Is medicare artificially inflating the doctor shortage? More harm then good?

[Daemos]

Here's a bit of an intresting topic.

I think the way medicare operates could artifically inflate the shortage of doctors we have.

a few reasons

1) It limits all healthcare related problems to MD or eqvalent degrees, although there are other LIGITIMATE allied health care professionals who could provide service on a similar level or even better leven than a MD could. (I'm not talking about 'alternative medicine' that's on it's own)

2) It makes the system easy to abuse, people go see doctors for the smallest things, making people who have ligitimate problems have to wait.

3) Some doctors are in it for the money, so those who dont' like to be regulated by medicare, move down to the US for more $$$

4) Since the government controls the spending, the potential to get newer equipment and to hire more physicians depends on the budget a hospital gets from the government. (this might not be totally 100% true, but I belive it's partially)

Any other thoughts?

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[megaman1x]

I think just as easily as these points are made they can be refuted as well. I'm not taking sides here at all. I'm just pointing out some facts I know regarding those topics.

1) It limits all healthcare related problems to MD or eqvalent degrees, although there are other LIGITIMATE allied health care professionals who could provide service on a similar level or even better leven than a MD could. (I'm not talking about 'alternative medicine' that's on it's own)

They are taking some steps to alleviate this. Such as increased training spots for Nurse Practitioners for some more common medications and diagnoses. Such as asthma. But at the same time, doctors in canada spend anywhere from 6 - 11 years getting education on healthcare. So if these responsibilities are to be shared, wouldn't you want them to be shared among those that are educated in a similar fashion to a similar degree? Right now there's a press for pharmacists wanting to be able to prescribe some medications. But how accurate of an assessment can pharmacists do in the middle of a safeway with people all over the place making noise? I think some responsibilities can be shared, others can't.

2) It makes the system easy to abuse, people go see doctors for the smallest things, making people who have ligitimate problems have to wait.

You are right on this. But one small way to battle this is when nurses triage patients who come into the ER. Then they assign a priority rating to them. "Bleeding profusely from the head and dying? Okay come on in!"
"A light cough? There's a bit of a wait"

3) Some doctors are in it for the money, so those who dont' like to be regulated by medicare, move down to the US for more $$$

You are right. Money is better in the states. But there are some benefits here in Canada too. One of them is that you can't get sued as a doctor here in Canada. Where as in the states you see many malpractise cases going on and thus must buy malpractise insurance. But potential earnings are higher for sure down in the states.

4) Since the government controls the spending, the potential to get newer equipment and to hire more physicians depends on the budget a hospital gets from the government. (this might not be totally 100% true, but I belive it's partially)

There are others ways to gain money too. For example hospitals can strike deals with private companies. For example I know of a women's hospital here where a lot of women go when in labour. The hospital struck a deal with the makers of Tylenol. The hospital agreed to exclusively give out free samples of Tylenol for pain relief to new mothers. And in return for only giving out Tylenol for pain relief, the makers of Tylenol bought the hospital a new CT Scan machine absolutely free. So this works out to be a nice partnership.

A similar deal was struck with the makers of Enflac. The makers of Enflac also bought the hospital new and much needed equipment if the hospital agreed to solely give out free trial samples of enflac baby supplement milk to new mothers so they can try it out and possibly buy it in the future. Deals like this are really helpful. The public hospital can get money from private companies.

 

[megaman1x]

Good points over all though.

 

[jefguth]

You are right. Money is better in the states. But there are some benefits here in Canada too. One of them is that you can't get sued as a doctor here in Canada. Where as in the states you see many malpractise cases going on and thus must buy malpractise insurance. But potential earnings are higher for sure down in the states.

Umm, Canadian doctors do get sued - anyone can be sued. As a physician you should expect to be sued at least once during your career. However, there are circumstances that mitigate the impact of malpractice in Canada. For one, patients tend to be much less likely to file suit against their doctors, and Canadian courts typically don't award very much money in compensation for doctors that are found liable. Which means they can also settle cases for less. The overall result is that malpractice insurance premiums are only a fraction for Canadian physicans versus their American counterparts.

 

[Daemos]

megaman1x: I'm not just talking hospital settings. Look at the walk in clincs, look at the wait time for primary care physicians. Some of these people don't even have any real issues "ohhhhh my god, I coughed once..." etc etc.

As well outside of the hospital, Medicare usually only covers MD related billing.

So say you have a mental health issue, if you don't have extra insurance, or don't want to pay out of pocket, you would deal with having to see a psychiatrist, who often like to push out drugs a little TOO fast on mental problems. vs say seeing a clinical psychologist, who depending on the circumstance is MUCH better trained at various techniques that may resolve the problem faster, without drugs. True Psychiatrists are allowed to do psychotherapy, but IMO they're not nearly as well trained in that area as a clinical psychologist. (There's are reasons why clinical psychologists are fighting for Rxn rights in the US) (but the AMA is fighting with huge oppression, just like they did for dentists, podiatrists, and optomatrists in the past when they fought for drug rights) Even with a referal from a GP, medicare will only cover a psychiatrist, and not a trained clinical psychologist.

Optomotrists, arn't there just for your eyeglasses, they CAN diagnosis some problems, but even reffered to by a GP, medicare won't cover it, and it forces you to see an ophthalmologist (which would be covered by medicare if refered to)

Podiatrists are often much better equiped to deal with lower extremities than GPs are, they are far better trained, and DO provide better service. I know a few GPs who will easily admit that they are not trained as well as they SHOULD be for problems regarding the foot/lower leg. Although others will disagree, but having a few ingrown toe nails, and having seen several GPs which temporarly fixed the problem, then going to see a podiatrist which fixed the problem right away.

Physiotherapists in private practice, I believe THEY might be covered under some sort of medicare (not 100%) but THEY can diagnosis some muscular/skeletal problems, and they may beable to treat a minor sprain or an injury just as well as a specalist in sports medicine.

So in some ways medicare does 'limit' or 'force' a decision on people on what kind of trained professionals they see, although there may be alternatives that are just as good, or sometimes better in some cases, which they could go see, and potentially free up some space in other areas.

As far as hospitals striking deals with companies, I completely forgot about that. haha, my mistake.

 

[megaman1x]

Umm, Canadian doctors do get sued - anyone can be sued. As a physician you should expect to be sued at least once during your career. However, there are circumstances that mitigate the impact of malpractice in Canada. For one, patients tend to be much less likely to file suit against their doctors, and Canadian courts typically don't award very much money in compensation for doctors that are found liable. Which means they can also settle cases for less. The overall result is that malpractice insurance premiums are only a fraction for Canadian physicans versus their American counterparts.

Sorry I guess I was given wrong information then. I was told my numerous med students that one of the advantages of practising in Canada is that you can't get sued as a doctor whereas you can in the states. I also read an article of a woman who wanted to sue a doctor but wasn't allowed to due to laws. So the most she could do was file a complaint to the hospital board and the hospital board then went and looked into the matter. Finally they ended up suspending his license for a few years because they certainly did find it was his error. I guess those things led me to believe Canadian doctors can't be sued by the general public.

 

[megaman1x]

Daemos -

I was only thinking or considering hospitals when I made my statement regarding nurses who triage patients to rank them according to priority. The reason why is that I, as well as my family, go to my family doctor and I can get a same-day appointment or next-day appointment. She is not over-booked at all.

However, I do understand and know of quite a few people who don't have a family doctor and thus rely on walk-in clinics. These are busier in general, I agree. And there's nothing you can do about patients coming in for a single cough. Unfortunately thats one of the downfalls to "free medicare".

That being said, there are tons of walk-in clinics around the city and some are certainly busier than others. So one is usually free to "shop" around. Granted this is not a very good solution to the "waiting" problem, but at least the option is there.

As for all the other occupations you mentioned, I guess I never really considered those. But I think one of the reasons those things are not covered (ie. going to a optometrist, or going to a podiatrist) is due to the cost-strain that this would put upon medicare even more. Money is always tight, and including those services under the umbrella of medicare would most likely cause tax increases over the long run. And the general public HATES tax increases. Yes, the money would be going to healthcare, but the generally healthy wouldn't be on board.

Clearly no system is perfect.

Also another thing to consider that the government/medicare actually do allow is that if a service cannot be provided within your own province or within Canada, the government will pay to have that service done within another provice or the States. So at least that's present. Not exactly what you were talking about regarding spreading the responsiblity, but it's kind of close, in a way....lol

 

[jefguth]

Optomotrists, arn't there just for your eyeglasses, they CAN diagnosis some problems, but even reffered to by a GP, medicare won't cover it, and it forces you to see an ophthalmologist (which would be covered by medicare if refered to)

Actually, depending upon which province we're talking about, optometrists do bill the respective provincal health plan when a patient is referred to them. The most common scenario would be for diabetic patients, at least in Ontario diabetics can recieve an annual eye exam covered by OHIP. Similar situation for glaucoma and some other issues, but only if the care was authorized/ordered by an MD. Otherwise the patient will pay cash.

I will fully agree with though, the burden could be lightened quite a bit if other non-MD providers were utilized to their potential. The dean of McMaster Meds wrote an interesting article on this subject a few years ago. That said I'm not so sure those professionals necessarily want to be sucked into the provincial medicare schemes to gain direct access to patients in exchange for very poor reimbursements. After 15 years with out a raise, Ontario OD's considered ending their relationship with OHIP earlier this year, fortunately for patients in need of care they decided to continue negotiating with the ministry.