Doctors Eying the U.S.: Canada Is Sick About It

NY Times ^ | 10/17/03 | CLIFFORD KRAUSS

[friendly]

Drs. Siva Sriharan and Srinivas Chakravarthi may never get rich staying in this small auto-producing city little more than a stone's throw from downtown Detroit, but they can eat all the hamburgers, ribs and potato skins they want for the rest of their lives at Casey's Bar and Grill.

For the next year, they can also get their hair cut free at the Touch of Class beauty salon, and lease a Pontiac Grand Am without charge from a dealer in nearby Essex. Patients have pledged free house repairs and landscaping for their properties, and nurses have teased them with offers of free massages.

All the two doctors have to do is continue practicing medicine in Windsor.

Residents started proffering gifts when rumors leaked out of Hôtel-Dieu Grace Hospital a few weeks ago that the two neurosurgeons — of the four serving the city — were toying with moving their practice to the United States.

"It's not about the money," said Dr. Sriharan, a 38-year-old immigrant from Sri Lanka. "We can't do our job properly with operating room time so extremely limited here."

Forced to compete for operating room time with other surgeons, he said that he and his colleague could complete only one or two operations on some days, meaning that patients whose cases were not emergencies could go months or even years before completing necessary treatment.

"Scarce resources are simply not being spent properly," Dr. Sriharan concluded, citing a shortage of nurses and anesthesiologists in the hospital where the single microscope available is old and breaking down.

The two surgeons are sharply critical of Canada's health care system, which is driven by government-financed insurance for all but increasingly rations service because of various technological and personnel shortages. Both doctors said they were fed up with a two-tier medical system in which those with connections go to the head of the line for surgery.

"It's the system that is pushing us out," said Dr. Chakravarthi, a 53-year-old Indian immigrant.

Many other Canadian doctors feel the lure of the United States these days, particularly if they live close to the border.

The supply of family doctors has increased at a rate lower than population growth in recent years, a problem that is complicated by an aging population and doctors seeking shorter hours. Waiting time for elective surgery is growing across the country, and becoming a hot political issue.

Meanwhile, there are signs that a brain drain of medical talent, particularly specialists to the United States, is becoming a serious problem.

There was a net migration of 49 neurosurgeons from Canada from 1996 to 2002, according to the Canadian Institute for Health Information, a large loss given that there are only 241 neurosurgeons in the country.

"Physicians across Canada are in an advanced stage of burnout due to work conditions," said Dr. Sunil V. Patel, president of the Canadian Medical Association, who attributed much of the problem to technological shortages and the powerlessness doctors feel when patients complain about long waits for treatment. "That burnout causes them to retire early or pull away from certain kinds of work or simply leave."

John O'Kane, 46, the owner of Casey's Bar and Grill, is leading the local crusade to keep the two neurosurgeons in Windsor. His offer of free food is rooted in personal experience; he is convinced that superior surgery performed on him last year by Dr. Sriharan to remove a broken piece of a spinal disk rubbing against a sciatic nerve is the reason he can again play ice hockey and tennis.

So far the doctors have not come by for any free food, nor have they responded to any of the other offers that have followed.

"For all I know they are vegetarians," Mr. O'Kane said with a laugh. (In fact, Dr. Chakravarthi is.)

The grass-roots surge of offers and almost daily letters to the editor published in the local newspaper urging the surgeons to stay put has not gone unnoticed by local politicians. Windsor's mayor, Mike D. Hurst, has speeded up a physician recruitment and retention initiative to combat local shortages of medical manpower.

"The popular response is an indication," he said, "that there is pure fear in our community of not having qualified, professional medical expertise available when it's needed."

As for the two surgeons, they say that while they are touched and embarrassed, they do not see how they can continue to work at the hospital under the present conditions.

[Ronin]

Of course, anyone with wealth, including the Canadian limosene liberals, just hops on an Airplane and heads south for any needed medical care.

[CWOJackson]

Must be why the Canadian government now provides free medicinal pot.

Here, smoke this...smoke lots of it and you won't notice your problem.

[Jim Noble]

Can someone explain why all the doctors are from India and the Middle East?

Canada strictly limits the number of specialists trained, to prevent their cheap primary care medical school graduates from morphing into expensive specialists (if you only have a few trained joint replacement surgeons, you can't do many operations, and you spend less money).

Like any administered pricing/central planning system, however, the targets are never right. The few Canadian MDs who are trained in specialties, like neurosurgery, where the pay differential Canada/USA is 10X or greater have a tendency to emigrate. They can be replaced with Commonwealth (India and Pakistan) MDs, following the same pay gradient (10X Pakistan/Canada).

Most Canadian primary care folks are Canadian, because the pay differential Canada/USA is much smaller.

[alrea]

Residents started proffering gifts when rumors leaked out of Hôtel-Dieu Grace Hospital a few weeks ago that the two neurosurgeons — of the four serving the city — were toying with moving their practice to the United States.

Come to New York. Mrs. Clinton has a plan to help these doctors.

[alrea]

Scarce resources are simply not being spent properly," Dr. Sriharan concluded, citing a shortage of nurses and anesthesiologists in the hospital where the single microscope available is old and breaking down.

This is right on page 12 of economics 101. Canadians ignore it. Europeans ignore it. Politicians promise it will be different. Democrats want it for you.

(this stuff is not supposed to be in the paper)

[crz]

Yup..in Canada its the Government and "free health" care thats the problem. In the USA its the Government and the lawyers who run it who are the problem. The insurance companies aint far behind either. The doctors I talk to say they'd sooner make less and be free of the fear of the scum sucking lawyers who follow the patients around to offer "free" money to them by suit. If we dont watch it we will get the socialized medicine stuck right down our throats because nobody will be able to afford the health insurances...which few can now. And those like Hilliary happen to be what?..or at least used to be what?

[alrea]

Needless to say the socialist politicians and leading bureaucrats bypass the cr*ppy system they impose on the general population via such Four Star facilities as the National Defense Hospital in Ottawa and the corruption the two neurosurgeons complain about in the article.

Amazing; but there are different qualities of care all over the country.

Can't these people sue?

[randita]

Part of our health care system is already socialized to a degree in the form of Medicare.

Many doctors are limiting their Medicare patients and/or refusing to treat Medicare patients at all because the reimbursement for services is too low and the paperwork required involves a full time staaffer or two.

As of now, doctors in the U.S. have the right to determine who they will or will not treat. As more and more doctors refuse to participate in Medicare, Congress will probably enact laws which force them to make Medicare patients a certain % of their practice in order to keep their licenses.

[beavus]

Socialists and Democrats constantly fight the laws of economics, and they constantly lose.

[RAY]

Many members of the "legal 'profession'" are simply practicing legalized extortion. That’s what is allowed to happen when trial lawyers buy off the legislatures (who in large part are also lawyers).

[Tax-chick]

Thanks for the info. Nice if our government would learn something from others' mistakes, but they seem determined to turn the US into a fusion of the worst features of Canada and Mexico.

I was in college with several premed students: Indian, Vietnamese, Filipino, and one incredibly overachieving Black American. (Only one was born in the U.S.) I guess I was boring, too - and made sure the rent was paid, there was food in the apartment, and turned off the lights and TV after they fell asleep in their books ...

[Maelstrom]

It is of particular note that the residents have attempted to resort to barter to compensate for the failures of socialism.

I could almost predict that such attempts to subvert the socialist system is illegal.

Consider, for example, if the residents had, instead of the items listed for barter...free food...free services...free vehicle...if they had instead set up an operating room for the two doctors.

Socialism has a fundamental flaw: It removes the power to allocate scarce resources from the point of economic impact where the decision must be made to a centralized point where it is impossible to have the correct information concerning all parties within an appropriate period of time in order to make the proper decision.

[Guillermo]

In Canada and the US, the vast majority of schoolchildren are taught Multiculturalism, Diversity and Sex Ed in lieu of Biology, Chemistry and Physics. Therefore, they are ill equipped to deal with the rigors of collegiate pre-med programs and medical school.

[Maelstrom]

There is no AMA(or Canadian equivalent) in India and the Middle East. The schools are mediocre, but the expense is far far less than Canadian schools.

[Prodigal Son]

Can someone explain why all the doctors are from India and the Middle East?

India, Pakistan and many middle east countries are part of the Commonwealth. It's easier for an Indian doctor to go to the UK or Canada for example than it would be for people from other nations.

Plus, India has over a billion people compared to Canada's 32 million. It's just pure statistics. There are a lot of Indian doctors out there.

It's similar to Australia. My wife has about a dozen different agencies from Australia and New Zealand sending her emails weekly wanting her to emigrate there and practice medicine- particularly in the Outback. There are just more German doctors than Australian ones- Germany has a surplus of doctors (or they did the last time I heard). It's not really a matter of whether Australia has enough medical schools- they just don't have enough doctors.

[Jim Noble]

The schools are mediocre, but the expense is far far less than Canadian schools.

Middle Eastern medical schools vary tremendously in quality-a few are excellent, most are terrible.

Indian schools are among the best in the world-except that they enroll and retain far too many students.

I have hired the valedictorian of the Lady Hardinge Medical College (New Delhi), and, trust me, the top 10% of that class is easily the equal of Harvard Medical School.

Pakistani schools vary a lot, but some are excellent. the best surgeon I ever worked with was from Pakistan-and he was the best, by far.

[Jim Noble]

Amazing; but there are different qualities of care all over the country. Can't these people sue?

No.

[Jim Noble]

It is of particular note that the residents have attempted to resort to barter to compensate for the failures of socialism. I could almost predict that such attempts to subvert the socialist system is illegal.

Hillarycare (the detailed proposal) specified a $50 000 fine and/or five years in prison for treating a patient outside the system.

The actual proposal contained many interesting and important reflections of what American socialists are planning, or fantasize about.

They clearly spent a lot of time thinking about how our liberties would tend to counteract their "solution", and planned accordingly.

Of course, as everywhere else, the politicians and their favorites would have access to a parallel system.

[Desparado]

The big question is "Why would anyone want to be a Doctor in this day and age?" I work in the medical field very closely with Cardiologists and Cardiac Surgeons, and I can tell you no matter how much money they make,(the average pay for a Cardiologist is $300,000+ per year in the South), nobody in their right mind would want their lifestyle. They have become absolute slaves to the HMO's and Hospitals. How would you like to work 80-90 hours a week including all holidays and nights to take care of people who, for the most part do not take care of themselves in the simplest ways, and are not paying for any of the care that they are getting thanks to our Govt?

[Maelstrom]

Wasn't there a bill sometimes referred to as "RISA" -- I think -- that would jail doctors for 2 years and $10K who refused Medicare/Medicaid patients...later overturned.

OR

Would jail them if they treated patients who *weren't* on Medicare if they accepted *any* Medicare patients in the last 2 years?