If Medicare is a political sacred cow, what are we sacrificing?
Kathleen Rosenberg*, a practical nurse with six years experience, gets angry while she tells me about a patient of hers.
“I have an HIV-positive patient who comes in for Chlamydia once a month. He says he uses protection. If you’re using protection, you’re not getting Chlamydia, and if you’re getting Chlamydia then you’re probably passing on HIV,” she says with disdain.
“He couldn’t identify the partner because it was in a bath house,” she continues. “Public Health monitors this kind of stuff, but clearly not enough.”
Dr. Anne Doig, former president of the Canadian Medical Association (CMA), agrees. “We don’t have good methods in place for proper checks and balances.”
Rosenberg, Dr. Doig, and Dr. Durhane Wong-Rieger, a patient advocate and doctor who helped Canada mitigate the tainted blood scandal in the late 80s and early 90s, believe Medicare has been broken, in part, by a lack of accountability.
Responsibility for your health rests as much with the doctor as it does with the patient.
“The good news about having doctors that are publicly funded is that you have health
care that could be accessible to everybody. [But some doctors think,] ‘You’re not my client. The government’s my client,’” notes Dr. Wong-Rieger.
In terms of checks, balances, and check ups, Dr. Wong-Rieger looks to her dentist as an example: “The part of my body [that’s best taken care of] are my teeth [because] my dentist is really accountable to me. If I miss a check up, he calls me. My doctor doesn’t do that.”
But is that because we pay for our dentists out-of-pocket?
Unfortunately, because dentistry is not covered, many people resort to walk-in clinics for tooth infections. “That doesn’t belong in a walk-in clinic,” says Rosenberg. If Medicare covered more services, wait times could be reduced because other health care practitioners, like dentists, could share the load.
Long wait times—the most common complaint about health care in Canada—are arguably caused by people misusing the system, but that’s just one part of the equation. Canada has always suffered from a brain drain that results in a doctor shortage, thereby making wait times longer.
In 2008, Statistics Canada reported 15 per cent of Canadians aged 12 or older —about 4.1 million people—did not have a regular medical doctor.
As the mother of a son with two holes in his heart, a daughter with a rare blood disorder—Thalassemia Minor—and a husband with Parkinson’s disease, Dr. Wong-Rieger understands this problem well.
Despite being a doctor herself, “we didn’t have a doctor for a year and half,” she says, so her family made use of walk-in clinics.
This was the only option available to her family—yet another aspect of the problem with wait-times and doctor shortages.
It’s a vicious circle. Walk-in clinics are reserved for patients who can’t get in to see their general physician (GP), but there are so few GPs people often rely on walk-in clinics for regular care. Also, Rosenberg says GPs are the lowest paid, while walk-in clinics provide doctors with fast, easy money, and there’s little or no responsibility to follow up with the patient.
Outside factors such as “talent poaching” are affecting the shortage, says Dr. Doig. Our doctors and nurses are extraordinarily well trained, and the problem is the U.S. loves to have our trainees.
In Canada’s failed version of talent poaching, Dr. Doig states the government and the CMA are both working towards making recertification for internationally trained physicians less difficult and cost-prohibitive. However, many are underemployed. And, she comments, “the whole planning of health human resource allocation across Canada is not well coordinated.”
This lack of coordination results in rural northern communities living without doctors in the region. Thirty-one per cent of Canadians live in rural or remote areas, but only 10 per cent of Canadian physicians practise outside metropolitan areas.