I received an email today from my family doctor's clinic telling patients to be less particular about whether they get to see their doctor or not when they schedule an appointment with... their doctor. The parts I take issue with are in bold. Here's the email body:
Good Morning <clinic> Patients,
A Reminder to Our Patients: <clinic> is Proud to Be a Teaching and Team-Based Facility.
Medical learners (students and residents, most of whom are training to be family physicians) are an important part of our team. Physician assistants, nurse practitioners, and locum/covering physicians are also crucial to our clinic functioning.
With the help of our team:
- We are able to offer non-urgent appointments usually within 1-2 weeks.
- We are able to offer same-day appointments for urgent issues.
- We are able to continue to provide care to our current <clinic> patients at a time when there are a record number of family physicians leaving practice.
- We play an important role in training the next generation of family physicians.
There have been an increasing number of patients requesting appointments with their provider only (and declining to see other members of the <clinic> team). This causes significant disruptions to the clinic and affects our ability to provide equitable care to all <clinic> patients.
Moving forward, when you book an appointment, you should expect that you may see a medical learner, physician assistant, nurse practitioner, or a physician covering for your primary family physician. For many appointments, your family physician will be available to see you after you have been seen by another practitioner, if requested or needed. Please be aware that learners and physician assistants are supervised directly by your physician.
This team-based model of care may not be the right one for you, and if you wish to transfer your care to another clinic, we will be happy to waive the usual fee for transfer of records.
We appreciate the important role you play in medical education and making practicing family medicine sustainable.
Sincerely,
The physicians and staff at <clinic>.
So basically, patients want to see their doctors instead of medical students and the clinic is telling the patients to fuck off with their standards and expectations. Instead of building rapport, confidence, and sharing personal vulnerabilities with your family doctor, you can now expect to do it with random, unqualified, inexperienced people who you'll never see again and who don't know your history. If you don't like it, despite paying these fuckers' wages, you can pound sand.
FYI, when this email says the students and assistants are directly supervised, it's figurative. It means the students and assistants report to the doctors, not that the doctors are in the room while the assessments and appointments are conducted. You're expected to meet with these unqualifieds one-on-one. There used to be supervised appointments where medical students would simply shadow the doctor with permission from the patient, but that hasn't been the case for years.
Also, moving to another family doctor is extremely difficult. Most doctors have a maxed-out roster and are not accepting new patients. There are 2.3 million Ontarians without consistent access to a family doctor in a province of 14.5 million.
Canadian tax dollars at work.
My 'insight' is that like you, I have absolutely no idea what is a better or worse system.
People criticize the British system, but the NHS seems to be loved by the British (to be fair, the same applies to grooming gangs). And people criticize the American system, but Americans seem to like their system as well. America is far richer than Europe, so it's not as if we could get a system with the quality of America (whether one thinks it is good or bad) by just adopting the system - that would bankrupt us.
For every argument for or against the system, there's another one refuting it. I'd be very arrogant to think that I in my infinite wisdom managed to figure out what apparently no one else can. And I don't want to be the guy who argues one position because he happens to live in a country which of course is much better than those Yankees, or to argue another position because my political tribe argues for it.
My own experience living in a country with 'universal healthcare' is that I have no complaints about urgent care, which I've always found excellent, but they don't seem to be able or willing to help anything that isn't a serious objective threat (like insomnia or pain).
It is always worth mentioning that part of the reason Europe could afford their healthcare systems (at least until infinity immigration) is that the USA is their defense force. Many countries haven't been paying their fair NATO share for decades.
We also subsidize their medical costs because we don't set price ceilings on drugs and such (generally). So when their governments say "We're paying you this much for this drug", they pass the losses on to Americans.
It's evolutionary niches. You can't chuck a saltwater fish into a freshwater pond and expect it to do well. Both do fine in their own ponds, but have many traits that could be improved upon... But chucking them in the other pond isn't going to develop those traits, only kill the fish.