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Two-Tier Health Care Not the Solution for Doctors or Their Patients

Re: “National Post editorial board: Make room for private health care options” (National Post Editorial Board, National Post, Monday, Oct. 11, 2010)

The National Post’s Editorial Board thinks that Canada could improve patients’ access to family doctors by allowing doctors to open up private practices to increase their earnings, thereby making family practice more attractive and preventing doctors from leaving Canada. As a Canadian family doctor I have never heard any of my colleagues or professional bodies advocate this solution. Why? Because it flies in the face of both the international evidence and the realities of family practice in Canada.

Last month this newspaper ran a story about the net movement of doctors from the United States to Canada (“Doctor drain turns to gain: Physicians move north”), noting that American doctors moving north of the border prefer practicing in Canada because the pay is much better in some specialties (and in family medicine, too, by the way) and there is more clinical freedom and autonomy.  The article cited John Philpott, the CEO of CanAM Physician Recruiting in Halifax, who explains that “Canada is the number one spot in the world for doctors to come and work, live and play." We don't have a problem with losing doctors to other jurisdictions, period, in family medicine or more generally.

On the question of whether private health care reduces wait times, Australia’s experimentation with two-tier health care should be instructive. In Australia, wait times in the public system increased in proportion to the increase in private, for-profit health care. The reason for this is simple: doctors simply moved from the public system to the private system, presumably in an effort to increase their compensation. Some doctors may have gotten richer, but the patients in the public system suffered.

The truth is that Canadian family doctors are now quite well-paid compared to their international counterparts, though still substantially less than their specialist colleagues. Persuading more medical students to choose family practice requires more than money. We need to look at who is admitted to medical school, how medicine is taught and by whom, as well as a myriad of practice and cultural issues. To suggest that simply allowing family doctors to bill outside the public system will solve our complex problems is to oversimplify the issues. The parallel for-profit health care system proposed by the Editorial Board would benefit few doctors and put our most vulnerable patients at risk.

Danielle Martin

Chair, Canadian Doctors for Medicare