OT Question for our Canadian Posters

I might regret asking this question, but I'm in a debate with a friend and thought some Canadian posters here would know the scoop. Simple question. I'm not taking sides on anything. But, in Canada, are you assigned a gatekeeper doc or can you pick a gatekeeper doc? In other words, are you told who your gatekeeper-type doc is without you having a choice or is there a list you can choose from as to who your gatekeeper-doc will be? Or do you even have gatekeeper-type docs? Now, I'm using a term we use here--gatekeeper--and it might be called something else in Canada, so I hope you know what I mean.

Again, hope this doesn't start anything nasty between any folks on here, but I really do just have a genuine desire to know so I can either set myself straight or set my friend straight! (My friend started the discussion, BTW .)

We have what we call "Primary Care Physicians", General Practitioners" or "Family Doctors" here in Canada.

We select our own, sometimes on a recommendation from a friend or family member who sees that doctor. They are the doctor that takes care of us overall. They take care of our general health. In many places in Canada, they are in short supply at present and steps are being taken to recruit more in many areas.

A PCP (GP) is needed to refer us to a "Specialist" - a surgeon, a sleep specialist, as cancer specialist, an eye specialist, an arthritis specialist and the list goes on.

I have never heard the term "gatekeepr type doctor" but in a sense, out GP is our gatekeeper to take care of us generally and refer us to specialists when and if needed. When we see a Specialist forny reason, test results and reports are send to our GP so that all our medical information is with one doctor.

Hi

Here in Quebec, Canada we can choose our GP as, said Hawthorne in Ontario; the problem is there is a shortage of GPs. I was very lucky to find one 3 years ago. I needed to fire the othere I had

You can fire your GP if he/she is not taking care of you. If you don't have a GP you go to an emergency clinic (this is a clinic with doctors who are not GPs; you sit there 2 or 3 hours without appointment and you can be seen by a doctor), this doctor will take care of you in that moment but if you need a follow up and you return to the same clinic it's very probably a different doctor will see you. But in any case they will give you the referal for the specialists or tests you need, or medication prescription.

That's what I did the time I didn't have a new GP. There are some of those clinics with very good doctors some of them GPs who make one day as emergency. Those are not hospital emergency clinics, the hospitals have their emergency clinics for complicated cases.

Something I discoverd is that some prescribed tests writen by a GP are refused in the hospitals if it's not a specialist from the hospital who wrote it. I even was refused for a new respirologist in one big hospital because I have been already seen by a respirologist from another hospital. Our health system is over loaded, this is public health system not private.

Hope this will help in your disussion. I'm very curious about the health reform in USA, hope that will be for good and not for bad.

I can go to any GP who will take new patients, any clinic in the province, except a CLSC where I don't live. I can walk into any emergency room in the country. Nobody tells us where we can go or what treatment we can have unless we want something experimental or purely cosmetic. Like I can have breast reducion surgery any time I want because of my bone density and their effects on my spine, but flat chested ditz needs to pay for implant surgery.

If I need a special kind of treatment not available here and on the ok list (ie not experimental) I will (eventually) be sent where it is available like my BIL got gastric bypass of some sort in Detroit.

As has been said by the others, our system in Canada is based on the concept of a General Practitioner or Family Doctor who acts as the quarterback, overseeing the treatment plan for his patients and making all the appropriate referrals to specialists as required. The idea is a good one but it breaks down in practice for a number of reasons. Most new doctors do not aspire to be GPs. They all want to be specialists. This means that GPs are in short supply and are over-worked; they are generally unable to act effectively as quarterbacks and advocate for their patients as the model requires. Many people have no GP anyway so they can only access specialists through the ER or walk-in clinics where they have no history and no continuity of treatment with any particular doctor. Also, because of the shortage of GPs, a specialist will often make a referral to another specialist. My cardiologist referred me to my sleep doctor and my GP was not informed so he learned of my sleep apnea from me (he's supposed to be the quarterback!). The system is really quite dysfunctional and, to make matters worse, knowledgeable patients cannot act on their own behalf by making an appointment with a specialist directly like they can in the US. Access to a specialist must come through a referral from a GP or another specialist. The result of all this, particularly in complicated cases involving multiple specialists over a period of time, is a lowered quality of health care with long waits and uncertain outcomes.

Not a pretty sight and Canadians with serious ailments who can afford it often simply opt out and head for the US where they can make an appointment with the appropriate specialist and get treatment right away, albeit at potentially high cost to them. Our socialized health care system will not pay for treatment in the US except in special circumstances where treatment is simply not available in Canada at all.

Now that Obamacare has passed, Americans should realize that this situation, or some variation on the theme with all its negative attributes, may where you are heading.

SleepyBobR wrote:

Not a pretty sight and Canadians with serious ailments who can afford it often simply opt out and head for the US where they can make an appointment with the appropriate specialist and get treatment right away, albeit at potentially high cost to them. Our socialized health care system will not pay for treatment in the US except in special circumstances where treatment is simply not available in Canada at all.

Now that Obamacare has passed, Americans should realize that this situation, or some variation on the theme with all its negative attributes, may where you are heading.

But considering that is a very small percentage and the trade off is tremendous for the rest of the population we hang on to our system for dear life and woe to the politician who tries to change it. The vast majority of us are adequately served by our system and now that the US is finally waking up maybe we won't have the GP shortage since they won't have a goldmine down there any more.

Hawthorne wrote:We have what we call "Primary Care Physicians", General Practitioners" or "Family Doctors" here in Canada.

We select our own, sometimes on a recommendation from a friend or family member who sees that doctor. They are the doctor that takes care of us overall. They take care of our general health. In many places in Canada, they are in short supply at present and steps are being taken to recruit more in many areas.

A PCP (GP) is needed to refer us to a "Specialist" - a surgeon, a sleep specialist, as cancer specialist, an eye specialist, an arthritis specialist and the list goes on.

I have never heard the term "gatekeepr type doctor" but in a sense, out GP is our gatekeeper to take care of us generally and refer us to specialists when and if needed. When we see a Specialist forny reason, test results and reports are send to our GP so that all our medical information is with one doctor.

Holy cow!

That sounds just like the system I use here in the states.

We must be socialists or something

BlackSpinner wrote:

SleepyBobR wrote:

Not a pretty sight and Canadians with serious ailments who can afford it often simply opt out and head for the US where they can make an appointment with the appropriate specialist and get treatment right away, albeit at potentially high cost to them. Our socialized health care system will not pay for treatment in the US except in special circumstances where treatment is simply not available in Canada at all.

Now that Obamacare has passed, Americans should realize that this situation, or some variation on the theme with all its negative attributes, may where you are heading.

But considering that is a very small percentage and the trade off is tremendous for the rest of the population we hang on to our system for dear life and woe to the politician who tries to change it. The vast majority of us are adequately served by our system and now that the US is finally waking up maybe we won't have the GP shortage since they won't have a goldmine down there any more.

This is so true. The Canadian health care system has become a political 3rd rail for all politicians. Despite galloping costs and declining quality of care, there is simply no way that any politician will risk suggesting any changes to the system, no matter how sensible or constructive. In all the world, only Cuba and North Korea are as restrictive as Canada in terms of enforcing the "public option" as it pertains to provision of health care services. It's hard to believe that no improvements are possible in light of the obvious deterioration of the system as time passes but that is currently the political reality. Eventually, changes will be required but only after things get much worse than they are now.

In saying these things, I don't mean to imply that Canadians are never satisfied with the health care services they receive. That is not the case; the system works fine for simple ailments which comprise the majority of cases. However, the system breaks down when things get complicated and where the indicated treatments and diagnostic tests are in short supply (MRIs, Cat Scans etc.). Meanwhile, Health care spending just keeps growing year after year, faster than overall government spending, as the inefficiencies and waste pile on. It can't go on forever but I can't predict when things will hit the wall, just that they eventually will.

SleepyBobR wrote:As has been said by the others, our system in Canada is based on the concept of a General Practitioner or Family Doctor who acts as the quarterback, overseeing the treatment plan for his patients and making all the appropriate referrals to specialists as required. The idea is a good one but it breaks down in practice for a number of reasons. Most new doctors do not aspire to be GPs. They all want to be specialists. This means that GPs are in short supply and are over-worked; they are generally unable to act effectively as quarterbacks and advocate for their patients as the model requires. Many people have no GP anyway so they can only access specialists through the ER or walk-in clinics where they have no history and no continuity of treatment with any particular doctor. Also, because of the shortage of GPs, a specialist will often make a referral to another specialist. My cardiologist referred me to my sleep doctor and my GP was not informed so he learned of my sleep apnea from me (he's supposed to be the quarterback!). The system is really quite dysfunctional and, to make matters worse, knowledgeable patients cannot act on their own behalf by making an appointment with a specialist directly like they can in the US. Access to a specialist must come through a referral from a GP or another specialist. The result of all this, particularly in complicated cases involving multiple specialists over a period of time, is a lowered quality of health care with long waits and uncertain outcomes.

Not a pretty sight and Canadians with serious ailments who can afford it often simply opt out and head for the US where they can make an appointment with the appropriate specialist and get treatment right away, albeit at potentially high cost to them. Our socialized health care system will not pay for treatment in the US except in special circumstances where treatment is simply not available in Canada at all.

Now that Obamacare has passed, Americans should realize that this situation, or some variation on the theme with all its negative attributes, may where you are heading.

Well here in the US I too have to get a referal from my PCP unless I want to pay out the a$$ to by-pass the referal system. I also heard on NPR that the US too has a shortage of PCPs because med school is so expensive that none want to be a lowly paid PC physician and have to become specialist in order just to pay off shool loans. I just don't see much difference in the sights ... pretty or not.

I guess it could be safe to begin calling it Obamacare even though he has yet to sign the bill into law ... stuff can still happen as I understand it. Anyway, the current US system is not all that different from Canadian except that more Canadians get the pretty and not so pretty sights than do the Americans since 15% to 20% or more Americans don't even get a chance to experience the pretty or not so pretty sights.

Oh well, what's another big bailout anyway? Sooner or later every industry will get bailed out and the whole world will be socialist debtor nations.

SleepyBobR wrote:As has been said by the others, our system in Canada is based on the concept of a General Practitioner or Family Doctor who acts as the quarterback, overseeing the treatment plan for his patients and making all the appropriate referrals to specialists as required. The idea is a good one but it breaks down in practice for a number of reasons. Most new doctors do not aspire to be GPs. They all want to be specialists. This means that GPs are in short supply and are over-worked; they are generally unable to act effectively as quarterbacks and advocates for their patients as the model requires. Many people have no GP anyway so they can only access specialists through the ER or walk-in clinics where they have no history and no continuity of treatment with any particular doctor. Also, because of the shortage of GPs, a specialist will often make a referral to another specialist. My cardiologist referred me to my sleep doctor and my GP was not informed so he learned of my sleep apnea from me (he's supposed to be the quarterback!). The system is really quite dysfunctional and, to make matters worse, knowledgeable patients cannot act on their own behalf by making an appointment with a specialist directly like they can in the US. Access to a specialist must come through a referral from a GP or another specialist. The result of all this is a lowered quality of health care with long waits and uncertain outcomes.

Not a pretty sight and Canadians with serious ailments who can afford it often simply opt out and head for the US where they can make an appointment with the appropriate specialist and get treatment right away, albeit at potentially high cost to them. Our socialized health care system will not pay for treatment in the US except in special circumstances where treatment is simply not available in Canada at all.

Now that Obamacare has passed, Americans should realize that this situation, or some variation on the theme with all its negative attributes, may where you are heading.

While I agree with SleepyB on the style of the system with the GP Doctor being the quarterback in the system and they make the referrals to specialists except in the case from one specialist to another... thats probably all that I agree with...

I strongly disagree that the system is dysfunctional because (quote) "knowledgeable patients cannot act on their own behalf by making an appointment with a specialist directly like they can in the US". Our style seems to me to be in keeping with trying to keep "free" Health Costs under some constraints. There are limits in place to stop people from "shopping" for specialists until they find someone who agrees with them or prescribes what they want and running up costs - if the "quarterback" does not feel the need. That places a great deal of pressure on GP's and creates overloaded waiting rooms and Emergency Rooms in hospitals. Health System training, it seems to me, to be what we don't have.

GP's are bombarded by a profitable medical industry to increase prescriptions, increase referrals etc so that the industry expands and "bottom lines" are enhanced. Our GP's are overloaded because our population is getter older and living longer; drug companies are finding more ways to treat illnesses; more and better medical machinery is available thus putting pressure on GP's to "keep up" and again make referrals for knowledgeable patients who may know as much or more about available treatments; and because some people may "abuse" the system because it is free and they find they get attention from a system that generally pays little attention to them. "Walk-in Clinics" seem to be designed to help with first aid, prescriptions and generally minor ailments to take some of the load off of GP's.

Unfortunately some Canadians have not found it easy to find a GP in some areas and more are being recruited for those areas - it is not always easy or immediate.

I personally have not had any "serious" illnesses and I don't make many trips to my GP, even if it is free to get treatment. At that same time I am happy to have paid into a system that treats a 10 year old child for cancer and his folks don't have to "sell their future" or their house to give their child a fighting chance to survive. I am happy to have the system that Canadians have and while I don't speak for SleepyB, I think most Canadians do feel happy as well. (In spite of some of the TV commercials that US Republicans ran)

Sorry, I don't really want to talk politics in this forum but I feel the need when I hear a narrowed viewpoint and look for more "balanced" reviews...

Nord

DreamStalker wrote:

Hawthorne wrote:We have what we call "Primary Care Physicians", General Practitioners" or "Family Doctors" here in Canada.

We select our own, sometimes on a recommendation from a friend or family member who sees that doctor. They are the doctor that takes care of us overall. They take care of our general health. In many places in Canada, they are in short supply at present and steps are being taken to recruit more in many areas.

A PCP (GP) is needed to refer us to a "Specialist" - a surgeon, a sleep specialist, as cancer specialist, an eye specialist, an arthritis specialist and the list goes on.

I have never heard the term "gatekeepr type doctor" but in a sense, out GP is our gatekeeper to take care of us generally and refer us to specialists when and if needed. When we see a Specialist forny reason, test results and reports are send to our GP so that all our medical information is with one doctor.

Holy cow!

That sounds just like the system I use here in the states.

We must be socialists or something

Well, of course, that's the model used all over the world. The difference is that in the US, if you don't have a family doctor or don't need one, or the model breaks down for any reason, you can just go ahead and make an appointment with a specialist yourself. In Canada, you can't do that. You're stuck.

It's a big difference.

SleepyBobR wrote:

DreamStalker wrote:

Hawthorne wrote:We have what we call "Primary Care Physicians", General Practitioners" or "Family Doctors" here in Canada.

We select our own, sometimes on a recommendation from a friend or family member who sees that doctor. They are the doctor that takes care of us overall. They take care of our general health. In many places in Canada, they are in short supply at present and steps are being taken to recruit more in many areas.

A PCP (GP) is needed to refer us to a "Specialist" - a surgeon, a sleep specialist, as cancer specialist, an eye specialist, an arthritis specialist and the list goes on.

I have never heard the term "gatekeepr type doctor" but in a sense, out GP is our gatekeeper to take care of us generally and refer us to specialists when and if needed. When we see a Specialist forny reason, test results and reports are send to our GP so that all our medical information is with one doctor.

Holy cow!

That sounds just like the system I use here in the states.

We must be socialists or something

Well, of course, that's the model used all over the world. The difference is that in the US, if you don't have a family doctor or don't need one, or the model breaks down for any reason, you can just go ahead and make an appointment with a specialist yourself. In Canada, you can't do that. You're stuck.

It's a big difference.

Well yes we can make an appointment with a specialist ourselves ... but it will cost a lot more than getting referred, unless you are wealthy and cost is not an issue. Of course, if you are a wealthy Canadian, you can bypass your system and come south to do the same.

Not a big difference really.

Nord wrote:

SleepyBobR wrote:As has been said by the others, our system in Canada is based on the concept of a General Practitioner or Family Doctor who acts as the quarterback, overseeing the treatment plan for his patients and making all the appropriate referrals to specialists as required. The idea is a good one but it breaks down in practice for a number of reasons. Most new doctors do not aspire to be GPs. They all want to be specialists. This means that GPs are in short supply and are over-worked; they are generally unable to act effectively as quarterbacks and advocates for their patients as the model requires. Many people have no GP anyway so they can only access specialists through the ER or walk-in clinics where they have no history and no continuity of treatment with any particular doctor. Also, because of the shortage of GPs, a specialist will often make a referral to another specialist. My cardiologist referred me to my sleep doctor and my GP was not informed so he learned of my sleep apnea from me (he's supposed to be the quarterback!). The system is really quite dysfunctional and, to make matters worse, knowledgeable patients cannot act on their own behalf by making an appointment with a specialist directly like they can in the US. Access to a specialist must come through a referral from a GP or another specialist. The result of all this is a lowered quality of health care with long waits and uncertain outcomes.

Not a pretty sight and Canadians with serious ailments who can afford it often simply opt out and head for the US where they can make an appointment with the appropriate specialist and get treatment right away, albeit at potentially high cost to them. Our socialized health care system will not pay for treatment in the US except in special circumstances where treatment is simply not available in Canada at all.

Now that Obamacare has passed, Americans should realize that this situation, or some variation on the theme with all its negative attributes, may where you are heading.

While I agree with SleepyB on the style of the system with the GP Doctor being the quarterback in the system and they make the referrals to specialists except in the case from one specialist to another... thats probably all that I agree with...

I strongly disagree that the system is dysfunctional because (quote) "knowledgeable patients cannot act on their own behalf by making an appointment with a specialist directly like they can in the US". Our style seems to me to be in keeping with trying to keep "free" Health Costs under some constraints. There are limits in place to stop people from "shopping" for specialists until they find someone who agrees with them or prescribes what they want and running up costs - if the "quarterback" does not feel the need. That places a great deal of pressure on GP's and creates overloaded waiting rooms and Emergency Rooms in hospitals. Health System training, it seems to me, to be what we don't have.

GP's are bombarded by a profitable medical industry to increase prescriptions, increase referrals etc so that the industry expands and "bottom lines" are enhanced. Our GP's are overloaded because our population is getter older and living longer; drug companies are finding more ways to treat illnesses; more and better medical machinery is available thus putting pressure on GP's to "keep up" and again make referrals for knowledgeable patients who may know as much or more about available treatments; and because some people may "abuse" the system because it is free and they find they get attention from a system that generally pays little attention to them. "Walk-in Clinics" seem to be designed to help with first aid, prescriptions and generally minor ailments to take some of the load off of GP's.

Unfortunately some Canadians have not found it easy to find a GP in some areas and more are being recruited for those areas - it is not always easy or immediate.

I personally have not had any "serious" illnesses and I don't make many trips to my GP, even if it is free to get treatment. At that same time I am happy to have paid into a system that treats a 10 year old child for cancer and his folks don't have to "sell their future" or their house to give their child a fighting chance to survive. I am happy to have the system that Canadians have and while I don't speak for SleepyB, I think most Canadians do feel happy as well. (In spite of some of the TV commercials that US Republicans ran)

Sorry, I don't really want to talk politics in this forum but I feel the need when I hear a narrowed viewpoint and look for more "balanced" reviews...

Nord

Nord, until recently, I shared your point of view on this issue. Only since I have developed some more complicated health problems have I encountered the shortcomings. Because, as you say, health care is "free" in Canada, the only way to control the costs is by rationing and that is what our system seems to be doing. I am not ideologically opposed to our health care system. My complaints are based on my experience with the quality of service and with the growing costs, something which even the rationing has not been able to rein in.

Yup, others have summed it up nicely. The big thing is we pay for our health care throught our taxes and not insurance. No insurance = no one telling us which hmo, or hospital will cover us...just walk into any hospital and you know you'll be taken care of. You don't have to worry about insurance ever denying you treatment, or that kind of thing. Our hospitals basically work as a non profit organization so to speak.

I have a family doctor who definately quarterbacks our family's health needs. It was my family doc who sent me to the sleep clinic, arranged for my allergist, ENT, OBGYN, my son's developmental pediatrician, husband's cardiologist etc etc.

We are fortunate that our family doc has priviledges at both of our local hospitals and has access to any ER records, or testing needing to be done there. We have bypassed the ER at times when we've walked into his office and he says...you need to go to the ER and have an MRI or whatever. He sends a note along with us to the ER...we get triaged and whisked off to wherever we need to be. I've never had to wait more than a few hours to be squeezed in at our family doc if the situation has warranted it. Basically I call, tell them what's going on and I get a "do you think you need to come in now, or are you okay for a few hours" type of thing.

Walk in clinics around here are pretty efficient. The longest wait I've ever had at an after hours clinic has been maybe an hour. Longest wait in an ER has been maybe two hours for something for the kids. When my appendix was going I was brought in immediately no wait, husband's chest pain...instantly brought in, etc etc.

One of my kids is at Sick Children's hospital regularly for eye issues and we were referred there via her pediatrician at the time (who has since passed away).

You can choose your doctors. I fired our pediatrician prior to his passing and moved the kids to our then Family Doc. He contracted SARS back when it hit here and we used walk in clinics for some time. When he started practising again he was only in two days a week and it became difficult to get in so we'd augment with walk in clinics but always ensured reports were forwarded to him. Last year we found a family doc close to home who we trust. In the year plus we have been with him, he caught the sleep apnea, a few issues with my husband, and one with my son, all requiring specialists. He monitors us all very closely and we have check ups every three months (for those of us on medications in the family) to ensure the meds are doing what they are supposed to etc etc. He encourages a proactive, all encompassing practise. First time I've had a doctor contact my chiropractor to coordinate treatment plans and ensure both are on the same page. (my chiro loves him!!)

I have never really had a long wait for a specialist so no need to access the US system although if we needed to we could. My husband is a high level executive here and we have access to private doctors and US specialists if we felt the need and the company covers the cost directly. Never have. Of our large circle of friends both in and out of the corporate world, only one exec from his company has ever utilized the US system and it was a very specific issue where they were pioneering some new techniques for something or another.
The government does not dictate which doctor you have to see or go to and you are also entitled to go to multiples if a second opinion is wanted (or third if you are really up for that). I didn't like the first OBGYBN my doc sent me to. I thought he was a jerk. Went back, told my family doc I didn't like him and I was sent to another immediately. No biggie.

To put this into a sleep apnea persepective. My wait time for a sleep clinic appointment was a few days. Titration done a few days after first sleep study. new machine in my hands within a couple of weeks from the inital referral to the sleep center.

Longest wait for an MRI has been a week for us, catscan? never had to wait...ever. Bone scan? two weeks, etc etc.

DreamStalker wrote:

SleepyBobR wrote:

DreamStalker wrote:

Hawthorne wrote:We have what we call "Primary Care Physicians", General Practitioners" or "Family Doctors" here in Canada.

We select our own, sometimes on a recommendation from a friend or family member who sees that doctor. They are the doctor that takes care of us overall. They take care of our general health. In many places in Canada, they are in short supply at present and steps are being taken to recruit more in many areas.

A PCP (GP) is needed to refer us to a "Specialist" - a surgeon, a sleep specialist, as cancer specialist, an eye specialist, an arthritis specialist and the list goes on.

I have never heard the term "gatekeepr type doctor" but in a sense, out GP is our gatekeeper to take care of us generally and refer us to specialists when and if needed. When we see a Specialist forny reason, test results and reports are send to our GP so that all our medical information is with one doctor.

Holy cow!

That sounds just like the system I use here in the states.

We must be socialists or something

Well, of course, that's the model used all over the world. The difference is that in the US, if you don't have a family doctor or don't need one, or the model breaks down for any reason, you can just go ahead and make an appointment with a specialist yourself. In Canada, you can't do that. You're stuck.

It's a big difference.

Well yes we can make an appointment with a specialist ourselves ... but it will cost a lot more than getting referred, unless you are wealthy and cost is not an issue. Of course, if you are a wealthy Canadian, you can bypass your system and come south to do the same.

Not a big difference really.

Well, yes, I think it is a big difference. Our system relies on the US system to provide the safety net. It is assumed to be there. The US system, at least for now, does not rely on another country to fill in the gaps in its health care system. Note, in saying these things, I'm not suggesting that there are no problems with the US system. It's very expensive, is badly in need of tort reform and there are problems with insurers (which could probably be solved by allowing/requiring the insurance companies to compete across state lines but that's another topic).

Both systems have their problems.

I seem to be the only one on this board with my point of view and I certainly don't want any arguments over it. My viewpoint is based on my personal experience as it compares to those of some American friends who, admittedly, have adequate coverage and seem to be much better served than I have been.