Behind the scenes of health care in Canada

What happened?

History of Medical Coding - CPT System

CPT stands for Current Procedural Technology. These are codes that identify the services performed on a patient by doctors and other healthcare providers. Every October codes are added, removed, and revised with each revision. Changes to codes can be initiated by providers, medical societies, or responsible organizations. Changes are governed by the CPT editorial panel consisting of 16 representatives.

Family physicians in Canada make an average of $202,000 a year (2006, before expenses). Alberta has the highest average salary of around $230,000, while Quebec has the lowest average annual salary at $165,000, arguably creating interprovincial competition for doctors and contributing to local shortages.

In 1991, the Ontario Medical Association agreed to become a province-wide closed shop making the OMA union a monopoly. Critics argue that this measure has restricted the supply of doctors to guarantee its members' incomes. 

Each province regulates its medical profession through a self-governing College of Physicians and Surgeons, which is responsible for licensing physicians, setting practice standards, and investigating and disciplining its members.

The national doctors association is called the Canadian Medical Association; it describes its mission as "To serve and unite the physicians of Canada and be the national advocate, in partnership with the people of Canada, for the highest standards of health and health care". 

Because health care is deemed to be under provincial/territorial jurisdiction, negotiations on behalf of physicians are conducted by provincial associations such as the Ontario Medical Association. The views of Canadian doctors have been mixed, particularly in their support for allowing parallel private financing. The history of Canadian physicians in the development of Medicare has been described by C. David Naylor. Since the passage of the 1984 Canada Health Act, the CMA itself has been a strong advocate of maintaining a strong publicly funded system, including lobbying the federal government to increase funding, and being a founding member of (and active participant in) the Health Action Lobby (HEAL).

However, there are internal disputes. In particular, some provincial medical associations have argued for permitting a larger private role. To some extent, this has been a reaction to strong cost control; CIHI estimates that 99% of physician expenditures in Canada come from public sector sources, and physicians—particularly those providing elective procedures who have been squeezed for operating room time—have accordingly looked for alternative revenue sources.

One indication of this internal dispute came when Dr. Brian Day of B.C. was elected CMA president in August 2007. Day is the owner of the largest private hospital in Canada and a vocal supporter of increasing private health care in Canada. The CMA presidency rotates among the provinces, with the provincial association electing a candidate who is customarily ratified by the CMA general meeting. Day's selection was sufficiently controversial that he was challenged—albeit unsuccessfully—by another physician. The newspaper story went on to note that "Day said he has never supported the privatization of health care in Canada, and accused his detractors of deliberately distorting his position.

OHIP, as one example of this bureaucracy has begun applying pressure to the already stretched thin doctors in Ontario, and with the new legislation restrictions are now attempting to claw back income from the doctors after they have already treated the patients in their care.

OHIP is increasingly indulging in posturing in order to make doctors appear dishonest and incompetent. These objectives can only be achieved by increasing pressure by way of harassment and interference to office practice.

A doctors duty of care to the patient is to diagnose the problem correctly and apply the optimal treatment available. It has little to do with the evaluation of charts, or any other particulars of the physician-patient relationship.

The problem with this type of monopoly is there always looms the potential for corruption and the individual(s) in power use that position for personal gain and not for the betterment of those under their control.

There are many ongoing private situations (private due to fear of retaliation), where there has been unrelenting and malicious persecution of physicians as well as outright extortion by representatives of the insurance company. Equally upsetting to those in this scenario is the fact that there is no choice about obtaining or not obtaining this insurance. The doctors are under obligation to participate with or without benefit. Many other similar programs with this uneven power have also been known to disappoint their paying patrons. One that comes to mind is WSIB (you pay but there is no help available for many including the payee, because of the way it's structured).

The problem is this system seems to go against individual and constitutional rights. The totalitarianism demonstrated by OHIP in the stories you will come to learn of through this coalition, equates with the methods used by the NAZI regime - Germany in the 30's and 40's.

No citizen, certainly not one so proficient and benevolent as a healthcare practitioner, should be treated in such a manner which defies the basic human rights of the individual.

What needs to happen!

When confronted with a bully, the best strategy is not to cower or hand over the lunch money which is essentially what's been happening and the results have been an ongoing abuse of power.

Some research done in Europe chose to use the term “mobbing” rather than bullying, because bullying is so strongly associated with children and a researcher felt that a different term was needed for adults. Mobbing can exist only in an environment that tolerates it either from fear or complacency. Preventing ongoing mobbing begins with each and every one of us. 

Here is what needs to happen ...

1. Rally: Form a support network which will become a collective voice for a positive change.

2. Record: Confide and be sure others know your experiences and are aware you have been threatened and by whom. This will be important in bringing awareness to the situation and in creating a resolution.

3. Redefine: Determine the best case scenario as well as limiting factors preventing the outcome of this possibility and redefine the parameters of this process for the betterment of healthcare professionals and patrons alike. 

4. Resolve: When there is mutual respect, and understanding occurs between all parties, the path unfolds with far fewer obstacles and the resolve to proceed without the previous communication barriers. 

What we're doing!

We have formed this coalition and are actively rallying political, legal and public support to first of all, bolster the confidence of this dedicated group and cause awareness, as well as collectively form a larger defence and voice to make sure that there is an independent process put into place that will prevent the continued private 'mobbing' which occurs one-to-one on a daily basis.

We also provide an opportunity for physicians and practitioners to showcase their practice and any promotions which will assist in the economic issues this group faces with escalating costs incurred and diminishing opportunity for financial growth. 

How you can help.

Join this elite and independent, politically neutral coalition designed to support and assist physicians and practitioners without worry of reprisal from bureaucratic or legislative forces.