Why this American doctor has decided to move to Canada

May 01, 2015

Although this OpEd is not about Vermont, it is a good illustration of how a single payer system allows providers to focus on taking care of patients rather than doing battle with insurance companies:

The Record:

I'm a U.S. family physician who has decided to relocate to Canada. The hassles of working in the dysfunctional health-care system in the U.S. have simply become too intense.

I'm not alone. According to a physician recruiter in Windsor, over the past decade more than 100 U.S. doctors have relocated to her city alone. More generally, the Canadian Institute for Health Information reports that Canada has been gaining more physicians from international migration than it's been losing.

Like many of my U.S. counterparts, I'm moving to Canada because I'm tired of doing daily battle with the same adversary that my patients face — the private health insurance industry.

Among the industry's more egregious faults:
•frequent errors in processing claims. The American Medical Association reports that one of every 14 claims submitted to commercial insurers are paid incorrectly.
•outright denials of payment (about one to five per cent)
•costly paperwork that consumes about 16 per cent of physicians' working time, according to a recent journal study.

I've also witnessed the painful and continual shifting of medical costs onto my patients' shoulders through rising co-payments, deductibles and other out-of-pocket expenses. According to a survey conducted by the Commonwealth Fund, 66 million — 36 per cent of Americans — reported delaying or forgoing needed medical care in 2014 because of the cost.
My story is relatively brief. Six years ago, shortly after completing my residency in Rochester, N.Y., I opened a solo family medicine practice in my adopted hometown.

I had a vision of cultivating a practice where patients felt heard and cared for, and where I could provide full-spectrum family medicine care, including obstetrical care. My practice embraced the principles of patient-centred collaborative care. It employed the latest in 21st-century technology.
I loved my work and my patients. But after five years of constant fighting with multiple private insurance companies, I made the heart-wrenching decision to close my practice down. The emotional stress was too great.

My spirit was being crushed. It broke my heart to have to pressure my patients to pay the bills their insurance companies said they owed. Private insurance never covers the whole bill and doesn't kick in until patients have paid the deductible. For some, this means paying thousands of dollars out-of-pocket before insurance ever pays a penny.

Doctors deal with this conundrum in different ways. A recent New York Times article described how an increasing number of physicians are turning away from independent practice to join large employer groups (often owned by hospital systems) to be shielded from this side of our system. About 60 per cent of family physicians are now salaried employees rather than independent practitioners.

Too often, I've seen in these large, corporate physician practices that the personal relationship between doctor and patient gets lost. Both are reduced to mere cogs in the machine of what the late Dr. Arnold Relman, former editor of The New England Journal of Medicine, called the medical-industrial complex in the U.S.

In seeking alternatives, I spoke with other physicians. We invariably ended up talking about the tumultuous time that the U.S. health-care system is in — and the challenges physicians face in trying to achieve the twin goals of improved medical outcomes and reduced cost.

The rub, of course, is that we're working in a fragmented, broken system. Powerful, monied corporate interests thrive on this fragmentation, finding it easy to drive up costs and outmanoeuvre patients and doctors alike. Having multiple payers, each with their own rules, also drives up administrative costs — about $375 billion in waste annually, according to another recent journal study.

I knew that Canada had largely resolved the problem of delivering affordable, universal care by establishing a publicly financed single-payer system. I also knew that Canada's system operates much more efficiently than the U.S. system, as outlined in a landmark paper in The New England Journal of Medicine.

When I looked at Canadian health care more closely, I liked what I saw. I would not have to sacrifice my family medicine career because of the dysfunctional system on our side of the border.

My husband and I decided to relocate our family. I'll be starting my own practice in Penetanguishene on the tip of Georgian Bay this autumn.
I'm excited about resuming my practice, this time in a context that is not subject to the vagaries of backroom deals between monied, vested interests. I'm looking forward to being part of a larger system that values caring for the health of individuals, families and communities as a common good — where health care is valued as a human right.

I hope the U.S. will get there some day. I believe it will. Perhaps our neighbour to the north will help us find our way.

Dr. Emily S. Queenan resides in Rochester, N.Y., where she ran a full-spectrum family medicine practice, Queenan Family Medicine and Maternity Care, for five years. She is an Expert Adviser with EvidenceNetwork.ca.