Access granted! barriers endure: determinants of difficulties accessing specialist care when required in Ontario, Canada
Among the common practices called into question south of the border are routine diagnostic imaging for headaches and short-term lower back pain, prescription of antibiotics for sinusitis, annual electrocardiograms (commonly called EKGs) for low-risk, symptom-free patients and annual Pap tests. Antibiotics arent effective against viruses the most common cause of illness and even bacterial ear and sinus infections frequently clear up on their own, avoiding risks of side effects and superbugs. While diagnostic imaging can provide helpful information in some cases, it also exposes patients to radiation, which can itself cause cancer, or leads to invasive tests that carry other risks. An unnecessary test is often worse than no test because it can lead to even more tests and procedures, some of which are invasive and carry their own risks, said Dr. Scott Wooder, president of the Ontario Medical Association . And testing opens the doors to false positives, causing anxiety on the part of patients. False positives are a kind of harm. It can be harm psychologically, and physically, said Dr. Wendy Levinson, a professor of medicine at the University of Toronto who worked on the Choosing Wisely campaign in the U.S. Levinson, who chairs Choosing Wisely Canada, said society has built an underlying belief that more is better. But when you talk about not ordering a test . . . Canadians can think this is about rationing, said Levinson.
Demand high but medical specialists not finding work in Canada
MacLean. It is expected that most of the jobless doctors will get work eventually, but the delay could mean a year or two of not applying highly-sophisticated abilities, though numerous studies have shown that the competency of surgeons, especially, improves as they perform more of a particular procedure. If youre not practising once youve been taught, your skills get a little rusty, said Dr. Geoff Johnston, an orthopedic surgeon in Saskatoon and a spokesman for his specialtys national association. Its important that one can promptly employ these people. While the situation varies from region to region and specialty to specialty, there is relatively little debate that Canada needs more doctors. In 2008, it ranked 26th of 32 Organization for Economic Cooperation and Development (OECD) countries on that front, with 2.3 physicians per 1,000 population, compared to the average of 3.2, and 2.4 in the U.S. In response to outcry over long wait lists, provinces have in recent years significantly boosted medical school enrollment and the number of on-the-job training positions: two-year family-medicine residencies and five-year residencies in a specialty. Once trained, family doctors and many other primary-care physicians, like pediatricians or psychiatrists, can simply hang out a shingle and start billing for their services. Surgeons and others who require expensive infrastructure like operating rooms to do their jobs, are often hired by hospitals or health regions. A cardiac surgeon, for instance, costs a hospital $1.5 million a year, though the doctors income is only part of that, said Ms. Frechette. Physicians say the job market has been tightened in part because the expected wave of retirements has yet to materialize, with many older doctors deciding to keep working after investment losses. Sometimes, as well, the jobs are out there, but might require a new specialist to relocate across the country, not always easy if they have working spouses and children, said Mr. MacLean. Yet in areas where demand for doctors is still high, budget-constrained health institutions are often not hiring the additional specialists recently churned out, medical leaders say.
Low income in this study was defined by having a household income adjusted by household and community size to in the province of Ontarios lowest quintile. Highest level of education was recoded to less than secondary school, secondary school only, and post-secondary education (e.g. University education, College education and higher). Statistics Canada uses the 35 health regions in Ontario as the primary sampling frame for the CCHS, and these were conceptualized as being enabling characteristics. Health regions were grouped into three categories: Urban, Rural, and the City of Toronto. The City of Toronto was separated from the other urban health regions because it is the largest metropolitan centre in Ontario, and the main centre for secondary and tertiary health care in the province. Urban areas were those that satisfied one of two criteria: (1) per guidelines proposed by the Organization for Economic Co-operation and Development [OECD] the health region had more than 150 people per km2 [ 25 ], or (2) the health region contained a Census Metropolitan Area that represented at least 85% of the population of the region. Census Metropolitan Areas in Canada are municipalities, or clusters of municipalities around a central core, with a total population over 100,000 people of which 50,000 live in the central core [ 26 ]. There is no universal definition of urban or rural in the Canadian context at the health region level, thus the addition of the second criteria. Eighty-five percent of a regions population living in a CMA was used as the cut-off point, as the most recent statistics show that 85% of the population of Ontario lives in urban areas versus rural areas [ 27 ]. Data used to calculate the proportion of the health region living in a CMA were available from the 2006 Canadian Census community profiles. The use and usefulness of this procedure for defining health regions as urban versus rural will be discussed further in the limitations section of the paper. The CCHS collects data on a range of chronic conditions used to create the variable measuring health need. These chronic conditions include: asthma, fibromyalgia, arthritis, back problems, high blood pressure, migraine headaches, chronic obstructed pulmonary disorder (COPD), diabetes, heart disease, cancer, stomach or intestinal ulcers, effects of a stroke, urinary incontinence, bowel disorders, chronic fatigue syndrome, multiple chemical sensitivities, mood disorders, and anxiety disorders. A total number of chronic conditions were tallied for each respondent, and coded as No chronic conditions, 1-3 chronic conditions, and 4 or more chronic conditions. Analysis All univariate and multivariate analyses are weighted to population weights provided by Statistics Canada in the public use microdata file for the 2010 CCHS.