U.S., Canadian health care systems share some challenges
In 2008, it ranked 26th of 32 Organization for Economic Cooperation and Development (OECD) countries on that front, with 2.3 physicians per 1,000 population, compared to the average of 3.2, and 2.4 in the U.S. In response to outcry over long wait lists, provinces have in recent years significantly boosted medical school enrollment and the number of on-the-job training positions: two-year family-medicine residencies and five-year residencies in a specialty. Once trained, family doctors and many other primary-care physicians, like pediatricians or psychiatrists, can simply hang out a shingle and start billing for their services. Surgeons and others who require expensive infrastructure like operating rooms to do their jobs, are often hired by hospitals or health regions. A cardiac surgeon, for instance, costs a hospital $1.5 million a year, though the doctors income is only part of that, said Ms. Frechette. Physicians say the job market has been tightened in part because the expected wave of retirements has yet to materialize, with many older doctors deciding to keep working after investment losses. Sometimes, as well, the jobs are out there, but might require a new specialist to relocate across the country, not always easy if they have working spouses and children, said Mr. MacLean. Yet in areas where demand for doctors is still high, budget-constrained health institutions are often not hiring the additional specialists recently churned out, medical leaders say. I dont think there was downstream planning as to How do we accommodate them once theyre finished? said Dr. Johnson The problems can also be traced back to medical schools, where there is scant science behind deciding how many positions to allot to each field, said Dr. John Haggie, president of the Canadian Medical Association. We dont know as a nation or a province or a jurisdiction what kind of physician population we actually need going forward, he said. As a result, people often take a fairly opportunistic, almost random career path, and end up with skills that are fairly focused and difficult to accommodate where they want to be. Successfully predicting needs is not necessarily easy, given the five-year lag before a medical-school graduate finishes specialty training. Ms.
Thirty-nine years later the U.S. was spending 50 percent more of its national income on health care, leaving its patients with the highest out-of-pocket expenses in the world. When I explained the high out-of-pocket expenses to Canadians, that notion simply did not compute. There is some talk about imposing copays for some services as a way to help both the federal and provincial governments save money. But the idea of making people pay 50 percent of a bill or a family paying $13,000 out of pocket before insurance benefits kick in is wildly unpopular. As in the U.S., there’s much soul searching about whether the country is getting as much bang for the bucks it spends. Does the quality of care match the country’s outlay? A number of studies, including the latest international comparison from The Commonwealth Fund , show that Canada and the U.S both fall down on several dimensions of care. Both Canadians and Americans were more likely to report long waits for primary care and high use of emergency rooms compared to other countries such as Germany, France and the United Kingdom. I asked Jeffrey Turnbull , M.D., F.R.C.P.C., chief of staff at Ottawa General Hospital, about criticisms of the quality of Canadian health care. He said that, when it comes to treating heart attacks, stroke, heart failure and pneumonia “we do relatively well.” But when you look at the broader indices that measure the inequities, the picture is very different. “Our vulnerable populations have rates like the developing world.” We can say the same for groups in the U.S. Our two countries also share the increasing burden of providing care for their aging populations . Indeed, lack of community support is one reason why waiting lists develop at Canadian hospitals. Seniors who are admitted to acute care hospitals sometimes stay much longer than what’s medically necessary because they have no place to go.