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Hasten registration of foreign trained medical professionals


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6 hours ago, herbie said:

Sorry but it's nowhere near Third World. It's not nearly good enough but still better than what most have. WE have to quickly accredit and approve foreign trained doctors and nurse for the short term and start fixing the little things that make more people enter those professions, where they are needed, right f***ing now!

I'm not happy that when I brought the wife there was no doctor available, no nurse qualified to drain her lung and an ambulance sitting in the entrance with no one to take her to the big city until morning, no. Not the least but happy. But such supposedly occasional things are becoming too frequent. How will the new hospital be better if they can't staff this smaller one?

Yes, it’s First World. But it could be much better. Thus a relative of mine is getting miraculous care for cancer at the moment but my local ER is completely overwhelmed, I can barely access my GP to fill my prescription and the care other relatives have recently received in Europe was definitely better than they would get here. The league tables don’t lie. Forget about the US, a model nobody wants to copy - on many key metrics we are clearly behind the likes of Germany, the Netherlands, France and also Australia, a country with the challenges of scale and isolated communities we have. Our system needs radical reform. It can’t be left as it is. Let’s leave nothing off the table for consideration, e.g. a compulsory medical insurance system for all, more private care, nurse practitioners, telemedicine, online medical tuition etc. 

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There’s a real lack of urgency reviewing the qualifications of foreign docs by the local authorities. I literally feel I could do a better job licensing them than the local medical board does - not true, of course, but a reflection on how dreadful they are. I have seen extraordinarily gifted candidates turned down on the basis of absurd rules. A lot of the correspondence is by paper when it should be electronic in nearly every instance. Get a move on, guys. Time is of the essence. People are dying out there. 

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Canadians need a reality check about medical sociology. The centres of medical power in each province - medical schools, licensing authorities, medical associations, departments of health, public payers of physicians - tend to be concentrated in large centres, often quite close to each other, and share a set of values no matter what is said to the contrary. So it is that everyone in the citadel, from the lowliest applicant to med school to the Minister herself, knows the importance of talking fulsomely about the vital importance of rural medicine before returning to their city homes at the end of the day…and fully intending to keep it that way. Our two medical solitudes in Canada are urban and outback; it’s about time we started an honest conversation between them. 

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6 hours ago, SpankyMcFarland said:

Canadians need a reality check about medical sociology. The centres of medical power in each province - medical schools, licensing authorities, medical associations, departments of health, public payers of physicians - tend to be concentrated in large centres, often quite close to each other, and share a set of values no matter what is said to the contrary. So it is that everyone in the citadel, from the lowliest applicant to med school to the Minister herself, knows the importance of talking fulsomely about the vital importance of rural medicine before returning to their city homes at the end of the day…and fully intending to keep it that way. Our two medical solitudes in Canada are urban and outback; it’s about time we started an honest conversation between them. 

So, moving association/licensing/regulatory  head offices to small towns makes them better?

What values are contrary??

So what is your solution? To force medical facilitators (doctors, nurses, lab techs, radiologists etc etc) to have to work in rural and remote locations??

Urban and outback?? City or village? Conversation about what? "Hey Doc, you have to work in Fort Simpson for 2 years" ???? Doc says no, I will move out of country. Bye Doc. You cannot force that.

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There's a complete ignorance towards technology involved as well. Dr gives a prescription of something you need to take every day for the rest of your life. Two weeks worth!
Then you call in fort an appt and are told the Dr isn't available for 6 weeks. Now I know the Dr wants that $35 to renew your prescription but unless they actually need to see you why in hell can't the Dr click a button on his laptop, get $25 instead and free some time up to see a patient that actually needs to be seen?

Everything online here in BC. Why when you go to the lab do they need to "fax" the form to your Dr at the clinic? That requires someone to print it, someone to fax it, someone to get the fax and bring it to the Dr's desk. Every step of which wastes time. Here it's just a bloody excuse... we didn't get the fax etc. etc. etc.

A $5 an hour developer in India can rewrite the MRI machine's code so they can do the scan in Prince George, click a button and it and your file goes instantly to the specialist in Vancouver and your Dr's computer in Fraser Lake FFS.

Give nurses and ambulance crews a decent raise, incentives to work where they're needed and speed up foreign qualified staff certification if they guarantee to work 5 years where they're needed, not just where they want. There's tons of $$ to be saved by modernizing and streamlining redundant and obsolete policies and procedures to cover that.

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8 hours ago, ExFlyer said:

So, moving association/licensing/regulatory  head offices to small towns makes them better?


It might be a start. There is a groupthink at work among these bodies. The same individuals frequently move from one to the other. With some notable exceptions, they are not really interested in making incentives work in the periphery sufficient to move doctors there. No public goals for rural recruitment are published and followed. There’s no accountability by anybody in the system, from the Minister down, for failing to replace rural FPs. We had a med school Dean who was appointed for his expertise in rural medicine. Once he was in the job we never saw him again. He didn’t visit the rural sites. Our licensing bodies have no need to consider the real world effect of their crazy rules on medical recruitment. They plough away happily in a vacuum. Many of their number come from the local med school where is there is a natural scepticism of foreign doctors and a bias in favour of restricting medical manpower supply. 

 

 

8 hours ago, ExFlyer said:

What values are contrary??

There is a profound conflict in Canadian medicine about rural medicine. On the surface, everybody emphasizes the importance of rural health care. If you were to listen to applicants to med school or prospective medical residents, you’d think that many couldn’t wait to get out to the boonies. (Academic physicians talk in the same way.) But that doesn’t happen when they are qualified and nobody has really investigated this mystery with a cold and courageous eye. 

 

 

8 hours ago, ExFlyer said:

So what is your solution? To force medical facilitators (doctors, nurses, lab techs, radiologists etc etc) to have to work in rural and remote locations??

My solutions are many. Let’s start by getting rid of the ‘force’ canard - none of that will be used. Get serious about bonuses for the periphery that are actually big enough to interest people in moving and creating community teams big enough to be sustainable. At the moment, the medical associations are dominated by people who live in larger centres. How keen do you think they really are to give the most peripheral doctors massive bonuses and better call schedules, especially when those people are often foreign doctors? 


 

8 hours ago, ExFlyer said:

Urban and outback?? City or village? Conversation about what? "Hey Doc, you have to work in Fort Simpson for 2 years" ???? Doc says no, I will move out of country. Bye Doc. You cannot force that.

Conversation about where doctors work in Canada. In my province c. 80% of the physicians in towns under 10,000 people are foreign. Nobody is talking about being forced anywhere. I am not building a gulag here. Canadian doctors need to have sufficient incentives to work in towns under 10,000 people. In addition, we also need more foreign docs, nurse practitioners and telemedicine. Private medicine will have to be expanded as well. 

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1 hour ago, herbie said:

There's a complete ignorance towards technology involved as well. Dr gives a prescription of something you need to take every day for the rest of your life. Two weeks worth!
Then you call in fort an appt and are told the Dr isn't available for 6 weeks. Now I know the Dr wants that $35 to renew your prescription but unless they actually need to see you why in hell can't the Dr click a button on his laptop, get $25 instead and free some time up to see a patient that actually needs to be seen?

 

My FP’s secretary responds to recorded queries only until 1 pm. There’s no other way of contacting the doctor. It’s like something from the Seventies. At the golf course I can book my game weeks in advance online but not at the medical clinic. It is surely not beyond the wit of man to code patients so that complex cases are not booked in beside each other? In addition, I have to wait for my 2pm appointment until he’s ready to see me because he’s backed up. There’s no reason why I couldn’t get a message on my phone telling he’s an hour behind and to come at 3 instead. Every medical clinic should have nurses assisting the doctors, fielding queries and offering detailed advice after the doctor leaves. There are so many bloody obvious improvements that could be made without even having to think about it. No doctor has asked to see my Fitbit recordings which show all sorts of interesting things going back years regarding exercise, heart rate and sleep. 
 

Medicine is naturally conservative - innovation has to be tested to ensure no catastrophic errors may come with it - but there is going to be more pressure for health care to catch up with the result of the world on IT. My province had an information system from the last century that was recently hacked with chaos resulting afterwards. A few IT people I know criticized some of the basic security measures taken that were not really up to snuff. 
 

 

 

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8 minutes ago, SpankyMcFarland said:

My FP’s secretary responds to recorded queries only until 1 pm. There’s no other way of contacting the doctor. It’s like something from the Seventies. At the golf course I can book my game weeks in advance online but not at the medical clinic. It is surely not beyond the wit of man to code patients so that complex cases are not booked in beside each other? In addition, I have to wait for my 2pm appointment until he’s ready to see me because he’s backed up. There’s no reason why I couldn’t get a message on my phone telling he’s an hour behind and to come at 3 instead.

I managed a private doctor's office for 2 1/2 years.

This is bad front end staff.  The problem is - most doctors do not want to pay anything other than minimum wage, so they get a lot of unqualified people who don't know how to organize and couldn't care less about it.

The doctor I worked for, paid me $10 more than min wage and  invested in a good computer program that did all the billing and colour-coded appointments by issue.

The biggest problem I found was patients who tied up too much of the doctor's time.  We had one who consistently did this, so I would never give her an appointment except the last one of the day - then she could take as much time as she wanted.

Patients can help move things along by not monopolizing the doctor's time.  If you say you're just coming in for a prescription refill, don't then bring up multiple other issues you're having.  Have questions ready, even written down, before you come to the clinic.  You don't' need an emergency "fit me in" doctor's appointment because you just woke up from a nap and feel like you might be getting a cold (this really happened.)

The other problem was new-to-Canada people who were so thrilled to be able to see a doctor, they made appointments several times a month for extremely minor things.

I have always said, I think we need to bring in User Fees.  Unless you have a chronic or terminal issue, everyone would be allowed X number of free visits a year.  After that, you pay.

Doctor's notes for work is another big time waster.

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41 minutes ago, SpankyMcFarland said:


It might be a start. There is a groupthink at work among these bodies. The same individuals frequently move from one to the other. With some notable exceptions, they are not really interested in making incentives work in the periphery sufficient to move doctors there. No public goals for rural recruitment are published and followed. There’s no accountability by anybody in the system, from the Minister down, for failing to replace rural FPs. We had a med school Dean who was appointed for his expertise in rural medicine. Once he was in the job we never saw him again. He didn’t visit the rural sites. Our licensing bodies have no need to consider the real world effect of their crazy rules on medical recruitment. They plough away happily in a vacuum. Many of their number come from the local med school where is there is a natural scepticism of foreign doctors and a bias in favour of restricting medical manpower supply. 

 

 

There is a profound conflict in Canadian medicine about rural medicine. On the surface, everybody emphasizes the importance of rural health care. If you were to listen to applicants to med school or prospective medical residents, you’d think that many couldn’t wait to get out to the boonies. (Academic physicians talk in the same way.) But that doesn’t happen when they are qualified and nobody has really investigated this mystery with a cold and courageous eye. 

 

 

My solutions are many. Let’s start by getting rid of the ‘force’ canard - none of that will be used. Get serious about bonuses for the periphery that are actually big enough to interest people in moving and creating community teams big enough to be sustainable. At the moment, the medical associations are dominated by people who live in larger centres. How keen do you think they really are to give the most peripheral doctors massive bonuses and better call schedules, especially when those people are often foreign doctors? 


 

Conversation about where doctors work in Canada. In my province c. 80% of the physicians in towns under 10,000 people are foreign. Nobody is talking about being forced anywhere. I am not building a gulag here. Canadian doctors need to have sufficient incentives to work in towns under 10,000 people. In addition, we also need more foreign docs, nurse practitioners and telemedicine. Private medicine will have to be expanded as well. 

All pie in the sky stuff.

The medical organizations have standards and all medical personnel must meet those standards. No matter where their offices are located. the medical people in your small towns must be equally as competent as the one in the major cities. The organization does not care where the person works. Or are you saying those that want to work in small places should be let through with less competence?? No groupthink. If you are implying to lower standards, why??

What conflict?? If no one want to work there, there is no conflict.

WTF is 'force' canard?

Bottom line with all you said is that anyone in Canada can work anywhere they want. Clearly bribes, incentives and enticements do not work as the towns, villages, communities in the "outback" are still without.

 

 

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2 hours ago, ExFlyer said:

All pie in the sky stuff.

The medical organizations have standards and all medical personnel must meet those standards. No matter where their offices are located. the medical people in your small towns must be equally as competent as the one in the major cities. The organization does not care where the person works. Or are you saying those that want to work in small places should be let through with less competence?? No groupthink. If you are implying to lower standards, why??


I don’t know where you’re getting the idea I would require lower standards in remote locations. The opposite is the case as physicians are often on their own out there, esp. at night. This is why it’s doubly wrong to send foreign doctors to remote locations for their first jobs in Canada. Their sole focus is then on escape and the churn of doctors just keeps on going. 

Standards are not a simple matter at all. As I explained already, requirements can be so arduous - and take so long to get through - that they can deter good candidates and leave only the people who have no other options. Not every new requirement increases medical competence. Canada also needs to radically increase the training posts for foreign docs. There’s no point telling somebody they need to do another year of training when it’s not available. 
 

 

2 hours ago, ExFlyer said:

What conflict?? If no one want to work there, there is no conflict.

WTF is 'force' canard?

Bottom line with all you said is that anyone in Canada can work anywhere they want. Clearly bribes, incentives and enticements do not work as the towns, villages, communities in the "outback" are still without.

I am not trying to force anybody to do anything so let’s forget that. And please don’t call incentives ‘bribes’. There is nothing illegal about them. What I am trying to explain to you is that the incentives so far offered have clearly been not enough. 

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13 minutes ago, SpankyMcFarland said:


I don’t know where you’re getting the idea I would require lower standards in remote locations. The opposite is the case as physicians are often on their own out there at night. This is why it’s doubly wrong to send foreign doctors out there for their first jobs in Canada. Their sole focus is then on escape and the churn of doctors just keeps on going. 

Standards are not a simple matter at all. As I explained already, requirements can be so arduous - and take so long to get through - that they can deter good candidates and leave only the people who have no other options. Not every new requirement increases medical competence. Canada also needs to radically increase the training posts for foreign docs. There’s no point telling somebody they need to do another year of training when it’s not available. 
 

 

I am not trying to force anybody to do anything so let’s forget that, shall we? And please don’t call incentives ‘bribes’. There is nothing illegal about them. What I am trying to explain to you is that the incentives so far offered have clearly been not enough. 

You said to move associations away from being in the same city.

You said and say that standards are not simple when in fact they are. Rules, regulations and minimum requirements to achieve certification. You say they are too arduous??? How do you lessen the rules, regulations and requirements without lowering them??

Doctors already do training in hospitals for up to 4 years after university. it is called internship., Are you insinuating that foreign doctors do not need to do that or some of that?? Increasing interns at a hospital requires more supervisory staff. where do they come form while maintaing (here comes that word again) standards??

In the case of getting staff to a small community, to offer incentives or bonuses, bribe is an acceptable term. Don't get hung up on terminology.

There is not a person in this country that wants a doctor that has bypassed the stringent rules, regulations and standards requirements.

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On 8/16/2022 at 8:16 PM, ExFlyer said:

You said to move associations away from being in the same city.

 

I don’t see what’s wrong with that. 

 

On 8/16/2022 at 8:16 PM, ExFlyer said:

You said and say that standards are not simple when in fact they are. Rules, regulations and minimum requirements to achieve certification. You say they are too arduous??? How do you lessen the rules, regulations and requirements without lowering them??


No, standards are not simple at all. How much clinical medicine should a 50 year old pathologist be expected to know, somebody who’s been in their specialty for 20 years?  Should they be expected know more about the management of bipolar disorder than their Canadian peers in lab medicine who are practicing away perfectly competently? What is the point of querying the training they had in their internship 25 years ago? There are hundreds of examples I could quote you on this. What about time away from clinical medicine? Should a person applying for a pathology residency, somebody who has had a brilliant career in basic science and surgery, be subject to the same requirement for time out of practice as the average young applicant who has no expertise? 

I could create standards so tough that nobody would pass. Would that be a good idea? You’re not going to test a fighter pilot on his knowledge of quantum physics. Standards have to be relevant to the ever-changing skills required for the job. Another aspect of this is the obsession in Canada with the details of medical school training, often decades ago. Good med students and doctors, like good businessmen, writers or scientists, aren’t limited by the teachers they have. Test their skills, not their courses. 

 

 

On 8/16/2022 at 8:16 PM, ExFlyer said:

Doctors already do training in hospitals for up to 4 years after university. it is called internship.,

Are you insinuating that foreign doctors do not need to do that or some of that?? Increasing interns at a hospital requires more supervisory staff. where do they come form while maintaing (here comes that word again) standards??

In the case of getting staff to a small community, to offer incentives or bonuses, bribe is an acceptable term. Don't get hung up on terminology.

There is not a person in this country that wants a doctor that has bypassed the stringent rules, regulations and standards requirements.


The four to five years of training you are referring to is called a residency. Internships are usually one year long after medical school and have now been merged with residency training in Canada, which is another mistake this country has made. 
 

Doctors who have done their residency training in the UK or Ireland have frequently trained for far longer than 4 years. If they are surgeons or obstetricians they would have performed surgeries on their own that few Canadian residents would have had a chance to do. In addition, the training programs are often discontinuous, meaning that a surgical trainee who gets into trouble will have a hard time finding a new job. Not ideal for patients perhaps but good for us here if we want to pick up people who are far more ready to work in an isolated centre than the average Canadian grad fresh out of a highly supervised five year residency. We have had many superb surgeons and anesthetists, mainly from South Asia, who did long stints in Britain before coming to North America. They are as good as experienced Canadian physicians but many would not be eligible for the Canadian exams because of the way their training is assessed. A colleague of mine with 8 years of residency training in the British Isles after internship, who was a lecturer in cardiology in a British university and had a fully independent internal medicine practice in Canada, was adjudged to have six months of Canadian-type training and was obliged to do 3.5 years of a Canadian residency before he could sit his exams here. An utter waste of time and money. 

 

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We have professional medical associations in this country. They are, in part what makes them medical “professionals”.

Our standards apparently not as tough as the UK, but that is my recollection from a few years ago.

It depends on the specific field.

Given how people are graduated through the system such as interns and residents, and students who work in hospital laboratories as part of the training requirement, there is good peer review of the person as they become a professional. When someone comes in from outside, all we have is some papers. Plus there’s some fakery going on. Obviously thereneeds to be intensive vetting.

It ain’t like making hamburgers all day, after all.   ;) 

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On 8/16/2022 at 9:58 PM, OftenWrong said:

Given how people are graduated through the system such as interns and residents, and students who work in hospital laboratories as part of the training requirement, there is good peer review of the person as they become a professional. When someone comes in from outside, all we have is some papers. Plus there’s some fakery going on. Obviously thereneeds to be intensive vetting.

It ain’t like making hamburgers all day, after all.   ;) 


Well, you have more than papers (and ‘papers’ are part of the problem - I hope this is changing but in my experience email was used less than it should have been to authenticate licensure in Canada instead of ye olde documents couriered endlessly back and forth). As in any other industry, you have the individual too, an individual who is not necessarily limited by the medical training they received. Imagine if Silicon Valley subjected every applicant to this malarkey instead of finding out what they could actually do? Mr. Gates, I see you dropped out of Harvard without a degree…Why not subject that person to a truly rigorous set of examinations and practical assessment that they assist in financing? It doesn’t matter what an eye surgeon studied or didn’t study twenty years ago if they are fully competent today in their scope of practice. Test that scope. Focus on the present and the future as regards skills.
 

With all that said, there is one major aspect to be looked at in the past of any applicant - evidence of incompetence or behaviour that is unethical or downright illegal. That area should be better done than it is now and nobody would object there. 
 

The thing is that the licensing authorities are only responsible for the doctors who are licensed here. Who is responsible for the people who quietly die prematurely at home because they didn’t have access to medical care? Somebody has to be accountable for them too. 

 

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7 hours ago, SpankyMcFarland said:


Well, you have more than papers (and ‘papers’ are part of the problem - I hope this is changing but in my experience email was used less than it should have been to authenticate licensure in Canada instead of ye olde documents couriered endlessly back and forth). As in any other industry, you have the individual too, an individual who is not necessarily limited by the medical training they received. Imagine if Silicon Valley subjected every applicant to this malarkey instead of finding out what they could actually do? Mr. Gates, I see you dropped out of Harvard without a degree…Why not subject that person to a truly rigorous set of examinations and practical assessment that they assist in financing? It doesn’t matter what an eye surgeon studied or didn’t study twenty years ago if they are fully competent today in their scope of practice. Test that scope. Focus on the present and the future as regards skills.
 

With all that said, there is one major aspect to be looked at in the past of any applicant - evidence of incompetence or behaviour that is unethical or downright illegal. That area should be better done than it is now and nobody would object there. 
 

The thing is that the licensing authorities are only responsible for the doctors who are licensed here. Who is responsible for the people who quietly die prematurely at home because they didn’t have access to medical care? Somebody has to be accountable for them too. 

 

Did you actually compare a coder for a gaming company to the qualifications required of a doctor???

I want solid proof and validation that a medical professional is as qualified and certified as any one licensed here in Canada. More OK, but no less.

The licensing authorities are responsible for the doctors that are licences here and the doctors getting licences here. Rightly so.

I am absolutely against anything that would make it easier for foreign medical staff. The requirements for foreign staff must be no less than any Canadian medical staff, be it proof of education, internship, or whatever else the provincial and federal requirements may be. My Daughter has worked in 3 provinces and in NWT has and has had to meet the requirements each time, no considerations regardless how badly they needed her services.

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3 hours ago, ExFlyer said:

Did you actually compare a coder for a gaming company to the qualifications required of a doctor???

I want solid proof and validation that a medical professional is as qualified and certified as any one licensed here in Canada. More OK, but no less.

The licensing authorities are responsible for the doctors that are licences here and the doctors getting licences here. Rightly so.

I am absolutely against anything that would make it easier for foreign medical staff. The requirements for foreign staff must be no less than any Canadian medical staff, be it proof of education, internship, or whatever else the provincial and federal requirements may be. My Daughter has worked in 3 provinces and in NWT has and has had to meet the requirements each time, no considerations regardless how badly they needed her services.

I did compare Bill Gates and his ilk to doctors because people need to think about medicine differently. The old ideas are not fit for purpose. The medical field of knowledge is constantly changing and doctors need to relearn their profession on multiple occasions through their careers which is why ancient details of med school training have become a way of excluding experienced specialty physicians for no good reason. Now, there does have to be a basic floor of knowledge that all doctors have to reach - which is a different situation from IT - but the emphasis in both fields needs to be on up-to-the-minute expertise and comparing like with like, e.g. how much psychiatry expertise does a Canadian orthopaedic surgeon with twenty years of practice actually have? Not much in my experience nor should they and that should be the standard expected of foreign orthopods too. 

BTW why should your daughter have to go through this silly bureaucratic exercise of relicensing on multiple occasions to practice medicine in a country with only 35 million people? If we truly believe in one standard of medical care in Canada for all it’s a clear waste of resources. For foreign grads it is even worse - a purgatorial repetition of document exchange from med school onwards each time another license is asked for. The Original Sin of a foreign medical degree is never forgiven. 

I have no desire to bring doctors into Canada who are of a lower standard than the doctors here and there is no need to do so if we actually spent the resources to test such applicants rigorously. Don’t profile doctors by their country of origin - examine their skills individually. Yes, India and Pakistan have some terrible medical schools but because of the numbers involved those countries also produce people who are at least as good as anybody in Canada. Some of those brilliant people might work here if we made it attractive for them to apply. We need them urgently. 

 

 

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In terms of recruitment of CMGs I would like to see substantial tax-efficient sums offered after, say, five and ten years of service in a remote location, perhaps a lump sum similar to the income earned, along with university appointments. I’ve seen both success and failure in such sites, often depending on the retention of one charismatic individual. My local university preaches the importance of rural medicine but very few of the preachers work in a remote rural site themselves. That has to change. Every year the head of the med school should be asked to publicly discuss a written audit on recruitment and retention of CMGs in rural sites, whether it has gone up or down in the last year, and what is being done to make things better.

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1 hour ago, SpankyMcFarland said:

I did compare Bill Gates and his ilk to doctors because people need to think about medicine differently. ....

BTW why should your daughter have to go through this silly bureaucratic exercise of relicensing on multiple occasions to practice medicine in a country with only 35 million people? If we truly believe in one standard of medical care in Canada for all it’s a clear waste of resources. For foreign grads it is even worse - a purgatorial repetition of document exchange from med school onwards each time another license is asked for. The Original Sin of a foreign medical degree is never forgiven. 

I have no desire to bring doctors into Canada who are of a lower standard than the doctors here and there is no need to do so if we actually spent the resources to test such applicants rigorously. ...

 

 

Bill Gates and his ilk are not on the same level as doctors in any way. Asinine comparison.

Provinces are the health care authorities in the country, regardless how many or how big Canada is.

Yes you do. You are the one that started this discussion based on making it easier to get accreditation and dissing the medical associations. Even saying that if they are co-located in the same city they should be separated :)

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3 minutes ago, SpankyMcFarland said:

In terms of recruitment of CMGs I would like to see substantial tax-efficient sums offered after, say, five and ten years of service in a remote location, perhaps a lump sum similar to the income earned, along with university appointments. I’ve seen both success and failure in such sites, often depending on the retention of one charismatic individual. My local university preaches the importance of rural medicine but very few of the preachers work in a remote rural site themselves. That has to change. Every year the head of the med school should be asked to publicly discuss a written audit on recruitment and retention of CMGs in rural sites, whether it has gone up or down in the last year, and what is being done to make things better.

People work where they want to. Where they feel comfortable. Where the like it.  And it is not just medical people. Period.

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1 hour ago, ExFlyer said:

Bill Gates and his ilk are not on the same level as doctors in any way. Asinine comparison.

Provinces are the health care authorities in the country, regardless how many or how big Canada is.

Yes you do. You are the one that started this discussion based on making it easier to get accreditation and dissing the medical associations. Even saying that if they are co-located in the same city they should be separated :)

 
Now, now, let’s keep it civil, shall we? Bill Gates has changed the world. Very, very few doctors or medical scientists can say that, maybe a guy like Charnley who invented hip replacements, the vaccine makers and a few of the drug developers. The message from innovative industries is as follows: judge peoples on their skills, not on courses they took thirty years ago. 

Canada is a very sparsely populated country. There is no reason why one college couldn’t operate here. We claim to have one standard of care - let’s make it happen like our national legislation on the matter sets out.

What do you mean when you say ‘medical associations’? I think you mean the licensing bodies, e.g. CPSO, not the medical associations like the OMA which are basically unions? I am primarily criticizing the licensing bodies (although the medical associations are part of the problem). They have become hamstrung in a typically Canadian way by bureaucracy and need reform. 
 

I have written at length here about what I think should happen. Do you think there is a problem with recruitment of doctors in rural Canada and what would you do about it? And what do you say to the millions of people in this country without a GP?

 

Edited by SpankyMcFarland
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34 minutes ago, ExFlyer said:

People work where they want to. Where they feel comfortable. Where the like it.  And it is not just medical people. Period.

In a publicly funded system, where doctors want to work can be influenced by many factors, including compensation and conditions of service. Do we want every Canadian-trained doctor in the country staying in large urban centres like Toronto or Vancouver? Imagine if we ran other public services like that. Canada has sleepwalked into a situation where too many of its young graduates are staying in urban centres. It’s an awkward topic but we need to talk about the long-term implications of this and what we should do about it. Another major issue is call flight - young Canadian doctors who used to shoulder more than their share of call now insist on doing as little as possible of it. Work-life balance, restrictions on the licensing of foreign doctors and love of the big city mean we need far more graduates than we used to have just to stay where we were but that is not happening. If we are going to do nothing, let’s at least be honest with the rural part of the country about what they face. 

Edited by SpankyMcFarland
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3 hours ago, SpankyMcFarland said:

 
Now, now, let’s keep it civil, shall we? Bill Gates has changed the world. Very, very few doctors or medical scientists can say that, maybe a guy like Charnley who invented hip replacements, the vaccine makers and a few of the drug developers. The message from innovative industries is as follows: judge peoples on their skills, not on courses they took thirty years ago. 

Canada is a very sparsely populated country. There is no reason why one college couldn’t operate here. We claim to have one standard of care - let’s make it happen like our national legislation on the matter sets out.

What do you mean when you say ‘medical associations’? I think you mean the licensing bodies, e.g. CPSO, not the medical associations like the OMA which are basically unions? I am primarily criticizing the licensing bodies (although the medical associations are part of the problem). They have become hamstrung in a typically Canadian way by bureaucracy and need reform. 
 

I have written at length here about what I think should happen. Do you think there is a problem with recruitment of doctors in rural Canada and what would you do about it? And what do you say to the millions of people in this country without a GP?

 

Was I in some way not civil?

Bill Gates was sure important in the tech world  but doctors save people lives every day. Very very few coders can save lives and do surgery.

Medical associations like licensing , examination, accreditation and standards organizations.

I have also written at length indicting that in no way should anyone get any quicker accreditation than a Canadian trained and licensed medical person should.

Recruit away, All can recruit. Never said they cannot. I cannot do anything  about no doctors taking up on the offers. If they do not want to be in _______ (pick any small village in Canada), that is too bad.

I sure hope you are not insinuating that because it is a publicly funded medical system that we can somehow force medical personnel to go where we tell them??

 

 

 

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I m not advocating forcing anybody anywhere. I believe in attraction, not coercion. We have a problem getting medical care in many parts of this country. How to sort this out?

1. Continue to encourage Canadian doctors to work where they are most needed.

2. Bring in more FMGs. There are lots of exceptionally good ones out there. 

3. Radically improve communication links between urban centres and universities to remote locations so that more care can be conducted remotely. Telemedicine is already working to some extent, e.g. in cancer care. 

4. Expand the use of other staff e.g. nurse practitioners, nurses, physician assistants, midwives to fill in as much as possible.

5.  Expand private care.

6. Admit failure and have the decency to warn the public they will no longer have adequate medical care in their communities. Encourage resettlement. 
 

I think a combination of (3) and (4) will be the main way my province goes. (5) may happen when we run completely out of options. Unfortunately as regards (6), being honest with people doesn’t come naturally to politicians. 

One other issue that should be addressed - the cost of medical school training. Much of the curriculum could be taught more cheaply online. That would leave students with lighter debts afterwards. 

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57 minutes ago, SpankyMcFarland said:

I m not advocating forcing anybody anywhere. I believe in attraction, not coercion. We have a problem getting medical care in many parts of this country. How to sort this out?

1. Continue to encourage Canadian doctors to work where they are most needed.

2. Bring in more FMGs. There are lots of exceptionally good ones out there. 

3. Radically improve communication links between urban centres and universities to remote locations so that more care can be conducted remotely. Telemedicine is already working to some extent, e.g. in cancer care. 

4. Expand the use of other staff e.g. nurse practitioners, nurses, physician assistants, midwives to fill in as much as possible.

5.  Expand private care.

6. Admit failure and have the decency to warn the public they will no longer have adequate medical care in their communities. Encourage resettlement. 
 

I think a combination of (3) and (4) will be the main way my province goes. (5) may happen when we run completely out of options. Unfortunately as regards (6), being honest with people doesn’t come naturally to politicians. 

One other issue that should be addressed - the cost of medical school training. Much of the curriculum could be taught more cheaply online. That would leave students with lighter debts afterwards. 

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"

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