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Victoria is facing a public-safety crisis

medicineman

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The guy looking after our daughter for her diabetes, was a spinal surgeon in India and is excellent to deal with. They can't call him "Doctor" as he is not certified here, we call him doctor because he does excellent work for us. The have about 6 "Case Managers" as they call these trained doctors. The medical profession is very much about guarding the sandbox for people trained in the "right schools".
We have similar folks here in Manitoba called "Clinical Assistants" - they're all Foreign Medical Grads, many of whom are attempting to get lincensure in Canada. They're legally recognized (as are Physician Assistantslike myself and a few others here) as a Regulated Health Profession under The Act and the College of Physicians and Surgeons of Manitoba. They work largely in hospitals doing in patient and sub-specialty patient care and have a codified scope of practice.

Small rant here...Many of you may/may not know, but my first job out of the CAF was family medicine in a small town in Manitoba that I did for about 3 years - my supervising doc was 35km away, we did stuff by phone/text and electronic chart review. They'd do in person stuff for me for my patients on long term controlled substances I couldn't prescribe or weird stuff I didn't think needed an immediate specialist consultation but could possibly benefit from a second set of eyes/ears for management at our level. I was largley working just as I did in the CAF if were remoted somewhere. I also looked after residents in a small PCH attached to the clinic, and I also had some priveliges at the hospital my Supervising doc was attached to, as that's where my patients would likely be admitted to and I worked some ED shifts there as well. I provided fairly comprehensive care - cradle to grave as it were, though I didn't do the delivery to the cradle. My wait times for appointments were reasonably short - within 2-3 days usually unless I was on holidays for a week - there'd be about 5-7 day catchup period. I accomodated same days for minor injuries/emergencies - something in the eye, lacerations, etc, even if the day was full. I often had people coming from places well outside my catchement area due to availability (and I hope general reputation). I also did house calls for folks, especially older folks ( a large majority of the population) to see if any red flags, check on them if they couldn't get in, etc.

This was all done on salary...which leads me to things that pissed me off. I'd see sometimes more patients per day, including daily rounding on my PCH residents, than some of the MD's at a nearby RHA town clinic/hospital did (not affilitated with the other town I worked with), who were also salaried. Because I wasn't an MD, I never got to benefit from the non-insured services I had to do, both on and off the clock. So things like social assistance and insurance paperwork - which are quite time consuming - driver medicals, even the occasional medical clearance for CAF enrollment, etc where an MD get a cheque or cash in hand to do the service, I'd see a cheque but have to hand it over to the Regional Health Authority, to allegedly go into my clinic's budget. I was enttitled to only 1 half day every two weeks for administration - so to do all this stuff which often added up to significantly more than 4 hours work by then, so it either had to be done after hours (ergo unpaid) or during an appointment slot which would have to be arranged as a full hour for some of these complex forms...which takes away up to 45 minutes of other appointment slots that day. Also, waiting too long to do those forms could serioiusly affect someone's life - so sooner done and off the better. As a for instance- medicals for a professional driver's permit were charged at a rate of $50 at our clinic...the first 6-9 months I was working there, I'd estimate I did about $15k worth of driver medicals, as the average going rate was $85-150 in private or RHA clinics (the MD's doing the deed got the money and charged ad lib)...do the math. I was supposed to charge for sick notes, but stuck it to the man by not doing that - if I thought the patient needed one, I gave it to them, however, I wouldn't if they came in demanding one, particularly if was for time prior to me seeing them. I justified it by if a person was paying me for the note, they'd tend to expect it would be for what they wanted, not what they actually needed. I did start sending employers invoices for BS notes though.

Other things - many of you may know of my general disdain for health care administrators. Don't get me wrong, worked for some great ones, but they're largely the minority. I feel the ratio of admins to operators is completely out of proportion to what it should be. My scheduling regarding admin and expected daily patient load was already mentioned. I found that there was an unreasonable amount of micromanaging by people not providing care to those doing it in the primary care side of things, and similar BS I'd seen in the CAF regarding everyone paying for one moron's fuckup. For example, I wasn't allowed to keep drug samples in my clinic because "it might affect your prescribing habits to one company or other" - BS, I worked off a codified formulary, so no it didn't. I was literally told by my "manager" that "People should have no problems affording their medications"...this coming from someone with a 6 digit salary and high end benefit package. I asked for dictation software for my electronic medical record - there was one available. However, the Region decreed that, because it was a shared/linked EMR, if one person had it, everyone had to be asked if they wanted it and had to obtain the number of licenses required...when they did, they didn't like how many people said yes because they didn't want to pay for the licenses. My first year there saw a running battle regarding my paid leave - I was told I'd be earning it from day one...then they said I couldn't take any of it for 10 months, "because the computer program won't let you". I told my boss that was BS -I just left a job with 25 paid days + stats for less time off that I was actually earning but couldn't take, despite my family being 3 provinces away. I talked to the Geek i/c of said computer program - I was told categorically that "the program doesn't allow you to take leave until the next leave year starts". My late dad programmed computers when 1K memory took up a skyscraper of magenetic tape...when I countered "Computers only do what you tell them to do, so you're either too dumb to manipulate the program, too lazy to do it, or you've been ordered not to. Which is it?" Crickets. "You answered my question"...they managed to sort things out surprisinly, eventually.

There are other things that were embuggerances, but many of these are part and parcel with family practice in many parts of the country...hope some of this helps. Thanks for listening too.
 

Good2Golf

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MM, an enlightening read, but sad that you and I’m assuming others like you are treated thusly (like crap) by the system(s)… 😔
 

medicineman

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MM, an enlightening read, but sad that you and I’m assuming others like you are treated thusly (like crap) by the system(s)… 😔
Irony is I'm seriously looking at going back to either full time FM or a hybrid of FM/acute care stuff...still waiting to flesh some details of that out. There is a specialty position at HSC that has been up for sale for several weeks I might consider as well that's straight days. Today at work was a perfect example of why - I want to say there were 39 people in the waiting room, all rooms full, >50% of those awaiting admission to a Low Acuity Unit at another facility or for an actual acute care bed in our hospital. I think the easiest thing I got to do was see someone at triage (no rooms available) and called the surgeon on call to directly admit them based on their presenting issue needing a body part out. Another easy one was straight forward neeed IV antibiotic therapy and follow up. I had someone who would have benefited from a proper procedural sedation to get something out of them that was being difficult, but had to settle for a really uncomfortable, but reasonably good local anaesthetic and a sniff of morphine...as there were no monitored beds around to snow them out in. Had someone I needed to get into a room for an intimate exam I had to wait about 3 hours for - had to manage the problem in an internal waiting room while waiting for that to free up. The one nurse in our pod was running around like headless RCR bait because of admitted patients and all the extra ones we were trying to treat and fire through...I'm pretty sure she got a break, but am actually unsure...and I didn't stop to pee until 8 hours into a 10 hour shift. It took me from 0700 when I started til about 1530 to finish my second cup of coffee of the day...and only got about half a litre of water into me and a protein bar. My doc, who's pretty efficient, was having issues seeing and treating people too. Bit of a demoralizing day overall.
 

CBH99

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So I know nothing about the internal grinding of the health care system and how/why the system works the way it does.

I do have some limited experience working in EMS prior to being hired onto my current job, but even that can be its own kettle of fish in some ways.

______

But just last week, I was actually shocked at how inefficient our system is, whether intentional or not.

The guy who works the night shift at the A&W around the bend & I were chatting while I was waiting for my meal. I had actually seen him pull up to A&W earlier that evening, and I watched him walk in wearing scrubs.

So I casually mentioned that, and asked him about it. Long story short, he’s a trained MD of 11 years - who worked at India’s largest cancer hospital, in Mumbai.

His wife was a nurse there.


In order to be a nurse here, she had to pay right around $800 for our ‘provincial association of whatever’ to contact that hospital in Mumbai to verify she had in-fact been employed there and in what capacity.

Official wait times for this to happen were approx 8 months.


______


Here we have a system that on the one hand is screaming for nurses, but on the other deliberately keeps qualified people from being employed as such.

$800 out of pocket & the better part of a year, just for someone to make a few calls or send an email to verify prior employment? FFS…

Until stupid people are no longer allowed to be in charge of things, we will continue to be the laggard that we’ve become in many respects.
 

medicineman

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So I know nothing about the internal grinding of the health care system and how/why the system works the way it does.

I do have some limited experience working in EMS prior to being hired onto my current job, but even that can be its own kettle of fish in some ways.

______

But just last week, I was actually shocked at how inefficient our system is, whether intentional or not.

The guy who works the night shift at the A&W around the bend & I were chatting while I was waiting for my meal. I had actually seen him pull up to A&W earlier that evening, and I watched him walk in wearing scrubs.

So I casually mentioned that, and asked him about it. Long story short, he’s a trained MD of 11 years - who worked at India’s largest cancer hospital, in Mumbai.

His wife was a nurse there.


In order to be a nurse here, she had to pay right around $800 for our ‘provincial association of whatever’ to contact that hospital in Mumbai to verify she had in-fact been employed there and in what capacity.

Official wait times for this to happen were approx 8 months.


______


Here we have a system that on the one hand is screaming for nurses, but on the other deliberately keeps qualified people from being employed as such.

$800 out of pocket & the better part of a year, just for someone to make a few calls or send an email to verify prior employment? FFS…

Until stupid people are no longer allowed to be in charge of things, we will continue to be the laggard that we’ve become in many respects.
While I understand the frustration, obviously there needs to be good background investigations done, which get harder if the educational documents aren't in English or French. There are folks out there like this creature: https://www.cbc.ca/news/canada/brit...ed-at-vancouver-hospital-for-a-year-1.6262965.

Having said that, if the Colleges/Ministries of Health really want to get people in, they will - like the Fillipino RN recruiting campaign in Manitoba not long before I started work out here. Alot of it comes down to being deliberately insular to protect people and/or either get money or save money - it's cheaper to pay for a resident than an attending, training facilities and trainers lose money if people bypass, etc, though in this case, not enough RN's were being pipelined here AND no incentive for those trained here to stay. The issue is multifactorial unfortunately.
 

CBH99

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While I understand the frustration, obviously there needs to be good background investigations done, which get harder if the educational documents aren't in English or French. There are folks out there like this creature: https://www.cbc.ca/news/canada/brit...ed-at-vancouver-hospital-for-a-year-1.6262965.

Having said that, if the Colleges/Ministries of Health really want to get people in, they will - like the Fillipino RN recruiting campaign in Manitoba not long before I started work out here. Alot of it comes down to being deliberately insular to protect people and/or either get money or save money - it's cheaper to pay for a resident than an attending, training facilities and trainers lose money if people bypass, etc, though in this case, not enough RN's were being pipelined here AND no incentive for those trained here to stay. The issue is multifactorial unfortunately.
After reading your last few above posts, but obviously getting a sense of what kind of person you are just by all of us interacting on this forum over the years…

I am especially and genuinely curious…


In your experience, what are some solutions to make our system work much more harmoniously?
 

Colin Parkinson

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So I know nothing about the internal grinding of the health care system and how/why the system works the way it does.




______


Here we have a system that on the one hand is screaming for nurses, but on the other deliberately keeps qualified people from being employed as such.

$800 out of pocket & the better part of a year, just for someone to make a few calls or send an email to verify prior employment? FFS…

Until stupid people are no longer allowed to be in charge of things, we will continue to be the laggard that we’ve become in many respects.
I had French Canadian girlfriend who was a teacher, met her doing a mining job in Flin Flon. She came out to BC to live with me, we went to the BC teachers association, she wanted to be certified here and she had the papers for her teaching degree and special needs degree from the University of Montreal. I was with her when she was interviewed and they were willing to recognize the teaching degree but not the Special Needs degree. I asked them why not and they said "We aren't sure of the syllabus" I told them to pick up the phone and call them (1980's). Lazy lying F**Ks, they just didn't want teachers from elsewhere coming in and taking "their jobs".
 

medicineman

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After reading your last few above posts, but obviously getting a sense of what kind of person you are just by all of us interacting on this forum over the years…

I am especially and genuinely curious…


In your experience, what are some solutions to make our system work much more harmoniously?
Succinctly, if we want to keep a fully public system like we have, the provinces and the feds need to come together, take control of and tap all available resources, devise a national/portable licensing system, decrease amount of layers of admin to increase operator numbers, including I think decreasing RHA's, give graduates of Canadian training programs little choice in where their first practice locations are, since Canadian medical and nursing schools are largely in universities with public funding, and taking some control of the licensing for foreign trained professionals from the regulatory colleges - after all, they pay the people, not the colleges. We also need better health literacy training in schools from an early age, which I think helps people not show up for things they should be able to handle themselves or demanding unnecessary/unwarranted treatments (antibiotics for a cold as a big for instance). A hybrid system is ok with me - if you make enough money or have a job with good benefits, why not, though I think things like certain surgeries should be centralized in public funded hospitals and done based on priority, not ability to pay - the whole need vs want thing.


I had French Canadian girlfriend who was a teacher, met her doing a mining job in Flin Flon. She came out to BC to live with me, we went to the BC teachers association, she wanted to be certified here and she had the papers for her teaching degree and special needs degree from the University of Montreal. I was with her when she was interviewed and they were willing to recognize the teaching degree but not the Special Needs degree. I asked them why not and they said "We aren't sure of the syllabus" I told them to pick up the phone and call them (1980's). Lazy lying F**Ks, they just didn't want teachers from elsewhere coming in and taking "their jobs".

BC is/was the worst - their EMS programs were the most insular in the country. I had a first aid instructor that had been trained as a critical care paramedic in one of the best programs in North America that when he moved there, had to start as an EMA nothing and work his way up. This was so bad that other provinces wouldn't recognize BC trainining because they wouldn't recognize their's...an issue when the CAF decided to go with JIBC for the paramedic training of CAF Med Techs. The lack of recognition caused issues when everyone had to go do maintenance of competency on local ambulances not in BC. When I heard they'd go with them, I just shook my head as I saw what was coming.
 

The Bread Guy

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Thanks MM for the granular details of present conditions & possible solutions - very much appreciated!!!
I would sometimes cynically observe that there are professional organizations that have no incentive to actually increase their own membership…
Sometimes it looks like that, but as others smarter than me have said, it's about protecting turf.
  • Why do doctors' associations say "more docs/more money for docs" is the answer? At best, "yeah, more nurse practitioners/PAs/MAs would help, BUT ..."
  • Why do nursing associations say "more nurses/more money for nurses" is the answer? At best, "yeah, more PSW's would help, BUT ..."
  • Why do unions representing front-line-non-doc/nurse workers say "more/more money for" is the answer? At best, "yeah, more docs and nurses would help, BUT ..."
  • Sometimes, you get a coalition of groups saying, "all of these above groups should get more money," but I've yet to see (and I stand to be corrected) ALL of these groups standing together with a unified solution short of the very broadest of principles.
This isn't to say any of these groups are evil, per se, and they all have a role to play, and more of each is needed. That said, don't be surprised at the answer you get re: breaking down where the help should go when you ask different groups.

And I've found in general, the group governments (generally provincial) seem most uncomfortable to push too far, too fast is the doctors.
 
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