Plumbers never complain about a plumber shortage. Same thing for bricklayers and accountants. But doctors complain about a doctor shortage, all the time.

We do not have a doctor shortage. We have an artificial doctor shortage caused by shackling doctors.

In some cases, patients cannot access care because government will not pay for technology or operating rooms.

But in most cases, patients experience a shortage because doctors are limited by the number of hours they can physically endure seeing patients. No other service industry operates this way.

Rationing

The state has placed artificial restraints on what doctors can do.

If doctors were woodchoppers, it would be like telling choppers that they can only chop with a child’s axe, and they must do 100% of the chopping themselves. Continue reading “Doctor Shortage and Other Nonsense”

Some doctors get forty happy years of practice, while others burn out in four.

Students choose medicine for the promise of meaningful work, but also because they could choose otherwise. Medicine offers more, in part, because it takes so much.

Friends collect jobs, houses, and husbands, while med students collect caffeine addictions and debt. But they survive on the certainty that practice will be worth the sacrifice. Happiness awaits.

Unprepared

A decade immersed in novelty and new skills does not prepare doctors. Practice means fixing the same problems, using old skills, over and over and over. Repetition defines expertise.

The same shortages of beds, tech, and backup impact all the same patients. Unnecessary suffering becomes insufferable.

A number of doctors dilute the insufferable with academia or administration. Academics work to reproduce the buzz of medical school. They chase novelty and credentials. It carries them beyond the point when most adults have stopped asking questions about meaning and work.

Administration also dilutes clinical work and can amplify influence in meetings about Important Things. But leadership is often a one-way street. Surgeons do not return to surgery after years as a full-time Chief of Staff.

Regular Working Doctors

Most doctors just practice medicine and suppress the insufferable. For many, “Just practicing medicine,” feels like saying you live in your mom’s basement. Regular working doctors jump from training into a practice, marriage, kids, house, cars, and more debt. Continue reading “A Happy Life in Medicine”

Everyone wants better health care in Canada. But no one knows who should fix it. Who’s the most responsible politician (MRP)?

The provinces are in charge, according to the constitution.

But the federal government is in charge based on the Canada Health Act (CHA) plus billions in Canada Health Transfer payments (CHT).

It’s like two people in a rowboat, one on each oar, both trying to row in different directions. It’s fun to watch, but painful to ride.

I wrote “The Most Responsible Politician: Who’s the MRP for Health Care in Canada”, with the Macdonald-Laurier Institute this summer.

Here’s the press release summary.

For a 2-minute version, check out the blog below.

Who’s MRP for Health Care?

The MRP concept is old. Most Responsible Physician (MRP) now includes Practitioner, with NPs as MRP in some cases.

When dozens of people run from all across the hospital to help a patient who is turning blue, one person needs to be in charge of the Code Blue.

Every major trauma needs a Trauma Team Leader. Someone needs to lead and take responsibility for team decisions.

Admitted patients come to harm if they do not have a clear and explicit MRP.

Canadian healthcare has no clear MRP.

Provinces run daily operations. Their authority comes from the British North America Act (1867). But the feds have ‘spending power’, which is the power to make payments “for purposes on which it (Parliament) does not necessarily have the power to legislate” (PE Trudeau).

In other words, the feds use money to get power. Instead of seeking a constitutional amendment, they can give grants with strings attached, called conditional funding. Continue reading “Going Nowhere Fast — Who’s the MRP for health care?”