leviathan said:
Better training? In what aspects. Please support your statements.
Some more socialist-minded people would.
1. Higher census in larger American cities
2. Higher proportion of board certified emergency medicine physicians
3. Greater variety of patients owing to the blend of insured/uninsured patients
4. More resources on a per-capita and per-institution basis with regard to infrastructure, sub-specialty support, and diagnostic techniques.
5. More robust off-service rotations
6. As a consequence of #5, less off-service rotation requirements -- as it currently stands, the Canadian requirements for board certification include some ridiculously excessive off-service stints -- mostly because its cheap labour. It adds very little to the training experience. Refer to the Canadian College of Physicians and Surgeons for a full list of required rotations.
6. Better use of time -- do emergency physicians really need a full year of research to be board certified as is currently required in Canada? By the way, even those with significant research experience are still required to do this year. This is RIDICULOUS.
I would do more "supporting of my statements" but an exhaustive review is not possible within the time limits I devote to this board. Do your own due diligence. Seriously, I'm not trying to flame your emotions, but I have compared the two residency systems exhaustively and the main point is that board certified emergency physicians in Canada are very skilled and well trained -- unequivocally -- even in Saskatoon. But this can be achieved in a much shorter time frame, a la 3 or 4 years as in the U.S. It will never change, though, as its cheap labour for a medical system creaking at the hinges -- Canada needs them (us!) to be residents for as long as possible. Can you imagine how bad it would be if there weren't so many family practice doing Emerg in Canada thanks to the FP + 1 year emergency configured residency (which, by the way, is an ingenious partial solution, I think.)? You would think they would be trying to modernize the residency requirements to entice more graduates to go into it.
As for your socialist comment, well, I will take some of the blame for being a little overzealous there. I should have stated "for everytime you have problems with the uninsured in the U.S., would you rather have the government TRY to alleviate the problem by garnishing YOUR paycheque!?!". Even some non-socialists (like me) would gladly have their paycheques garnished if it WOULD alleviate the problem
🙂 However, it isn't happening in Canada -- the taxes are woefully misappropriated, the recent increases in health funding in Ontario and Eastern provinces (I don't know as much about the West) are grossly inadequate and targeted at the wrong sources (for example, why throw money at reducing the wait-list time for things like MRI by paying for patients to go to the U.S. to get the test, but not putting money into more MRI machines and trained technicians in Canada or reducing the waiting list for things like hip surgery, the #1 surgical intervention with regard to reducing mortality and morbidity?
The truth is, and I support this by saying that I have seen it in action -- is that the strategy that would best serve Canadians at the moment would lie somewhere in the middle between the U.S. and Canada -- a well co-ordinated, carefully designed two-teired system like that which is being proposed in Alberta but is facing stiff oppostion from many Canadians who hold to a romantic, antiquated, misplaced sense of nationalism in having a "free health care system". It ain't free.
I know the knee jerk reaction when anyone compares Canadian vs. American training and/or health systems is to be defensive. I was there once. But if you take the emotion out of it, remove the nationalist tendencies, you see that there really is a gross inequity between the two countries and the U.S. is superior in this regard. Sorry.
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