Doctors/Nurses: Stay or Repay

Health Minister Kevin Falcon deserves kudos for his announced plan ..or should I say at least an attempt … to have all British Columbians have ther own family doctor within five years. 

 But he doesn’t go far enough.

I am fortunate to have a GP (general practictioner) but it was not easy finding one and getting accepted as a new client  a few years back after my previous family doctor shut down his practice. And I am convinced that, in the long run,  having a dedicated GP who knows my “file” saves the health system a lot of money.

On occasion, especially on weekends, I have used walk-in clinics for minor ailments  … and frankly,  felt I experienced substandard and even uncaring “attention”.  No one should have to put up with walk-in clinics as their regular medical provider. And I can easily understand why many prefer to go to the Emergency department of a hospital for care, even in non-emergency situations, and  despite the hours-long-wait and horrendous cost to the health system.

I agree with Falcon that linking every British Columbian with a family doctor could not only result in better care …but a more efificient and cost-effective system.

But he should go further.

As the Minister noted, BC’s medical schools are now turning out about 288 new doctors a year.  That will help … if they stay in B.C. to practice. But almost as soon as they graduate, doctors are head-hunted by U.S. sources, and even health authorities/practices in other Canadian provinces,  offering bigger salaries and even signing bonuses.

And nurses and other health care workers … as well as specialists in other areas of the economy… are regularly raided as well.

Of course, in a democracy, there is no way to force people to stay here. However, I believe there is something terribly wrong with a system,, under which taxpayers subsidize or almost completely cover the cost of  educating  anyone … especially highly trained  and expensively-trained experts … and then off they go to “greener” pastures.

(And I don’t like the idea of BC or Canada doing it either to others, espeically third world countries, that dearly need the sometimes specialzed help they have educated with very scant resources.)

What’s the solution?   They should  stay or repay.

As the cost of providing highly advanced education skyrockets, governments should require those who accept subsidies or public funding  for their education to sign commitment contracts: agree to stay and work in the province for say,  five to eight years after graduation … or repay the publicly-funded portion of their education, on a sliding scale.

And not just doctors, nurses etc … but engineers, educators, high  tech  specialists … anyone who falls into a category, where there is a demonstrated need or shortage in the province or country. .. and has been designated so by the provincial or federal government. 

We are talking hundreds of millions of education dollars here that could be recouped and plowed back into the system and help  those who need it.  And I have no doubt that, once settled in to a job, a practice or a community for five to eight years after graduation, prospects would be more difficult to be targettted by the out-of-province raiders.

It would be a bold move .. . but it would send a real message to those lucky enough to be so highly educated by taxes paid by others much less fortunate: there is no more free ride.

Harv Oberfeld

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17 Responses to Doctors/Nurses: Stay or Repay

  1. Lynn says:

    Absolutely they stay for a specified amount of years or they repay their tuition.
    The government stopped students from declaring tuition bankruptcies.
    Why can’t the government demand they fulfill a contract obligation similar to a military scholarship.
    Subsidise an education equals an 8 or 10 year hitch.

    (Response: Glad you agree. There is little way we can compete with the HUGE U.S. for profit system. But at least we can prevent those who would literally sell us out from just taking the money … and our education … and running. h.o)

  2. Grant G says:

    You are drinking the kool-aid again Harvey…

    Let me get this straight, someone has a problem, heart, lungs, brain etc etc….

    Your doctor(a GP)……Doesn`t give you a referral to a specialist, instead your GP…Calls up a specialist, quickly describes your condition to a specialist?

    Does that specialist have your medical record?

    Is the specialist sitting around waiting for the phone to ring?

    Is your family doctor(GP) seeing patients while he is yacking on the phone.

    Harvey, dont you know bullshit when you see it.

    My family doctor, most family doctors don#t hand out referrals on a whim, in fact my doctor only gives referrals when HE IS SURE the patient needs an expert…

    How long does it take for a GP(family doctor) to describe your condition to a specialist…

    5 minutes…10 minutes…1 hour…..

    How many patients dont get seen because the doctor is busy on the phone with a specialist…Now you have 2 doctors tied up at the same time.

    Sheesh Harvey…I thought you were smarter than that…

    Although, it did take you 6 months to figure out the HST is a scam…

    (Response: Your’re really confusing two completely different things. I thought you were smarter than that! 🙂 My point is that I agree with Falcon that EVERY British Columbian should have a family doctor or GP .. as the first-line of medical service. Why not? What’s wrong with that? Nothing! Good idea! Great goal! The use of specialists is a completely different matter. If a doctor feels a phone call to a specialist on some matter he feels could be discussed immediately and directly, that could assist and expedite treatment or care , why not?? He wasn’t talking about replacing all specialist visits with a call center! Or doing colonoscopies over the phone. h.o)

  3. Henri Paul says:

    Yes Harv, Falcons plan is good ,except that taking 5 years to implement is far too long, 3 years would be far more reasonable
    ****Harv replied to Grant, He wasn’t talking about replacing all specialist visits with a call center! Or doing colonoscopies over the phone****
    As for doing colonoscopy over the phone Im game, additionally gastronomy and cystoscopy over the phone would also be nice. I haven’t an orifice left that a camera or scope hasn’t been shove into or up into.
    I suggested to the specialist to just leave the scope in ,then I could hook up and send it via the video cam the next time from home. He thought it was a great idea, but the hospital may get a little pissed at him for loaning out their scope.

    (Response: Loan? Leave the hospital with the scope still in place and they’ll put it right onto your Visa bill …plus HST …. but then, of course, you’ll understand why they really left it there. h.o)

  4. Norm Farrell says:

    You know the slippery slope argument.

    Doctors, ok. Nurses, ok.

    How about Engineers? Mathematicians? Journalists? Nutritionists? Chemists, welders, plumbers, traffic control flag people?

    You know what is really needed in BC healthcare? Highly trained and knowledgeable managers who have had their feet on hospital floors.

    Over 40+ years, I’ve observed them making change for the sake of change because that’s what they think managers do. Old becomes new while new gets back on the loop waiting for when it can become new again.

    They put hiring freezes in place and then load the regular staff with overtime. When they figure out that is too expensive, they overhire. With surplus staff, they encourage the people to take leaves of absence and soon they are back to relying on overtime. Yada, yada, yada.

    (Response: Yes, it is not easy to regulate. But what’s wrong with ANYONE who goes through our universities or post grad specialty training on a subsidized basis signing an agreement to stay for 5 or 8 years or repay the publcly-paid cost if they leave immediately or on a sliding scale if they leave before their agreed term is up? Especially if the government could come up with a specific list of specialties where there is a greater than usual need in this country and lots of jobs available to fill. I’m not saying force them to stay if they can make a lot more elsewhere, but just pay back what Canadian taxpayers have shelled out to train them…so we’ll have more $$$ to plow back into the system. h.o)

  5. Crankypants says:

    One has to wonder how much our shortage of doctors would be alleviated if the College of Physicians was a little quicker in giving accreditation to foreign doctors that emigrate to BC. I’ve heard this issue discussed on a few occasions on the radio, and some of the hurdles the College throws in front of these foreign doctors seem more about protectionism than qualifications.

    Only time will tell if Falcon’s idea will prove useful, but as long as the hospitals ration access to things such as MRIs and operating hours to the extent they do now, nothing much will change for many people.

    I don’t know how much the taxpayer subsidizes post-secondary education anymore. I believe that it was determined that student fees from all post-secondary institutions bring in more revenue to the BC government than corporate taxes. And this was determined before the recession.

    A lady phoned in to CKNW today stating that her daughter was enrolled to become a doctor, and by the time she gets her degree, her student loans will total over $100,000. I think it would be pretty difficult to demand someone in a situation such as this to limit her options and in the process prolong her indebtedness. I believe that there is a six-month grace period upon completion of one’s degree, but after that the interest meter kicks in and a payment schedule must be met.

    (Response: There is a lot more public expense tov training doctors than just student loans. I beleive if thet leave right after graduating, they should pay that bill, as well as their student loans. The immigrant doctors is another issue … we must ensure people qualified as “doctors” in other countries are indeed properly trained by our standards, and maybe that process could be speeded up. But again, I worry that we should not be raiding poorer countries and robbing them of their doctors the way richer US hospitals and clinics do to us. h.o)

  6. patrick bell (NOT THE MLA) says:

    A hot air statement intended to divert attention away from other issues IMHO.

    I’ll believe it when I see it…

    (Response: It could be a diversion,sure. But on the other hand, all government departments and policy development don’t just stop because of another issue, like HST or a deceit-filled election process. And I believe the goal is laudable …and now that it’s out there…will have a better chance of becoming reality than if Falcon never proposed it. h.o)

  7. Leah says:

    Harv, this one I totally agree with you. If a students tuition is being paid by the taxpayer, then we have not only the right, but the expectation to receive the goods we’ve already paid for.

    If the States wants our medical personnel, there is another option: pay out the student loan on behalf of your new acquisition, and have them sign a contract to work in your country for X number of years.

    As for the doctors from third world countries – I find it all very alarming. Half of the doctors in this city come from there darn near…which means…their people are not being served as they should be. What is right, or fair in that? Mind, I suppose if our house, car, vacations, golf fees for exclusive clubs, and the cost of the move to wherever were being paid by our employer…some of us would likely jump at the pot of gold sitting waiting to be picked too.

    There has to be a better way, for everyone concerned.

    (Response: Yes..if Canada loses people for $$$, just imagine the impact the for-profit recruiters have on poorer countries. The system has to be fixed ..and can be by governments brave enough to stake a stand and have advanced education students sign contracts…stay or at pay back what our taxpayers have shelled out to train you! h.o)

  8. blaffergassted says:

    It’ll be interesting to see how they accomplish this laudable goal.

    My question? Why would doctors move to the “heartland” of BC when they can make more money in the bowels of the big city?

    (Response: There’s a lot more to life than money. I have a friend who is a teacher..gave up Vancouver for a post in the Interior, now has a family there, a home near a lake, a superb quality of life and would not come back to the hugely expensive,crowded city….except to visit. h.o )

  9. Leah says:

    The “heartland” of BC is now growing by leaps and bounds as a result of professionals moving from the “bowels of the big city.” They’ve discovered they can get to work in 10 to 15 minutes (or less), that the food they eat is most likely grown within 30 miles (never mind 100), their earnings are not dramatically affected…and that it requires less money to live outside the big city.

    That’s something the rest of us who have always lived in the heartland knew all along. We also knew that somewhere along the way, the “city folk” would come to see what “good living” really means…and buy up everything in sight. Some things really can be too much of a good thing!

  10. Henri Paul says:

    If could some how convince the yanks to take our surplus of lawyers and Judges and leave us our much valued health professions .

    (Response: Maybe trade them five-for-one to get our hockey players back? h.o)

  11. Kim says:

    Leah, I hear you. I liked rural BC much better when it was a well kept secret, rather than “cottage country” for the rich.

    Just to play devil’s advocate, imagine a world where educated professionals were traded like hockey stars, for multimillion dollar contracts? How far do you think we sit from that scenario?

    Also, I am beginning to worry that some universities might have undue corporate influence. For instance, UBC seems cozy with the current regime. University of Calgary comes to mind (specifically the economics dept).

    I am lucky to have a GP that I trust and has peer respect. Still, I have been prescribed questionable pharmaceuticals (celebrex, prednisone) for inflammatory response that have been proven to cause significantly worse disease than the original problem. I worry that pharmaceutical companies may have undue influence on medical schools.

    For the record, my parents were blue collar and a university education was never an option.

  12. Henri Paul says:

    (Response Jun 27, 2010 at 9:43 pm :
    Maybe trade them five-for-one to get our hockey players back? h.o)
    That’s 5 Judges and or Lawyers for 1 Canadian Hockey Player, correct?

    (Response: OK you’re a tough negotiator! Make it 10 Judges and lawyers for 1 hockey player. h.o)

  13. Henri Paul says:

    Kick in Wigs and Robes ? It’s a done deal.

  14. Steve says:

    Back when the BC Ambulance service paid for employees to upgrade to Advanced Life Support the employee had to sign an agreement to work for the BC Ambulance service for 3 years after graduation or pay back the costs. No one complained that I know of.

    (Response: Very interesting. By the way, have not forgotten the paramedics ..will mention them in my Canada Day blog. Fight on for a fair deal. h.o)

  15. Beth T says:

    Harvey, further to your great comments:
    Not only did they sell B.C. Rail after being elected on the promise not to do so, but they may have sold it for $500m rather than the $1b they claim. (Vaughn Palmer Apr 21 2009, Vancouver Sun). Another lie?
    As late as June of 2009 in a Vancouver Sun article announcing the increased cabinet size Colin Hansen was still claiming that the deficit was $1b less than reality.

    (Response: Interesting. And they wonder why the lack credibility! h.o)
    Beth T

  16. J.S. says:

    Reviewing all these comments about the HST, and past and other sins of the Campbell Cohort, reminds me of a group of people who have too much time on their hands; fiddling while Rome starts to burn (world economy starts to implode).

    One writer goes on about BC Rail, another about ambulance paramedics, endless picky-picky grind about the HST, realization that Carole James will lose again, no chance of a Conservative government (in other words the Liberals will be re-elected!!). The list of hurts and slights and kvetches is endless.

    So, I’m watching CNN about a REAL PROBLEM a very sad looking man talking about the apocalyptic the Gulf oil spill now about to leak into the ATLANTIC OCEAN!!

    The gentleman is none other than Jean-Michel Cousteau. He is the son of the famous and sadly late Jacques Cousteau. The younger Cousteau is not optimistic about any kind of positive result anytime soon. He is simply overwhelmed.

    Meanwhile back at the BC ranch, the pathetics continue their bitching…

    …they keep pouring through their favourite Campbell ENTRAILS (my entrails are better than your entrails, you putz!) to prove exactly what? Whose hurt the most! What is the end result? Nothing! Does the rest of the world care? No!

    Have you dared to look at other provinces or states or countries to see the dynamics of government/business relations there? Why should BC be any different? Just because you say it SHOULD BE SO?

    Government/business relationships are part of life in the industrialized world and BC is no different.

    Look at Alberta, with no HST, and its relations with BIG OIL, and HST-Ontario with BIG AUTOMAKERS, and socialist non-HST (for now) Manitoba with BIG AGRICULTURE.

    If governments need tax revenues to pay for programs for their people (and yes WAC Bennett cozied up to big business, too!) they will court whomever they think will bring jobs to their place.

    Big business is needed because that’s where the big money is. FOLLOW THE MONEY!! Were you people all born a couple of hours ago or what?!

    (And, yes, the HST IS another tax grab, to pay for government services when the rest of us will need them and we damn well will.)

    If you asked M.Cousteau Jr. about the HST he’d think you were NUTS. He would point to the Gulf and say, THAT’S a problem!

    Meanwhile stock and bond markets around the world are signalling the onset of a world-wide economic catastrophe now breaking out anew. This will stick a fork in the HST debate, shortly.

    Get your bearings straight. BTW, most BC voters did not sign that damnable petition.

    (Response: You’re right on one point ..MOST BC voters did not sign the petition. But in many ridings more signed the petition than actually voted for the successful candidates. Interesting. h.o)

  17. cassandra says:

    In our family’s experience the walk-in clinics are closely tied to the private medicine philosophy – except B.C. Medicare spares the WIC Doctor the care and expense of billing and collecting from their customers. One rule enforced by a WIC in Kerrisdale is to strictly limit the time and attention given to any customer. No customer gets more than 10 minues in any consultation and which is strictly limited to the customer asking no more than two questions per appointment. A healthcare consumer who has a third question must make another appointment for another session.
    Consequently the WIC offices serve as little more than money-grabbing referral and prescription writing drop-in centers: Which may be right in line with Falcon’s and the Liberal’s make-the-consumer-pay philosophy.

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