Hi all,
My partner and I are thinking of packing up and moving to Canada. He’s currently a GP in the UK and is investigating the possibility of practicing in Canada. The licensing process seems long-winded, but do-able.
We’re not exactly sure how the Canadian health service works from either the physician’s or the patient’s point of view.
In the UK the GP is the first point of call for everyone. Everyone can sign on to a specific GP’s list (providing s/he is taking on patients) and all visits are free no matter how often. Further care is provided by assorted Consultants in specialist or hospital settings and is also fully covered by the NHS. Physicians are paid by the NHS and the rate of pay is dependent on the number of individuals on their list (not the number of consultations), and also on meeting certain targets set by the health service. Some physicians (especially consultants) supplement their income by taking private patients and are then paid directly by the patient or by private insurance.
In the USA (which I’m personally more familiar with) each physician (or group practice) is a private business and bills the various private insurance companies (or medicare/medicaid) for services provided - or bills the patient directly, depending.
Is there anyone here who can explain to us how the Canadian system works? Who pays, when, and how?
From the point of view of a patient (in Quebec, every province has its own system): I visit a doctor, either my family doctor or one he has referred me to. I hand him my medicare card and he stamps it or writes down the number. He treats me and that is that, from my point of view. I had a pacemaker implanted just 5 days ago. It started with a referral to a cardiologist a few months ago, account of a very slow pulse. First he weaned from the beta blockers I had been using for 34 years. When that didn’t work well enough, he had some tests (24 hour ECG, ultrasound). The technician who scanned the ultrasound called him the same morning and he called me that afternoon, to tell me to see him two days later and 10 days later it was done. Anyway, I presented the medicare card to the hospital, was admitted, operation a couple hours later, 4 hours of monitoring and goodbye. No money changing hands at any point. My only cost was the taxi home after. Doctors do supplement their incomes by charging for supplies or forms. Mine charges $30 to fill out a form for driver’s licence queries and the ophthalmologist charges $25 for .02 worth of eye drops, but these are minor.
I really cannot answer the question from the point of view of the physician. But as far as I know, they take these medicare numbers, turn them in and get reimbursed. There is, in Quebec, an annual limit so some doctors take December off. Once I got an official query, had such and such medical acts been performed (they had). My daughter-in-law practicing in New York City spends an incredible amount of her time filling forms and generally arguing with insurance companies. So far as I know, this simply doesn’t happen here. There are no exclusions for pre-existing conditions (what is the point of insurance that doesn’t insure what ails you?) and it generally runs smoothly.
Thanks Hari Seldon. The sense I’m getting is that it is pretty straightforward. Different from the UK but probably not any more complicated. Can’t say that about the US system (which is just another reason not to go there).
Cheers,
slumtrimpet
Many areas in Canada (especially smaller cities) are experiencing a doctor shortage and will bend over backwards to help you and answer any questions, if indicate you are considering moving there.
Thanks Lionel. That website certainly looks like they’re a bit desperate. That’s good (for us) right? (not so good for you guys though) We’re actually looking at Nova Scotia at the moment. It’s a bit closer to both family in England and family in New England. GingerOfTheNorth, Yellowknife might be just a little too much culture shock for us. I love the idea of living somewhere less crowded (135,000 people in our local 15sq.miles) but again, we’re trying to stay a bit closer to family if we can. And then there’s the cold…
We are super-short on doctors and only the idiot doctors ever have space for new patients, as their patient turn-over is so high. Please, move to my town.
Not a particularly nice town, but there are many opportunities if you like outdoor recreation. Winters are nasty. Vancouver/Victoria are only an hour away by plane (not far by our standards) if you need some cosmopolitan exposure.
Is there some correlation between the Canadian health system and the shortage of doctors? Here in the states, it seems we have a huge influx of physicians coming here from overseas.
One thing is that it may be a struggle to get licensed by the provincial college of physicians and surgeons. I would contact the college for the province you’re planning to move to, well in advance.
Thanks. Yeah, that’s our first move for sure.
What we’re still wondering about though is the day to day billing and how a doctor would actually go about practicing and getting paid for it. Like I said, the UK system is very different from the USA system. So we’re wondering what the Canadian system is.
My understanding (again for Québec) is that the doctors fill out forms and charge the government for their services. They are kind of considered to be self-employed, so treated like contractors to the government, but it is the province that pays them. My FIL, a psychiatrist, is paid by the consult, I think. A GP associated with a hospital may or may not have a base amount, but I do think it’s all based on the number of patients they see.
Certain geographic regions have premiums, to try and get doctors to go there. In Québec, everyone wants to work in Montréal/Laval, Québec City, or Sherbrooke (maybe even Trois-Rivières) so they are paid at the normal rate. Drummondville, however, which is really only about 45 mins from Sherbrooke and 1 hour from Montreal, will hire at something like 104% of the rate. It might be even higher in more remote areas, complete with agreements to transport you back to civilisation X times per year, etc. (Apparently this movie is a very funny take on a small town trying to convince a doctor to stay Seducing Doctor Lewis (2003) - IMDb)
mnemosyne, It sounds like a cross between the USA and the UK system. Billing for each consultation but only to one payee. I’ll have to see if I can find that movie around here … or maybe not. Shamozzle, Yes. Nova Scotia at the moment but mostly for it’s proximity to New England. Flights to London are manageable from Halifax too. I think Air Canada or somebody goes non-stop.
