Do we really need disgruntled doctors?

Published on the editorial page of The Medicine Hat News, Wednesday, December 2, 1998, Page B6. At that time Dr. Bharwani was Regional Chief of Staff, Palliser Health Region, Medicine Hat, Alberta.

People keep asking me how the Palliser Health Authority got dragged into a situation which should be a Provincial issue?

It is a good question, but I do not have a good answer. What I know is that we have three very unhappy, angry Obstetricians – Obstetricians who have served this Region well for several years. They have kept our obstetrical care at the highest level in the Province, and they are fine family people who want to be appreciated and remunerated appropriately for what they do.

We are seeing a very sad situation. Angry, unhappy Obstetricians with a Health Authority strapped for money and pushed against the wall. “Give us the on call money or we quit” say the Obstetricians. But the Regional Health Authorities are not funded to pay for services provided by physicians.

The Obstetricians’ anger is only the tip of the iceberg. Physicians, in general, are angry and frustrated. They say, compare our hourly take home pay and lifestyle with those of dentists, lawyers, accountants, realtors, stockbrokers, bankers, etc.

This year the Canadian Medical Association conducted a survey on doctors’ attitudes and activities. This revealed that almost two-thirds of Canada’s physicians (62 percent) feel they are over worked, and more than half (55 percent) say that their family and personal life has suffered because they chose medicine as a profession.

Physicians feel that their income is declining even though their hours of work have increased. With the explosion of medical information on the Internet, the patient’s expectations have risen dramatically. In the era of cut backs, the physicians feel great pressure to satisfy their patients’ needs.

In a 1997 national survey of doctors, done by The Medical Post, the young doctors nationwide expressed extreme unhappiness with the health care system.

In Defense of the Obstetricians, From Where I Sit – 2

In the U.S.A, the situation is no different. In an editorial in The New England Journal of Medicine, Dr. Jerome Kassirier wonders if a health care system functions effectively if a sizable fraction of physicians are disgruntled. He asks, “Are patients well served by unhappy physicians?”

Physicians in the United States working in managed care organizations get financial incentives, which depend on limiting referrals, and care which would compromise their work. Physicians feel that incentives, which reward quality of care and provide patient satisfaction would offer better job satisfaction.

In his book “Paging Doctors”, David Woods, a medical journalist says, “The doctor’s dilemma, as George Bernard Shaw defined it in his play of that name, was the moral one imposed by getting paid for operating and not getting paid for not operating.” Bernard Shaw also raised some broader questions about the relative worth of people and objects. How do you define worth?

Finally, sixteen years ago, Modern Medicine of Canada wrote, “Doctors surely are stressed. The strain comes mainly from the profession that bears the most direct responsibility for other peoples quality of life and the nature and timing of their deaths. In fact, there is hardly a single human being living in a developed society who has not been treated by a physician several times in his life. But no matter how strenuously a doctor has toiled or how miraculous the results, it is all taken for granted and in this day and age, gratitude is minimal”.

So where do we go from here? The Palliser Health Authority would love to have happy doctors providing excellent quality service in an environment, which would recognize and reward their special skills. How can we do this?

I will leave you with these questions which were asked earlier: Can a health care system function effectively when a sizable fraction of the physicians are disgruntled? Are patients well served by unhappy physicians? Think about this, and tell me how we can keep our doctors happy and satisfied.

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Graduates of foreign medical schools: false hope.

Canadian Medical Association J, Vol. 132, May 15, 1985

Letter to the Editor

Graduates of foreign medical schools: false hope

I read Chouinard’s article on foreign-trained physicians with interest (Can. Med. Assoc J 1985; 132: 231).

Most graduates of foreign medical schools who come to North America have no illusions about the problems facing them. The fact that they have to take a number of “knowledge” – testing examinations and the experience of dealing with several licensing bodies in one country prepare them for the worst, unlike in the United Kingdom, where there is one licensing body for four countries.

What upsets foreign-trained physicians is the deliberate coolness or harassment of some of the licensing bodies. The physicians are kept running from pillar to post to fulfil the requirements in a frustrating vicious circle consisting of the evaluating examination, rotating internship, licensing by the Medical Council of Canada and postgraduate training for certification.

Most foreign-trained physicians suffer in silence, afraid of offending those in authority. There is no organization sympathetic to their plight, and their point of view is rarely heard.

I have experienced such obstruction twice. In 1979 I was told by the College of Physicians and Surgeons of Alberta (CPSA) that to practise as a surgeon in Alberta I had to be a licentiate of the Medical Council of Canada and a fellow of the Royal College of Physicians and Surgeons of Canada. After I had fulfilled these criteria, I was told that I should be a Canadian citizen or landed immigrant (which I am) and that the CPSA was “reluctant to register anyone who is outside the province unless they are actually going to start working in this province”. When I protested this new requirement, I was told that it had been laid down in the Medical Profession Act and its bylaws since 1975. Why did the CPSA not tell me at the start what the act required?

The second experience occurred when I was offered a fellowship in surgical oncology by the M.D. Anderson Hospital and Tumor Institute in Houston. I had been working towards this goal during my research and residency years, and when I received the offer I was ecstatic. I was eligible for a licence in Texas, but when it came to obtaining a non-immigrant visa for 1 year of training in the United States, the Education Commission for Foreign Medical Graduates refused to approve my application because I had not passed the basic science portion of the Visa Qualifying Examination. Anyone who has taken this test knows how difficult it is to pass a pure basic science examination after being qualified for 5 to 10 years. I had to have up-to-date knowledge in basic medical science to obtain a temporary visa.

Graduates of foreign medical schools are ready to take up any challenge to make themselves acceptable and useful in Canadian society once they are allowed to enter the country. The ultimate effects of obstruction on their personal and professional lives are largely unknown. It is time someone looked at this problem.

Noorali Bharwani, MB, BS, FRCS (Edin), FRCS (Glasg), FRCSC
North Battleford Medical Clinic
North Battleford, Sask.

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