www.thestar.com/politics/provincial/2022/08/22/status-quo-is-just-not-working-doug-ford-rallies-maritime-premiers-in-push-to-change-how-health-care-is-delivered.html

There is agreement that something has to change, but what? More private delivery of publicly funded care or, dare I say it, more outright private care? I think the latter is coming.