2022 CPC Leadership Discussion: Et tu Redeux

[mariomike]

This was predicted way back in 2007.

Canada's looming acute-care crisis

T he health-care system is about to embrace the baby-boom generation and a recent symposium at Queen's University forecast that, at best, the results will be problematic. At worst, our system may implode.

www.thestar.com

Years ago, my former dept. put it this way,

The "Baby Boom" generation is aging. As it does so, all of those 'boomers' become net consumers of health care, driving up demand for services. Simultaneously, all of those 'boomers' employed by the service in the early 1970s are reaching the end of their careers and retiring. Since subsequent generations are typically much smaller, the service is experiencing difficulty in recruiting suitably trained replacement staff, just as demand for services is increasing.

 

[Brad Sallows]

We might be better off with the US system. I suppose we would at least do it better than them. We wouldn't have the burdens of [euphemism]inner cities[/euphemism] and large numbers of illegal immigrants. (Much of "health care outcomes" originates with lifestyles, not health care.)

 

[mariomike]

We might be better off with the US system.

Can't speak to their system. But, I do keep an eye on their ambulance billing. Truly terrifying, compared to Ontario.

I only know how "the system" worked / works with my employer. Not to suggest it is any better, or worse, than any other Canadian, American, or international system for pensioners.

Retired on 55th birthday on a 70% defined benefit pension.

Nine-months Sick Bank Gratuity. Put into an RRSP to be used "in case of emergency".

Remain on full, employer paid, benefits until age 65.

At age 65, they put you on a non-cummulative Health Care Spending Account ( HCSA ) payable until age 75.

After age 75, the employer cancels your life insurance, and only provides a $5,000 lifetime insurance policy for funeral / burial expenses.

 

[Halifax Tar]

This was predicted way back in 2007.

Canada's looming acute-care crisis

T he health-care system is about to embrace the baby-boom generation and a recent symposium at Queen's University forecast that, at best, the results will be problematic. At worst, our system may implode.

www.thestar.com

Years ago, my former dept. put it this way,

The same generation that didn't plan for their medical future and set up the mess we're in.

I feel bad, but at this point it might be best just to ride out the storm.

 

[mariomike]

I feel bad, but at this point it might be best just to ride out the storm.

That's a shame.

 

[lenaitch]

A couple of things, some of which the CPC is talking about which is one of the reasons I haven't completely written them off.

First and foremost, recognizing qualifications from abroad. It is far too hard for a foreign trained doctor to work here. I just found out that a girl I went to high-school with has decided to move her family to Australia because, after a year and a half of trying, she can't get her Canadian license to practice as a Doctor, despite the fact that she was educated in Australia. Don't even get me started on cross-province qualifications. Why we have multiple colleges vice one national one eludes me. Actually, it doesn't; they have their own little fiefdoms and they refuse to see that disappear.

Second, as has already been mentioned, increase throughput in universities, and I think "direct to Med school" is something we should look at. One issue I don't have an idea on though is throughput in hospitals. After graduating university, doctors need to complete a residency, and I've heard (anecdotally) that that is a bigger bottleneck than universities; there simply aren't enough spots in hospitals for residents (since they need to be chaperoned/trained by fully qualified doctors; it's essentially OJT).

Lastly, incentives. We are actually producing a lot of doctors, but everyone wants to be a surgeon because it's sexy. No one wants to be a GP or work in rural areas, so they leave the country to go be private doctors somewhere else. Create a real incentive program to encourage doctors to stay in Canada, especially wrt GPs and rural doctors.

I have two nieces, both Canadian, who got their medical degrees in Ireland and had to requalify back here when they returned. I get that not every medical school in every country, by default, can be assumed to have similar standards to us, but it must be feasible to create a list of 'accredited' foreign schools.

Regarding 'colleges' (medical regulatory authorities), each US state and territory has their own. Who-does-what is largely a Constitutional matter and I'm not convinced having a 'national' something is always the answer.

There has to be some manner of OJT to translate 'schoolin' to the real world, but I have several family members both former and practicing in the medical field and they describe the way interns are used as akin to hazing. Like articling students in law, there's a lot of 'we had to go through it so you do to' involved.

In our system, doctors are essentially self-employed as opposed to government employees. There are incentives for under-served areas, but it remains a challenge. I recently learned my doctor, who I have only physically seen once since Covid, is actually in the GTA. He Zooms from there and travels up to do in-person appointment on day a week. He maintains an office presence hear, I assume to satisfy the terms of whatever he gets as an underserviced area physician.

 

[mariomike]

Don't even get me started on cross-province qualifications.

Only familiar with qualifications for one health care profession, in one province.

You can't simply "do a lateral" into an Ontario municipality from out of province.

 

[Blackadder1916]

I have two nieces, both Canadian, who got their medical degrees in Ireland and had to requalify back here when they returned. I get that not every medical school in every country, by default, can be assumed to have similar standards to us, but it must be feasible to create a list of 'accredited' foreign schools.

There is. World Directory of Medical Schools

But being a graduate of an acceptable medical school is only the beginning. Yes, there are differing requirements among the provinces and territories, but most (I think the main outlier is Quebec) are pretty much the same when it comes to minimum educational and training requirements needed to register for independent practice. Despite that an IMG may have completed their schooling and internship (Ireland still calls the first year of post graduate medical training internship), had successfully passed any exams needed in that jurisdiction for registration on the (Irish) general practice register and could have started "general" practice in that country, there are a few more hoops to jump through to meet the medical education requirements of Canada (the same ones that Canadian graduates have to meet).

The first are the Medical Council of Canada exams. While the MCCs role is to set the standard (and judge that individuals meet that standard) the provincial Medical Regulatory Authorities (MRA) also have a say. I'll use Alberta as an example.

Apply for Independent Practice - College of Physicians & Surgeons of Alberta | CPSA

cpsa.ca

Since everybody loves a flowchart



Simple, right?

Using your nieces' experience. They did their medical undergrad in Eire as well as (I assume) their one year internship, at which point they were eligible to register with the Medical Council of Ireland (their licensing body) in the General Division and thus practise independently in Ireland. Like many IMGs who wish to move to Canada and work as doctors, they naturally assume that since they speak English (Irish accents notwithstanding), have attended an acceptable school and now have a license to practise in Ireland (and may have already put out a shingle in the Auld Sod) that they are qualified doctors so why doesn't Canada accept them.

The major impediments to foreign trained doctors not getting a license are usually failure to pass the MCC exams (sometimes that's due to a language deficiency and sometimes because it's been years since they were in med school). The other is unacceptable, unverifiable or insufficient post-graduate training, i.e. residency. What would be acceptable post-grad? In Alberta

https://cpsa.ca/wp-content/uploads/2023/01/Approved-Jurisdictions-for-Additional-Registration-Route.pdf

For Irish trained doctors (FM/GP), that means

IRELAND Graduates of general practice vocational training schemes that have been accredited by the Irish College of General Practitioners (ICGP) who also hold Membership of the Irish College of General Practitioners (MICGP)

MICGP would mean four years post-graduate training (two years in a hospital and two years under supervision in a practice) instead of the one year internship licensing. In Canada family medicine residency is two years, and in the case of Alberta two years is the minimum amount of post-grad to be eligible for independent practice registration.

I don't know if there are any Canadian jurisdiction that still accept a one year residency/internship. Quebec used to and maybe one of the territories. Back in the 1980s (when I was the Hosp Adm O at CFB Edmonton) one of our doctors was unable to get an Alberta license (it pissed her off because she couldn't moonlight downtown like all the other MOs) because she had only done one year post-grad before getting her Quebec license which acceptable at the time for the CAF.

While the simple answer is to have them do a Canadian residency, there are limitations (capacity, financial, etc) to how many IMGs can be absorbed into existing Canadian residency programs.

 

[Remius]

Latest 338 poll aggregate.

338Canada Canada | Poll Analysis & Electoral Projections

338canada.com

Some more movement. I suspect PP is going to get some internal backlash due to recent events.

 

[lenaitch]

There is. World Directory of Medical Schools

But being a graduate of an acceptable medical school is only the beginning. Yes, there are differing requirements among the provinces and territories, but most (I think the main outlier is Quebec) are pretty much the same when it comes to minimum educational and training requirements needed to register for independent practice. Despite that an IMG may have completed their schooling and internship (Ireland still calls the first year of post graduate medical training internship), had successfully passed any exams needed in that jurisdiction for registration on the (Irish) general practice register and could have started "general" practice in that country, there are a few more hoops to jump through to meet the medical education requirements of Canada (the same ones that Canadian graduates have to meet).

The first are the Medical Council of Canada exams. While the MCCs role is to set the standard (and judge that individuals meet that standard) the provincial Medical Regulatory Authorities (MRA) also have a say. I'll use Alberta as an example.

Apply for Independent Practice - College of Physicians & Surgeons of Alberta | CPSA

cpsa.ca

Since everybody loves a flowchart

View attachment 78379

Simple, right?

Using your nieces' experience. They did their medical undergrad in Eire as well as (I assume) their one year internship, at which point they were eligible to register with the Medical Council of Ireland (their licensing body) in the General Division and thus practise independently in Ireland. Like many IMGs who wish to move to Canada and work as doctors, they naturally assume that since they speak English (Irish accents notwithstanding), have attended an acceptable school and now have a license to practise in Ireland (and may have already put out a shingle in the Auld Sod) that they are qualified doctors so why doesn't Canada accept them.

The major impediments to foreign trained doctors not getting a license are usually failure to pass the MCC exams (sometimes that's due to a language deficiency and sometimes because it's been years since they were in med school). The other is unacceptable, unverifiable or insufficient post-graduate training, i.e. residency. What would be acceptable post-grad? In Alberta

https://cpsa.ca/wp-content/uploads/2023/01/Approved-Jurisdictions-for-Additional-Registration-Route.pdf

For Irish trained doctors (FM/GP), that means

MICGP would mean four years post-graduate training (two years in a hospital and two years under supervision in a practice) instead of the one year internship licensing. In Canada family medicine residency is two years, and in the case of Alberta two years is the minimum amount of post-grad to be eligible for independent practice registration.

I don't know if there are any Canadian jurisdiction that still accept a one year residency/internship. Quebec used to and maybe one of the territories. Back in the 1980s (when I was the Hosp Adm O at CFB Edmonton) one of our doctors was unable to get an Alberta license (it pissed her off because she couldn't moonlight downtown like all the other MOs) because she had only done one year post-grad before getting her Quebec license which acceptable at the time for the CAF.

While the simple answer is to have them do a Canadian residency, there are limitations (capacity, financial, etc) to how many IMGs can be absorbed into existing Canadian residency programs.

Great post! Thank you.

Ontario recently announced that they will accept medical professional registered in other provinces/territories "as of right". I don't know if other provinces will/have followed suit but I can see it happening. Quebec, like in so many other matters, will not.

 

[Quirky]

I suspect PP is going to get some internal backlash due to recent events.

What recent events?

 

[Remius]

What recent events?

There were 4 bi elections. And the various things that went on in those races.

O’Toole’s parting words.

Mulroney’s recent statements at the AEC.

And the current overall divisive political environment.

 

[Good2Golf]

What recent events?

Cross over of seats won projection?

 

[Quirky]

There were 4 bi elections. And the various things that went on in those races.

O’Toole’s parting words.

Mulroney’s recent statements at the AEC.

Don't think Canadians payed attention to any of those things. The Titan sub got more interest.

 

[Remius]

Don't think Canadians payed attention to any of those things. The Titan sub got more interest.

You’ll note I said internal backlash. Those people are paying attention. And it would seem enough Canadians voting in 4 bi elections across the country paid enough attention to cause some eyebrows to raise.

Chantal Hébert has a good piece that sums it up and seems to be in line with the current 5 week trend of CPC numbers dropping and LPC numbers climbing.

Opinion | Pierre Poilievre is becoming a liability to Conservatives

Nine months into his tenure, there is no denying that Poilievre is having a measurable impact on Canada’s federal dynamics. But can he return his party to power? Chantal Hébert writes.

www.thestar.com

Might be behind a pay wall.

Also, it seems the CPC is also paying attention as they have voted unanimously for the child care legislation they weren’t too fond of. And PPs Twitter feed seems to have shifted to only economic bread and butter messaging.

but these polls are only a snapshot at this time. I’ve said it before, campaigns matter. We’ll see what that brings when the time comes.

 

[Quirky]

Chantal Hébert has a good piece that sums it up and seems to be in line with the current 5 week trend of CPC numbers dropping and LPC numbers climbing.

Good, we need a LPC majority next election with the same characters in cabinet. Canadians think it's expensive to live or crime is bad now, just wait and see if they have another 4 full years going unchecked. Canada will turn into Seattle or Los Angeles, everything a Liberal manages turns into shit.

 

[mariomike]

Ontario recently announced that they will accept medical professional registered in other provinces/territories "as of right".

Not exactly a "lateral", but do-able.

Paramedic Labour Mobility EquivalencyInformation and Application Package

Application and Verification forms for the Ministry of Health (MOH) Paramedic Labour Mobility Equivalency for Paramedics who hold a valid license or certification in good standing from other Canadian provinces or territories and wish to obtain equivalency in Ontario for their paramedic qualification.

https://www.health.gov.on.ca/en/pro/programs/emergency_health/edu/docs/plm_info.pdf

Paramedic Labour Mobility Application - Central Forms Repository (CFR)

Application and Verification forms for the Ministry of Health (MOH) Paramedic Labour Mobility Equivalency for Paramedics who hold a valid license or certification in good standing from other...

forms.mgcs.gov.on.ca

 

[suffolkowner]

There were 4 bi elections. And the various things that went on in those races.

O’Toole’s parting words.

Mulroney’s recent statements at the AEC.

And the current overall divisive political environment.

Yeah I was hoping for better numbers for the CPC overall from the 4+1 byelections. Have the CPC and PP peaked? Need that breakthrough in the 905 I think for a majority government not much else matters

 

[QV]

Good, we need a LPC majority next election with the same characters in cabinet. Canadians think it's expensive to live or crime is bad now, just wait and see if they have another 4 full years going unchecked. Canada will turn into Seattle or Los Angeles, everything a Liberal manages turns into shit.

Next election I'm hoping for either a majority CPC, or a majority LPC win with Trudeau still at the helm. Either way I think we will then get down to business:

1. CPC hopefully to right this sinking ship; or
2. LPC to drive this sucker to the bottom faster so that events force a self correct.

 

[Quirky]

2. LPC to drive this sucker to the bottom faster so that events force a self correct.

LPC policies are like that of the Titan sub. You can reach the Titanic once, maybe twice, but sooner rather than later your policies and lack of competency will cripple you.