Canadian patients wait longest to see family doctors
John’s will meet with Members of Parliament and Senators to discuss strategies to ensure that all Canadians have access to two important determinants of health: adequate and affordable housing and medical care. Lack of access to safe and stable housing has significant negative consequences on one’s health. According to the 2010 Health and Housing in Transition Study from the Research Alliance for Canadian Homelessness, Housing and Health, people who are homeless or vulnerably housed have higher rates of chronic health conditions like Hepatitis B and C, asthma, high blood pressure, and cancer. Sustaining current social housing units remains a significant area of unaddressed need. The agreements that created most social housing units are set to expire from the present time until 2034. For example, between 2012 and 2018, more than 100,000 social housing units will have lost their annual subsidies. With social housing waiting lists growing across the country, hundreds of thousands could be put at greater risk of homelessness. In recognition of the link between housing and health, Canadian medical students are calling upon the federal government to reinvest the savings gained from the end of social housing agreements to enable social housing providers to maintain the same number of units with the same affordability. Medical students have also recognized that patients who are adequately housed may not have access to medical services, particularly within rural and remote areas. A 2012 report from the Canadian Institute for Health Information revealed that while 18% of Canadians live rurally, only 8% of physicians live within these regions. In April 2013, the Government of Canada launched a program to provide loan forgiveness to family physicians and nurses who practice in rural and remote areas. However, medical students are concerned this program may not be maximally effective.
Pay doctors more and they do less
In 2007, after bitter negotiations between physician federations and the Quebec government, agreements were signed to significantly increase fee schedules. Over the following five years the average cost per service rose by 25 per cent for family doctors and 32 per cent for specialists (the term service describes all medical care provided, such as visits, procedures and tests). At the same time, the number of physicians per capita grew by eight per cent to reach an unprecedented number of physicians in the province. Combined, these two trends increased medical compensation expenditures in Quebec by $1.5 billion over five years. After controlling for inflation, these investments translate into average net income increases of 15 per cent for family doctors and 25 per cent for specialists. As these are inflation-controlled figures, these are real increases in purchasing power. Whats interesting, however, is that during this same period, the average number of specialized service visits per inhabitant stagnated, and the average number of family medicine service visits per person actually dropped by five per cent. The average number of services provided by each physician also dropped by five per cent for specialists and seven per cent for family doctors. In other words, the net impact of investing an additional $1.5 billion no small sum in physician remuneration was either a stagnation or reduction in the volume of services provided to the population. Moreover, the decrease in the average volume of services per physician offsets most or all of the increases in the overall number of physicians. Unfortunately, this result is not surprising. In fact, it is highly convergent with what is known in economics as the “target income hypothesis.” This hypothesis posits that people aim for a given level of income and will adjust their work load to reach it. This implies, among other things, that when the rate paid for a given amount of work increases, workers might choose to work less rather than to increase their revenues. What our study shows is that as the unit price of services rose, physicians who are overwhelmingly self-employed entrepreneurs adjusted their work practice to improve their quality of life instead of opting to earn more.
Brantford, Ont., resident Richard Kinsella said he had trouble finding a family doctor when he moved to the city east of Hamilton 15 months ago. Kinsella said people in Brantford commonly turn to the emergency department. “The emergency, I’ve been twice, and I was there waiting over six hours.” Family physician Dr. Nandini Sathi’s practice is now able to see more patients within 48 hours of when they call. (CBC) People in the U.S. have quicker access to their family doctors, with48 per cent of those polled saying they could get a same-day or next-day appointment, ranking second last among the 11 countries. Germany was listed as first in how quickly residents saw their doctors, at 76 per cent, followed by New Zealand at 72 per cent. Many Canadians don’t have aregular doctor Dobrow said the report raises important questions about the wide variations among provinces in areas such as access to after-hours care, emergency department wait times, affordability of care, co-ordination among care providers, and uptake of screening programs. “Do we have the rights goals for our system? Are we looking at better health, better care, better value for all Canadians?” he said. In September, the council suggested that provinces pay attention to issues such as leadership, having theright types of policies, and legislation and capacity building. For example, overall resources in primary care could be increased by expanding scopes of practice of somehealth professionals and improving their interdisciplinary training. At Toronto’s Wellpoint Clinic, the physicians changed to an “open access” system, meaning patients no longer make appointments weeks in advance. Exceptions include people who need to prebook wheelchair transit services or a physical checkup. “As physicians, we were worried that we would become inundated with patients on a daily basis,” said family physician Dr. Nandini Sathi.