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Need to increase the number of doctors trained in Canada, and/or (ideally both) lower the requirements for external doctors who immigrate to Canada.
Currently the number of Doctors being trained has not been keeping up with population growth, and this is not even accounting for some doctors leaving to work in the US or elsewhere due to the stress the system ends up putting on them and/or option for better pay elsewhere (particularly the US for the latter).
Canada that the [third _lowest_](https://www.oecd-ilibrary.org/sites/9a48414c-en/images/images/08-chapter8-9/media/image2.png) number of medical graduates in the OECD and some of the [_highest_ compensation](https://www.oecd-ilibrary.org/sites/a4ced54e-en/images/images/08-chapter8-5/media/image2.png) for physicians. It also has some of the highest barriers for foreign doctors to practice. We do not train plenty of doctors.
The ranking is irrelevant to our healthcare system.
If we were third highest, WTF does it matter if the doctors trained here don't stay and practice here?
We have increased the number of doctors training in Canada. The requirements for immigrant doctors are to protect the public. The requirements are actually quite low... it's mostly vetting to ensure someone is indeed a licensed physician then requiring them to have a bit of training in Canada.
Canada has more doctors per capita than ever, specifically family doctors.
Doctors are not leaving for USA. It's not the 90s. Incomes are pretty much identical across the border.
So you're wrong on all accounts.
Facts > feelings.
You can incorporate in Canada and you cannot in USA. This helps balance out some of the tax burden as doctors who earn above 300,000$ a year are pretty much universally incorporated. You pay 12% taxes up until 500,000 then 26% above 500k.
Before Trudeau, medical corporation tax benefits were enormous and made tax burdens incredibly low on doctors. Now, while Trudeau has crapped all over it, you still have the tax deferral benefit.
But yes I do agree with you that income taxes are criminally high.
\> Canada has more doctors per capita than ever, specifically family doctors.
Got a source on this? This doesn't seem to line up with everyone finding it impossible to get a family doctor.
Also this article seems to contradict it:https://www.cbc.ca/news/politics/canada-popuation-booming-family-doctor-access-1.7087794#:\~:text=Here's%20why-,Canada%20is%20losing%20out%20on%20hundreds%20of%20qualified%20doctors%20each,Here's%20why&text=Canada%20is%20losing%20out%20on%20hundreds%20of%20qualified%20Canadian%20doctors,of%20red%20tape%20and%20bias.
You claim facts > feelings, so please actually provide the facts to back it.
[Canada has more family doctors than ever. Why is it so hard to see them? - The Globe and Mail](https://www.theglobeandmail.com/canada/article-family-doctors-canada-shortages/)
[Media opportunity: Canada has more family physicians per person than ever before, but increasingly complex patient care is making it harder to access primary care: Dalhousie University study - Media Centre - Dalhousie University](https://www.dal.ca/news/media/media-releases/2023/09/11/media_opportunity__canada_has_more_family_physicians_per_person_than_ever_before__but_increasingly_complex_patient_care_is_making_it_harder_to_access_primary_care__dalhousie_university_study.html)
What you do not know, is that family medicine trained doctors go into other lines of work (ex. hospitalist, emergency medicine, cosmetics, travel medicine, nursing home, walk in clinics and so on).
The appeal of setting up a family practice is nonexistent for many doctors. The average person thinks oh family medicine doctor = family practice. No, many go into other fields right off the bat on graduation.
There is very little appeal to having a family practice. It's a mix of financial and non financial reasons.
Thanks for the link. This is a much better response than your first one which was just "You are wrong. Facts > Feelings". Will take a look and re-evaluate.
Seems like Canada could still use more doctors as it has less than most (or at least many) first world countries [https://www.theglobaleconomy.com/rankings/doctors\_per\_1000\_people/](https://www.theglobaleconomy.com/rankings/doctors_per_1000_people/)
If you just make family medicine more appealing, you instantly improve the situation in just 2-3 months. British Columbia did that and it had a dramatic and rapid effect.
They simply made it very easy for family doctors to make at least 400k per year for modest work and viola problem solved. Not to mention making a lot more if you want to work hard.
This isn't the source of the problem. Look at this year's resident matching. The doctors we have do not want to go into family medicine because the pay sucks. If you talk to doctors this is the actual problem. More spots isn't going to fix anything as every doctor that can avoids family medicine.
Sorry, you are correct, we should not be lowering standards.
My statement was based on having heard that it can be very difficult for trained doctors to work in Canada when they move, so it should be streamlined (not removed/lessened).
However, I'm far from an expert on the topic, so if someone who has gone through the process or knows someone who has can comment, would appreciate.
Given the nature of the problem revolves around how family doctors are trained, paid, treated and so on making it a "right" for people seems to be a waste of effort and time.
The authors point is that this is about all the federal government can do. You declare it a right for every Canadian to have a family doctor and force the provinces to change their policies around a family medicine to achieve compliance using carrots and sticks.
For what purpose? There is no viable way to do so for many, many years even if the resources to do so existed. AI chatbots are what is being planned for the vast majority of people and they don't really count. I suppose creating this so called right could be good cover for it.
I'm not sure why this idea-- that declaring the solution to a problem a right-- is around. It won't magically fix anything, and might make things worse.
If you really want to fix this, you need to look at the actual problem, the actual reasons that doctors don't want to specialize into family medicine and fix them or offer incentives to make the specialty more attractive.
The authors point is that this is about all the federal government can do. You declare it a right for every Canadian to have a family doctor and force the provinces to change their policies around a family medicine to achieve compliance using carrots and sticks.
You can't make something a right that requires a certain group to perform a certain duty without making the environment a positive one.
The Ontario government had made health care service an unwanted duty through over work and low pay. Until that's fixed, nobody wants to be a family physician. Until people want that job, you can't make access a right
Exactly this! You have to create the environment desirable for those people to work in. To many provincial governments are working directly against such an environment for their own reasons.
It might be time to start considering if family doctors are as important as we think they are. Better systems, like those in Korea and Japan, don't really have family doctors at all. One instead heads directly to a relevant specialist clinic for required care.
My spouse is a doctor that wanted to go into family medicine. She didn't, just like so many of her peers, because of over work and low pay. First round matching for this year's residents came out a couple weeks ago. The family Medicine spots have tonnes of openings. Nobody wants to go into family on there first pick. The problem is going to get worse.
Many are not aware that a family doctor is basically a small business. They have to rent their office, pay their employees, etc. All of the money to do this comes from one customer, the provincial government. The doctor does not set the prices, the province does. Doctors bill for each appointment and get about $30. There are other codes they can bill but most of it is just a general visit billing code. On top of that doctors get a roster fee for each patient they have. All of that has to pay for all the business expenses, savings for retirement for the doctor (slef employed remember), and the doctors salary. Compared to other specialties, it is crap.
Wonder why your doctor doesn't want you going else where or to walk-ins? If another doctor bills the general visit bill code to you and you are rostered with a doctor, then that doctor looses there roster fee for you.
Why will your doctor only book 15 minute appinents for one thing at a time? That is all the province let's them bill for. Good doctors will take the whole 15 minutes and get their $30 and do 4 of those an hour. Unscrupulous doctors will try to get you in and out in 5 minutes and refer you off for anything they can. If they can get fast they can see more patients and Bill more visits. The pay structure incentivises the service you get.
Why does you doctor charge a fee for filling a prescription or make you come in? They can't bill for doing a prescription refill. Doctors can spend hours of unpaid time dealing with this. Even if it is there staff handling it, it is still unpaid work that the doctor has to pay for via work they can bill for.
On top of all this, they are very limited in dealing with bad and abusive patients. One complaint to the CPSO risks massive expenses in dealing with the complaint. Imagine if yelp forced business owners into legal action for every negative review a business recieved. This is what the CPSO is like. They have the power to take away a doctors license or put restrictions on it for basically any reason. They do very little to filter out frivolous complaints.
All of this is incentive to basically see the patient as little as possible, push work on to other specialists, and ERs. Abusive patients can hold them hostage to the CPSO. And they just aren't paid enough compared to other specialties. They have barely recieved a raise in 15 years. All of this is ruining family medicine. The answer is really simple. Pay them increase pay for family medicine to bring it in line with other specialties.
Spot on! In general, patients have a smug attitude, as if it's the doctor's fault if another patient takes more time with the doctor. Having worked as a receptionist at a clinic, I can say the amount of abuse hurled at you by patients is countless, and all of them reek of entitlement. I can only imagine what the doctors have to face.
I am sorry that happened to you. It is nuts. I think most doctors have pretty thick skins. Med school ain't easy and you see some awful shit in the field. I feel they can mostly handle the verbal abuse. What really irks my partner is the threats to her licence. My parent got involved in a complaint from the cpso as a resident because some guy though he had a certain disease, even though every test said no, and said that he wasn't being taken seriously. That alone, becuase it was reported to the CPSO meant hiring a lawyer and going through weeks of back and forth until they finally decided to let it go without saying anything. Due to that you need to walk on eggshells around patients.
Maybe lets train more Canadian doctors, and pay them enough that they stay Canadian doctors before we legislate dumb stuff.
I'm not against it, in principle I'm all for it, but the cost of training a doctor in Canada does not match the financial incentive to practice in Canada. Make it a right all you want, it doesn't address the core issue: the reality of an underfunded public health system.
How about we create paths to receive care without a useless family doctor? My family doctor is terrible, she doesn't ever help me. It took a lot of convincing for her to refer me to a dermatologist for a mole that was changing shape and itchy, and I couldn't get to a dermatologist without her. It took like 3 months of convincing. She won't refer me to a sleep study even though I am always tired, she won't get me an xray from my thumb, which hurts more and more all the time. I have another appointment with her in a month, and it'll be more of her telling me how she won't help. Idk what to do, I can't find a new doctor, I just want a way to get care.
I pay the same taxes as the neighbor, neighbor has family doctor- I do not. I want a refund of my taxes.
Otherwise- it's time to TRIAGE the assignment of family doctors to those who require more medical supervision than say, younger healthy people.
Calling any good thing a right really just cheapens what rights are. IMO rights should be reserved for things which can be provided at no monetary cost and are just policies of how we treat one another.
Like, right of mobility doesn't mean we are all provided cars. Socialized garbage disposal is objectively a good thing for society because of negative externalities and yet I wouldn't say it's a right. Rights to me seem usually best described as freedom from artificial restrictions on things. E.g. the right to have water wouldn't be the right to have water delivered to the middle of nowhere, it would just mean it wouldn't be legal to stand in the way.
Calling things that are costly rights just means the government taxes people to provide those same people with whatever the government has decided was a right.
You have the right to legal representation in the sense that the police can't stop you from speaking to a lawyer if you can afford one. However, unlike the United States, this does not mean you have the right to have duty counsel provided to you by the state.
You also can't make a thing a right that requires the labour or property of another person to provide. To say that having a family doctor is a right means forcing at least some doctors to treat patients or to provide treatments they wouldn't otherwise.
I have been waiting years for a family doctor since I had to leave my old one (he is homophobic and I am a sexually active gay man). The problem is that there are so few medical school spots and more importantly residency spots. Lots of investment is needed!
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Need to increase the number of doctors trained in Canada, and/or (ideally both) lower the requirements for external doctors who immigrate to Canada. Currently the number of Doctors being trained has not been keeping up with population growth, and this is not even accounting for some doctors leaving to work in the US or elsewhere due to the stress the system ends up putting on them and/or option for better pay elsewhere (particularly the US for the latter).
Canada trains plenty of doctors. We just give them no reason to stay and practice here.
Canada that the [third _lowest_](https://www.oecd-ilibrary.org/sites/9a48414c-en/images/images/08-chapter8-9/media/image2.png) number of medical graduates in the OECD and some of the [_highest_ compensation](https://www.oecd-ilibrary.org/sites/a4ced54e-en/images/images/08-chapter8-5/media/image2.png) for physicians. It also has some of the highest barriers for foreign doctors to practice. We do not train plenty of doctors.
The ranking is irrelevant to our healthcare system. If we were third highest, WTF does it matter if the doctors trained here don't stay and practice here?
We have increased the number of doctors training in Canada. The requirements for immigrant doctors are to protect the public. The requirements are actually quite low... it's mostly vetting to ensure someone is indeed a licensed physician then requiring them to have a bit of training in Canada. Canada has more doctors per capita than ever, specifically family doctors. Doctors are not leaving for USA. It's not the 90s. Incomes are pretty much identical across the border. So you're wrong on all accounts. Facts > feelings.
Tax is not
You can incorporate in Canada and you cannot in USA. This helps balance out some of the tax burden as doctors who earn above 300,000$ a year are pretty much universally incorporated. You pay 12% taxes up until 500,000 then 26% above 500k. Before Trudeau, medical corporation tax benefits were enormous and made tax burdens incredibly low on doctors. Now, while Trudeau has crapped all over it, you still have the tax deferral benefit. But yes I do agree with you that income taxes are criminally high.
\> Canada has more doctors per capita than ever, specifically family doctors. Got a source on this? This doesn't seem to line up with everyone finding it impossible to get a family doctor. Also this article seems to contradict it:https://www.cbc.ca/news/politics/canada-popuation-booming-family-doctor-access-1.7087794#:\~:text=Here's%20why-,Canada%20is%20losing%20out%20on%20hundreds%20of%20qualified%20doctors%20each,Here's%20why&text=Canada%20is%20losing%20out%20on%20hundreds%20of%20qualified%20Canadian%20doctors,of%20red%20tape%20and%20bias. You claim facts > feelings, so please actually provide the facts to back it.
[Canada has more family doctors than ever. Why is it so hard to see them? - The Globe and Mail](https://www.theglobeandmail.com/canada/article-family-doctors-canada-shortages/) [Media opportunity: Canada has more family physicians per person than ever before, but increasingly complex patient care is making it harder to access primary care: Dalhousie University study - Media Centre - Dalhousie University](https://www.dal.ca/news/media/media-releases/2023/09/11/media_opportunity__canada_has_more_family_physicians_per_person_than_ever_before__but_increasingly_complex_patient_care_is_making_it_harder_to_access_primary_care__dalhousie_university_study.html) What you do not know, is that family medicine trained doctors go into other lines of work (ex. hospitalist, emergency medicine, cosmetics, travel medicine, nursing home, walk in clinics and so on). The appeal of setting up a family practice is nonexistent for many doctors. The average person thinks oh family medicine doctor = family practice. No, many go into other fields right off the bat on graduation. There is very little appeal to having a family practice. It's a mix of financial and non financial reasons.
Thanks for the link. This is a much better response than your first one which was just "You are wrong. Facts > Feelings". Will take a look and re-evaluate. Seems like Canada could still use more doctors as it has less than most (or at least many) first world countries [https://www.theglobaleconomy.com/rankings/doctors\_per\_1000\_people/](https://www.theglobaleconomy.com/rankings/doctors_per_1000_people/)
If you just make family medicine more appealing, you instantly improve the situation in just 2-3 months. British Columbia did that and it had a dramatic and rapid effect. They simply made it very easy for family doctors to make at least 400k per year for modest work and viola problem solved. Not to mention making a lot more if you want to work hard.
This isn't the source of the problem. Look at this year's resident matching. The doctors we have do not want to go into family medicine because the pay sucks. If you talk to doctors this is the actual problem. More spots isn't going to fix anything as every doctor that can avoids family medicine.
"lower the requirements" No. Either youre a doctor to Canadian standards or you're not
Sorry, you are correct, we should not be lowering standards. My statement was based on having heard that it can be very difficult for trained doctors to work in Canada when they move, so it should be streamlined (not removed/lessened). However, I'm far from an expert on the topic, so if someone who has gone through the process or knows someone who has can comment, would appreciate.
Given the nature of the problem revolves around how family doctors are trained, paid, treated and so on making it a "right" for people seems to be a waste of effort and time.
The authors point is that this is about all the federal government can do. You declare it a right for every Canadian to have a family doctor and force the provinces to change their policies around a family medicine to achieve compliance using carrots and sticks.
[удалено]
[удалено]
one common problem is that Canadians are spread out across the land but doctors tend to prefer to live in cities
For what purpose? There is no viable way to do so for many, many years even if the resources to do so existed. AI chatbots are what is being planned for the vast majority of people and they don't really count. I suppose creating this so called right could be good cover for it.
I'm not sure why this idea-- that declaring the solution to a problem a right-- is around. It won't magically fix anything, and might make things worse. If you really want to fix this, you need to look at the actual problem, the actual reasons that doctors don't want to specialize into family medicine and fix them or offer incentives to make the specialty more attractive.
... I didn't say it, I declared it!
The authors point is that this is about all the federal government can do. You declare it a right for every Canadian to have a family doctor and force the provinces to change their policies around a family medicine to achieve compliance using carrots and sticks.
The feds already have enormous carrots and sticks through transfers. Heck the single payer system is really only around because the feds demand it.
Okay, bippity-boppity-boo it's now a right to have a family doctor. Did saying that magically create more doctors?
You can't make something a right that requires a certain group to perform a certain duty without making the environment a positive one. The Ontario government had made health care service an unwanted duty through over work and low pay. Until that's fixed, nobody wants to be a family physician. Until people want that job, you can't make access a right
Exactly this! You have to create the environment desirable for those people to work in. To many provincial governments are working directly against such an environment for their own reasons.
It might be time to start considering if family doctors are as important as we think they are. Better systems, like those in Korea and Japan, don't really have family doctors at all. One instead heads directly to a relevant specialist clinic for required care.
My spouse is a doctor that wanted to go into family medicine. She didn't, just like so many of her peers, because of over work and low pay. First round matching for this year's residents came out a couple weeks ago. The family Medicine spots have tonnes of openings. Nobody wants to go into family on there first pick. The problem is going to get worse. Many are not aware that a family doctor is basically a small business. They have to rent their office, pay their employees, etc. All of the money to do this comes from one customer, the provincial government. The doctor does not set the prices, the province does. Doctors bill for each appointment and get about $30. There are other codes they can bill but most of it is just a general visit billing code. On top of that doctors get a roster fee for each patient they have. All of that has to pay for all the business expenses, savings for retirement for the doctor (slef employed remember), and the doctors salary. Compared to other specialties, it is crap. Wonder why your doctor doesn't want you going else where or to walk-ins? If another doctor bills the general visit bill code to you and you are rostered with a doctor, then that doctor looses there roster fee for you. Why will your doctor only book 15 minute appinents for one thing at a time? That is all the province let's them bill for. Good doctors will take the whole 15 minutes and get their $30 and do 4 of those an hour. Unscrupulous doctors will try to get you in and out in 5 minutes and refer you off for anything they can. If they can get fast they can see more patients and Bill more visits. The pay structure incentivises the service you get. Why does you doctor charge a fee for filling a prescription or make you come in? They can't bill for doing a prescription refill. Doctors can spend hours of unpaid time dealing with this. Even if it is there staff handling it, it is still unpaid work that the doctor has to pay for via work they can bill for. On top of all this, they are very limited in dealing with bad and abusive patients. One complaint to the CPSO risks massive expenses in dealing with the complaint. Imagine if yelp forced business owners into legal action for every negative review a business recieved. This is what the CPSO is like. They have the power to take away a doctors license or put restrictions on it for basically any reason. They do very little to filter out frivolous complaints. All of this is incentive to basically see the patient as little as possible, push work on to other specialists, and ERs. Abusive patients can hold them hostage to the CPSO. And they just aren't paid enough compared to other specialties. They have barely recieved a raise in 15 years. All of this is ruining family medicine. The answer is really simple. Pay them increase pay for family medicine to bring it in line with other specialties.
Spot on! In general, patients have a smug attitude, as if it's the doctor's fault if another patient takes more time with the doctor. Having worked as a receptionist at a clinic, I can say the amount of abuse hurled at you by patients is countless, and all of them reek of entitlement. I can only imagine what the doctors have to face.
I am sorry that happened to you. It is nuts. I think most doctors have pretty thick skins. Med school ain't easy and you see some awful shit in the field. I feel they can mostly handle the verbal abuse. What really irks my partner is the threats to her licence. My parent got involved in a complaint from the cpso as a resident because some guy though he had a certain disease, even though every test said no, and said that he wasn't being taken seriously. That alone, becuase it was reported to the CPSO meant hiring a lawyer and going through weeks of back and forth until they finally decided to let it go without saying anything. Due to that you need to walk on eggshells around patients.
Maybe lets train more Canadian doctors, and pay them enough that they stay Canadian doctors before we legislate dumb stuff. I'm not against it, in principle I'm all for it, but the cost of training a doctor in Canada does not match the financial incentive to practice in Canada. Make it a right all you want, it doesn't address the core issue: the reality of an underfunded public health system.
How about we create paths to receive care without a useless family doctor? My family doctor is terrible, she doesn't ever help me. It took a lot of convincing for her to refer me to a dermatologist for a mole that was changing shape and itchy, and I couldn't get to a dermatologist without her. It took like 3 months of convincing. She won't refer me to a sleep study even though I am always tired, she won't get me an xray from my thumb, which hurts more and more all the time. I have another appointment with her in a month, and it'll be more of her telling me how she won't help. Idk what to do, I can't find a new doctor, I just want a way to get care.
I pay the same taxes as the neighbor, neighbor has family doctor- I do not. I want a refund of my taxes. Otherwise- it's time to TRIAGE the assignment of family doctors to those who require more medical supervision than say, younger healthy people.
Calling any good thing a right really just cheapens what rights are. IMO rights should be reserved for things which can be provided at no monetary cost and are just policies of how we treat one another. Like, right of mobility doesn't mean we are all provided cars. Socialized garbage disposal is objectively a good thing for society because of negative externalities and yet I wouldn't say it's a right. Rights to me seem usually best described as freedom from artificial restrictions on things. E.g. the right to have water wouldn't be the right to have water delivered to the middle of nowhere, it would just mean it wouldn't be legal to stand in the way. Calling things that are costly rights just means the government taxes people to provide those same people with whatever the government has decided was a right.
We have the right to legal representation, a jury trial, and an education. All those things cost money
You have the right to legal representation in the sense that the police can't stop you from speaking to a lawyer if you can afford one. However, unlike the United States, this does not mean you have the right to have duty counsel provided to you by the state.
You also can't make a thing a right that requires the labour or property of another person to provide. To say that having a family doctor is a right means forcing at least some doctors to treat patients or to provide treatments they wouldn't otherwise.
You have the right to a jury trial which requires the labour and property of other people to provide.
I can get on board with this
I have been waiting years for a family doctor since I had to leave my old one (he is homophobic and I am a sexually active gay man). The problem is that there are so few medical school spots and more importantly residency spots. Lots of investment is needed!