ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, April 14, 1996 TAG: 9604120023
SECTION: HORIZON PAGE: 1 EDITION: METRO
DATELINE: TORONTO
SOURCE: COLIN NICKERSON THE BOSTON GLOBE
Canadian doctors are heading south in record numbers to practice in the United States, complaining that their country's once-vaunted national health system is denying them the freedom, technological resources and funding to provide top-notch medical care.
Most depart more in sadness than in anger, praising Canada's guarantee of free health care to all citizens - but fed up with a system that is desperately strapped for cash and is a constant target for politicians seeking to rein in government spending.
``Practicing in Canada simply became too frustrating,'' said Dr. Robert F. Heath, a family physician who in 1994 quit a 12-year practice in rural Gravenhurst, Ontario, to join a medical group in Petal, Miss. ``The system is overextended, underfinanced, and the government keeps clawing back, making cuts here, cuts there.
``Things U.S. doctors take for granted - ordering necessary tests, getting a CT scan done, securing operating room time - were a constant struggle,'' he said. ``There is only the one payer, the government, and it determines how much doctors get, and when. It got so that you could make more delivering topsoil than delivering babies.''
Canada for years has suffered a steady drain of specialists to the United States. But now family practitioners and other front-line physicians - who form the professional bedrock of the country's ``soft socialist'' medical system - are deserting in droves as health services deteriorate in some regions.
Especially alarming to medical analysts is that those leaving are mostly young physicians or doctors entering their prime years as practitioners and teachers. Government officials try to shrug off the problem, noting that major cities such as Toronto or Montreal probably have too many doctors, but top physicians fear that Canada may be headed for a public health calamity.
``We've got a crisis on our hands, but the government doesn't believe,'' said Dr. Walter Rosser, head of the University of Toronto's Department of Family Medicine. He warns that Canada faces ``a lost generation of physicians.''
In 1994, the most recent year for which complete figures are available, at least 410 doctors quit Canada, most of them moving to the United States, according to the Canadian Medical Association. The rate of departure has nearly doubled in five years, from 241 doctors in 1990. These are net losses, taking into account Canadian physicians who returned here and foreign physicians who immigrated to Canada.
Indeed, the numbers sound small by U.S. standards. But for a country of fewer than 30 million inhabitants they represent a serious and even dangerous loss, health care analysts say - a loss roughly equivalent to the entire annual graduating classes of four medical schools. Canada has 16 medical schools that produce about 1,700 interns a year. The country has only 55,000 doctors, compared with 640,000 in the United States.
``As more and more doctors quit, the pressures on remaining doctors intensify,'' said Dr. Richard W. Hu, a spinal surgeon at Toronto's Sunnybrook Health Science Center. ``The intensified workload provides incentive for more and more doctors to leave.''
Of the 96 doctors who graduated from the University of Toronto's family medicine program in 1995, for example, 34 have either taken up practice in the United States or are preparing to move. Tuition at Canada's medical schools is heavily subsidized by the government, so, in effect, Canadian taxpayers are underwriting U.S. health care every time a young physician departs.
A recent joint report by medical universities in the provinces states that the migration of physicians to the United States ``has created an acute shortage of family physicians ... which threatens access to health care for the population.''
Partly it is a matter of income. Doctors who set up even in rural areas of the United States, where demand for family physicians is greatest, can often make $120,000 a year just starting out, substantially more than Canadian physicians who usually earn less than $100,000 a year.
But recent surveys by medical organizations indicate that most doctors who have quit Canada in recent years are less pulled by the prospect of better money than pushed by deep dissatisfaction and distrust of what they say is an increasingly intrusive and bureaucratized system.
``It is not a purely money thing. There is great unhappiness among physicians with the capriciousness of government health policies,'' said Hu, who also teaches orthopedic surgery at the University of Toronto. ``Canada is essentially driving away a large proportion of its youngest and most productive doctors'' by ``limiting what they can do, where they can go, what levels of care they can provide.''
All across Canada, hospitals are shutting down, and other health services are being curtailed, as provincial and federal officials try to pare down massive government debt resulting from decades of freewheeling spending on social welfare and other programs.
Physicians here are far more restricted in the types of tests they can order. There are severe limitations on operating room availability. Certain specialists are in such short supply - even in major cities like Toronto - that it is often difficult for general practitioners to arrange appointments for patients needing more sophisticated care.
Doctors practicing in medium-sized cities, much less small towns and rural communities, do not have easy access to such technologies as magnetic resonance imaging that are routinely available in regional hospitals in the United States.
Meanwhile, provinces are considering new laws that would dictate where physicians practice, what sorts of treatment they can prescribe, and even require them to open patient medical files to prove they are providing the most ``cost-effective'' treatment.
``Socialism is disappearing from everywhere in the world except Canada, where the government seems determined to turn doctors into unglorified civil servants,'' said Dr. David Berman, a plastic surgeon who moved from Ontario to Northern Virginia three years ago. ``There are great doctors in Canada. You can still get excellent treatment, but the system is gradually destroying itself, and too many doctors are deeply discouraged.''
Berman found fame if not yet fortune by leaving Canada. He was on call at Prince William County Hospital in July 1993 when John Wayne Bobbitt stumbled into the emergency room, his penis slashed off and tossed in a vacant lot by his angry wife. Berman and urologist James T. Sehn successfully reattached it in a 91/2-hour operation that made headlines around the world.
Bobbitt might have been just as lucky in Canada. This country still offers some of the best medical care in the world. All Canadians are covered by government insurance paying the full cost for treatment of everything from the common cold to cancer. But patients needing care for conditions that are not immediately life-threatening - hip replacements, cataract surgery, even the removal of certain tumors - often have to wait for months, even years.
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