I have thought about this issue a lot and now at almost 81 years of age I am concerned selfishly about the state of our health care system because I most likely will need to access it more in the future. Til now I have never stayed over night in a hospital except when I was on call. In fact a lot of people require very little health care especially if they take care of themselves. There is no Universal patient and there should be no Universal health care!. I worked for the patient until I believe 1985 and I was forced to join OHIP. The patient was responsible to pay me. Yes we have to provide access to health care for everyone but that doesn't mean it has to be free for everyone. There is what I call responsibility. We know that Socialism fails be cause of socialism and free enterprise fails because of the people, therefore they have to be controlled. Interestingly, Daniel Kahneman recently died and he won the Nobel Prize for economics in 2002 . He was primarily a Psychologist and pioneered "Behavioual Economics"
1. Do everything in your power to stay healthy and not need to use the health care system.
2. Aren’t we fortunate to even have a health care system to complain about.
Over 30 years ago, when I completed my MPH degree in England I concluded that a hybrid system is best. For profit and not for profit. There’s always going to be problems in health care systems but an individual should always have the ability to choose. Certain life choices preclude choice however once again we’re all lucky that anyone even wants to be a doctor these days.
The so-called 'health care' in this country is disastrous. To hear of ER's closing, wait times out of this world, and people dying while waiting for some intervention - what a crying shame. Many do not even have a doctor or feel any hope that they will get one. The bureaucrats are the main issue I think.
Some people also abuse the system. I don't know what the answer is but it's bad - really bad. Maybe your suggestion can put a ray of hope into the darkest of corners.
I think this article was an attempt t clarify the previous one that I pushed back on, but I don't actually see any more points being made - nothing that I didn't understand the first time.
My criticism remains. Like it or not, you are saying that doctors should give up their autonomy and ability to run their own clinics as they see fit and become employees at a government clinic (one can split hairs and say "private contractors" or whatever, but I would say it's the same thing).
Decisions like how many clinics, who works there, will they be EMR or paper, do you have to wear masks, will we put up a flag for pride season, who is responsible for what - will be determined by bureaucrats. Communities will fight. (Ward A got a clinic, so Ward B should have one too!). Less work will be done as more dollars are spent. Doctors will feel less empowered.
I will point out that I'm not speculating. Every province has already created many publicly-run primary care clinics. They haven't worked. Ontario's FHT's (or whatever the correct acronym is currently) are case in point. They started 20 years ago. Things are not better for primary care access but rather worse.
I think the new generation of docs who don't want to run their own clinic is due to 2 factors:
1) the payment-per-patient hasn't nearly kept pace with inflation. I made somewhere just over 30$ per visit in 1999 when I started. I don't know the current FFS rate in Ontario, but in NS it's less than 40$.
2) the young generation of docs are a great example of people who would "trade liberty for safety". Yeah, it's hard to run your own clinic. It's nice to have someone run it for you so you can have more "me-time". But you give up a lot of autonomy in that bargain.
A centrally-planned society always fails, because no one person (or group) is wise enough to design a system that works for everyone, everywhere. This is true in healthcare as well. Canada is a glaring example.
I’m not sure why, but it seems to me that you are going out of your way (again) to willfully mischaracterize the points I tried to make.
I don’t know how many ways to say this, but as I said quite clearly in the article I do not propose that government bureaucrats run or administer these centres. I say exactly the opposite, if you care to reread the piece.
Government can (and should) enable the creation of these types of centres, but the centres should be 100% privately owned and administered. And that private ownership and administration should be amply peppered with physicians who control how we run our affairs.
Again, I am puzzled as to why you persist in asserting that I am in favour of enabling more layers of bureaucracy, when I am 100% opposed to that.
I spoke with Frank Stronach as I was putting this piece together, didn't include his comments because of the subsequent controversy that exploded around his personal life, but he is a huge proponent of enterprises in which everyone has "skin in the game".... it's one of the key reasons underpinning his astounding business success, and it's a principle we should use to advantage in health care delivery.
I had an appt with my PCP yesterday to go over medications. He's upset that I didn't go for my bloodwork last time I was in. But I did go for my bloodwork. Twice. However since I'm sick and tired of being treated like a cattle that if I don't get seen within a half an hour I leave. I said to him "I'm here in your office right now. Why don't you get one of your assistants to draw my blood and send it to the lab?"
The question shocked him. The fact that I brought it up shocked him. Service? IN A DOCTOR'S OFFICE? Preposterous.
PS- I'm in Ontario, so it's not like I can shop around for a PCP. I'm also an informed patient, and I do my own research on various meds he assigns to me and I decide if the adverse effects are worth it based on the ARR. If it's not, I decline.
Oh, one more thing.... how does a patient respect a physician that, despite all the evidence to the contrary, STILL wears a masks because he's afraid of covid?
When I first started family practice in 1999 in rural Ontario, we had a room in our clinic where we drew blood, put it in the fridge, and it was picked up at the end of the day by Brian - our friendly MDS labs deliveryman. He would bring with him the stack of lab reports from the previous day. It was efficient for patients, efficient for me, and never once in all that time did I have any problem.
When I moved back to NS I was shocked and disappointed that government facilities have a monopoly on blood analysis. As I understand it this is a bureaucratic/regulatory issue, not a logistical one.
The bit about having your doc draw the blood in his office, while you are there, actually highlights the problems, because it’s not as simple as you might think.
As soon as the blood leaves your body, it starts to change. For some tests, it doesn’t change very fast, but for other tests it does. Some tests have to be done while fasting, and not all patients arrive at the office with an empty stomach. Bottom line is that the blood has to be drawn under the right circumstances, and it has to get to the lab within a defined time frame, with proper temperature control and biohazard measures while in transport. Your doc won’t be paid to draw the blood, and somebody has to pay for the needles, blood tubes, technician time, and transport costs.
In other words, what seems logical and convenient to you is not actually logical or feasible. Yes, it’s a pain in the ass when labs only offer first-come, first served blood collection, but it’s not impossible for them to offer appointments.
Come on man. The places that draw your blood don't have an on site lab. The blood is sent to centralized labs for analysis. A doctor's office can draw the blood and send it off just as well as the lowly paid employees at the blood clinics can.
PS- No one said the doctor's office had to do it for free.
I’m not shilling for anyone. I’m a retired family doctor, with past admin experience that means I know a bit more about this topic than the average person on the street.
I was a provincial head of family practice in Nova Scotia, and went through a protracted negotiation with the provincial lab people. At the time, we had private venepuncturists (people who draw blood “for money”, one of them offering service in my office). The provincial lab was trying to get rid of the private services. The issue really honestly is that the blood samples have to be processed within a specified period of time after the blood is drawn, or else the test results are invalid. Sometimes it’s within a couple of hours - the blood doesn’t stay stable forever. You can’t simply collect blood all day then fire it off to the lab at closing time.
So, when a large facility is drawing blood in the community, away from the actual lab where the samples are processed, they are sending multiple courier runs per day to the lab, using couriers who can keep the samples at the right temperature and properly transported (blood is considered a biohazard, and there are federal regulations about how it is to be transported).
I have thought about this issue a lot and now at almost 81 years of age I am concerned selfishly about the state of our health care system because I most likely will need to access it more in the future. Til now I have never stayed over night in a hospital except when I was on call. In fact a lot of people require very little health care especially if they take care of themselves. There is no Universal patient and there should be no Universal health care!. I worked for the patient until I believe 1985 and I was forced to join OHIP. The patient was responsible to pay me. Yes we have to provide access to health care for everyone but that doesn't mean it has to be free for everyone. There is what I call responsibility. We know that Socialism fails be cause of socialism and free enterprise fails because of the people, therefore they have to be controlled. Interestingly, Daniel Kahneman recently died and he won the Nobel Prize for economics in 2002 . He was primarily a Psychologist and pioneered "Behavioual Economics"
Two thoughts come to mind:
1. Do everything in your power to stay healthy and not need to use the health care system.
2. Aren’t we fortunate to even have a health care system to complain about.
Over 30 years ago, when I completed my MPH degree in England I concluded that a hybrid system is best. For profit and not for profit. There’s always going to be problems in health care systems but an individual should always have the ability to choose. Certain life choices preclude choice however once again we’re all lucky that anyone even wants to be a doctor these days.
The so-called 'health care' in this country is disastrous. To hear of ER's closing, wait times out of this world, and people dying while waiting for some intervention - what a crying shame. Many do not even have a doctor or feel any hope that they will get one. The bureaucrats are the main issue I think.
Some people also abuse the system. I don't know what the answer is but it's bad - really bad. Maybe your suggestion can put a ray of hope into the darkest of corners.
I think this article was an attempt t clarify the previous one that I pushed back on, but I don't actually see any more points being made - nothing that I didn't understand the first time.
My criticism remains. Like it or not, you are saying that doctors should give up their autonomy and ability to run their own clinics as they see fit and become employees at a government clinic (one can split hairs and say "private contractors" or whatever, but I would say it's the same thing).
Decisions like how many clinics, who works there, will they be EMR or paper, do you have to wear masks, will we put up a flag for pride season, who is responsible for what - will be determined by bureaucrats. Communities will fight. (Ward A got a clinic, so Ward B should have one too!). Less work will be done as more dollars are spent. Doctors will feel less empowered.
I will point out that I'm not speculating. Every province has already created many publicly-run primary care clinics. They haven't worked. Ontario's FHT's (or whatever the correct acronym is currently) are case in point. They started 20 years ago. Things are not better for primary care access but rather worse.
I think the new generation of docs who don't want to run their own clinic is due to 2 factors:
1) the payment-per-patient hasn't nearly kept pace with inflation. I made somewhere just over 30$ per visit in 1999 when I started. I don't know the current FFS rate in Ontario, but in NS it's less than 40$.
2) the young generation of docs are a great example of people who would "trade liberty for safety". Yeah, it's hard to run your own clinic. It's nice to have someone run it for you so you can have more "me-time". But you give up a lot of autonomy in that bargain.
A centrally-planned society always fails, because no one person (or group) is wise enough to design a system that works for everyone, everywhere. This is true in healthcare as well. Canada is a glaring example.
Chris,
I’m not sure why, but it seems to me that you are going out of your way (again) to willfully mischaracterize the points I tried to make.
I don’t know how many ways to say this, but as I said quite clearly in the article I do not propose that government bureaucrats run or administer these centres. I say exactly the opposite, if you care to reread the piece.
Government can (and should) enable the creation of these types of centres, but the centres should be 100% privately owned and administered. And that private ownership and administration should be amply peppered with physicians who control how we run our affairs.
Again, I am puzzled as to why you persist in asserting that I am in favour of enabling more layers of bureaucracy, when I am 100% opposed to that.
I spoke with Frank Stronach as I was putting this piece together, didn't include his comments because of the subsequent controversy that exploded around his personal life, but he is a huge proponent of enterprises in which everyone has "skin in the game".... it's one of the key reasons underpinning his astounding business success, and it's a principle we should use to advantage in health care delivery.
Speaking for hurry up and wait....
I had an appt with my PCP yesterday to go over medications. He's upset that I didn't go for my bloodwork last time I was in. But I did go for my bloodwork. Twice. However since I'm sick and tired of being treated like a cattle that if I don't get seen within a half an hour I leave. I said to him "I'm here in your office right now. Why don't you get one of your assistants to draw my blood and send it to the lab?"
The question shocked him. The fact that I brought it up shocked him. Service? IN A DOCTOR'S OFFICE? Preposterous.
PS- I'm in Ontario, so it's not like I can shop around for a PCP. I'm also an informed patient, and I do my own research on various meds he assigns to me and I decide if the adverse effects are worth it based on the ARR. If it's not, I decline.
Oh, one more thing.... how does a patient respect a physician that, despite all the evidence to the contrary, STILL wears a masks because he's afraid of covid?
When I first started family practice in 1999 in rural Ontario, we had a room in our clinic where we drew blood, put it in the fridge, and it was picked up at the end of the day by Brian - our friendly MDS labs deliveryman. He would bring with him the stack of lab reports from the previous day. It was efficient for patients, efficient for me, and never once in all that time did I have any problem.
When I moved back to NS I was shocked and disappointed that government facilities have a monopoly on blood analysis. As I understand it this is a bureaucratic/regulatory issue, not a logistical one.
The bit about having your doc draw the blood in his office, while you are there, actually highlights the problems, because it’s not as simple as you might think.
As soon as the blood leaves your body, it starts to change. For some tests, it doesn’t change very fast, but for other tests it does. Some tests have to be done while fasting, and not all patients arrive at the office with an empty stomach. Bottom line is that the blood has to be drawn under the right circumstances, and it has to get to the lab within a defined time frame, with proper temperature control and biohazard measures while in transport. Your doc won’t be paid to draw the blood, and somebody has to pay for the needles, blood tubes, technician time, and transport costs.
In other words, what seems logical and convenient to you is not actually logical or feasible. Yes, it’s a pain in the ass when labs only offer first-come, first served blood collection, but it’s not impossible for them to offer appointments.
Come on man. The places that draw your blood don't have an on site lab. The blood is sent to centralized labs for analysis. A doctor's office can draw the blood and send it off just as well as the lowly paid employees at the blood clinics can.
PS- No one said the doctor's office had to do it for free.
The places that draw blood are drawing and shipping it in bulk, not one patient at a time!
So they're shipping it what, once a day? Just like the doctor's office could do?
Who are you shilling for?
No need to be rude - not cool.
I’m not shilling for anyone. I’m a retired family doctor, with past admin experience that means I know a bit more about this topic than the average person on the street.
I was a provincial head of family practice in Nova Scotia, and went through a protracted negotiation with the provincial lab people. At the time, we had private venepuncturists (people who draw blood “for money”, one of them offering service in my office). The provincial lab was trying to get rid of the private services. The issue really honestly is that the blood samples have to be processed within a specified period of time after the blood is drawn, or else the test results are invalid. Sometimes it’s within a couple of hours - the blood doesn’t stay stable forever. You can’t simply collect blood all day then fire it off to the lab at closing time.
So, when a large facility is drawing blood in the community, away from the actual lab where the samples are processed, they are sending multiple courier runs per day to the lab, using couriers who can keep the samples at the right temperature and properly transported (blood is considered a biohazard, and there are federal regulations about how it is to be transported).
See my above comment - clinics can and do draw their own blood. It works well.