Proletarian Doctors Redux

Bethune led the way. And Canada quietly has produced a model for creating doctors faster than the monopoly guild that is the College of Physicians and Surgeons would like to admit to.

As I have pointed out here before the way to create more doctors and reform the medicare system is to break the haughty power of the monopoly the doctors guild has on its profession. And it appears that such a possibility has been in place for forty years but nobody bothered to admit it existed.

Add to this a program of nurse practitioners, free tuition and a commitment to work in rural areas, as well as community based health clinics with doctors on salary we would well be on our way to ending the health care crisis. And it would cost far less than any other reform.

Canada could produce a lot more doctors at a lower cost, and medical students would save thousands in tuition if most of its medical schools moved to a three-year program, the Canadian Medical Association Journal suggests.

Such three-year programs have existed for decades at McMaster University in Hamilton, Ont., and at the University of Calgary.

Dr. Paul Hébert, editor-in-chief of the Canadian Medical Association Journal and a professor of medicine at the University of Ottawa, wants to know how they measure up against the four-year programs at the rest of the country's medical schools.

"We've had a 40-year experiment go on, and no one's looked at that data as far as I know in a very cogent and detailed manner," he told CBC Radio's Ottawa Morning Friday, the same week he published an editorial titled "Is it time for another medical curriculum revolution?" in the bi-weekly journal.

Dr. Norman Bethune, assisted by Henning Sorensen, performing a transfusion during the Spanish Civil War

Norman Bethune (1890-1939) was a Canadian thoracic surgeon. During the 1930s he became a convinced communist, and this led him to Spain, where he joined the anti-Fascist struggle. On the Spanish battle fields he became aware that 75% of serious battle casualties would survive if operated on immediately. In early 1938, he arrived in China, and proceeded to Yan'an, the revolutionary base area of the Chinese Communist Party. Mao Zedong commissioned him to organize a mobile operating unit in the interior of North China. Although he was forced to work under extreme circumstances, sometimes operating for forty hours straight without sleep, and within minutes of the front lines, he saved the lives of many Chinese party members and soldiers. He died of septicemia, contracted when he cut himself while operating under great pressure from advancing Japanese forces.

Norman Bethune (1890-1939)

• born in Gravenhurst, Ontario
• served as a stretcher bearer in a field ambulance unit of the Canadian army in France in 1915
• a bout of tuberculosis inspired his interest in thoracic surgery
• joined the surgical team at Montreal's Royal Victoria Hospital
• produced over a dozen new surgical instruments
• became disillusioned with medical practice because often patients who were saved by surgery became sick again when they returned to squalid living conditions
• visited the Soviet Union, and secretly joined the communist party in 1935
• opened a health clinic for the unemployed
• promoted reform of the health care system
• fought the fascists in Spain in 1936
• in Madrid he organized the first mobile blood-transfusion unit
• in 1938 he went to aid the Chinese against the Japanese invasion
• in China he formed the first mobile medical unit, which could be carried on two mules
• died of an infection due to the lack of penicillin, the infection ocurred during surgery due to a lack of surgical gloves
• Bethune is regarded as a martyr in China and is referred to as "Pai-ch'iu-en" which means "white weeks grace"
• next to his tomb in China there is a statue, a pavillion, a museum, and a hospital dedicated to him
• the family home in Gravenhurst is now a museum
• played by Donald Sutherland in the biographical film: "Bethune: Making of a Hero"
• biography: The Scalpel, The Sword by Ted Allen and Sydney Gordon
• for more information see Canada firsts (1992) by Ralph Nader, Nadia Milleron, and Duff Conacher

History of the Norman Bethune Tapestry by William C. Gibson, MD, DPhil

One day when I had just arrived back in Vancouver from World Health Organization meetings in Geneva I dropped in to see H.R. MacMillan at his home. As usual he began: "What is the best thing you saw while away?" I told him of a very fine tapestry which was in a travelling exhibition, showing Norman Bethune in the Chinese countryside. "Find it," he said. After months of correspondence with Chinese and Geneva sources, I had to report failure. So H.R. said: "Get one made in China and send me the bill." So I sent off to Shanghai a colour photo to be reproduced, giving the approximate size which we could accommodate. Six months later the Bethune tapestry arrived, almost buried in mothballs! We placed it in the Sherrington Room, where many came to study it.* The setting depicts a former Buddhist temple, which Bethune had converted to his operating room for the Eighth Route Army in Hopei Province in the north. Bethune had sailed on a CPR Empress liner from Vancouver soon after Japan attacked China, because he was at that time in Salmon Arm, B.C. on a fundraising mission for his blood transfusion service in the Spanish Civil War. On hearing of the invasion of China, he gave up his efforts for Spain, where he had done yeoman service for the legal government of Spain despite the Department of External Affairs in Ottawa, which threw no end of roadblocks in his way. With a Canadian nurse he set off for China, accompanied, alas, by an American Red Cross surgeon who turned out to be a chronic alcoholic (as I believe he had been in Newfoundland). In 18 months Bethune became a legend. After his death at age 49 of an infected finger, cut while operating, Mao wrote a eulogy which was memorized by every schoolchild in China. When I first visited China in 1973, with the Bethune Foundation, every stop we made was highlighted by children reciting it. * One visitor was Dr. Wong, who was Bethune's anesthetist, shown in the tapestry. Bethune is doing a rib resection to get at a lung damaged by a bullet. You can see him bending over the wedged-open chest of the soldier.

SEE:

Proletarian Doctors

Socialized Medicine Began In Alberta

Ex Pat Attacks Medicare

Privatizing Health Care

Laundry Workers Fight Privatization

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Still Waiting and waiting and.....

For all their talk about how the Harper government takes action it is just that talk.

Jim Flaherty's timelines on national securities regulator, international tax

Finance Minister Jim Flaherty has repeatedly talked about plans to strike two panels: One to create draft legislation for a national securities regulator, and the other to identify ways to improve the fairness and competitiveness of Canada’s system of international taxation.

The latter panel was even suppose to produce an interim report by the end of 2007 and a final report in 2008. But the panels don’t exist yet. When will they be created?

“Soon,” Mr. Flaherty told reporters after speaking at a Rotary Club of Toronto event. Asked to clarify how soon, he said the international tax panel will show up within the next ten days. He did not elaborate on the national securities regulator panel.

Canada's health care rated poorly

Canada has the worst rating in a new study of health care in seven countries when it comes to wait times for seeing doctors and getting elective surgery.

And the Commonwealth Fund says Canadians are most likely to report going to an emergency room as an alternative to a visit to a doctor's office or clinic.

Only 22 per cent of Canadians surveyed say they could get a same-day appointment when they're sick. Thirty per cent -- by far the highest among the countries -- say they had to wait six days or more.

And 15 per cent reported waits of six months or more for non-emergency surgery.

Meantime, two-thirds reported having a lot of difficulty getting care at night, on weekends or holidays.

"The report indicates that Canadians are saying the same thing to politicians that they're saying to the Commonwealth Fund: access to physicians and access to medical services has to improve," said Health Minister Tony Clement.

"We share that concern."

SEE

Finally Some Common Sense

Still Waiting On Wait Time 2

Still Waiting On Wait Time 1

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Proletarian Doctors

Medicare reform can only occur when we break the doctors business monopoly and 'their haughty power' over health care. One of the ways is to put doctors on salary.

Another is by creating integrated community medical centers and thus the proletarianization 0f Medicare through the use of salaried Nurse Practitioners and Physician's Assistants. It's an idea Norman Bethune would approve of.

Dr. Sigurdson, who worked with a physician assistant during a fellowship in Atlanta, just completed a master of business administration degree at Saint Mary's University during which he examined the business case for physician assistants.

"We could do things much better here," he said Wednesday.
Dr. Sigurdson said in an average 10-hour day set aside for operating, he only spends about six hours in the operating room and the rest of the time waiting for patients to be moved, the room to be cleaned and so on.

But much of what he does in the operating room could easily be done by a trained physician assistant.

He said it doesn't require a surgeon to prepare and drape a patient for surgery, sew up an incision or dress a wound.

"A (physician assistant) could sew up just as good as I can," Dr. Sigurdson said.

In fact, by his calculations, a surgeon is needed for only about 37 per cent of what happens during an operation. And a physician assistant could handle 51 per cent of the patients he now sees in a clinic.

About 100 patients were booked to see Dr. Sigurdson on Thursday morning. He needs to see patients having or recovering from major procedures like breast reconstruction. But when the appointment is simply to check whether someone who's had a minor procedure is faring well, a physician assistant would do just as well.

Comparing the cost of hiring a physician assistant at about $70,000 per year to a conservative estimate of Dr. Sigurdson's increased productivity, he estimated the province would see a modest cost saving over 10 years.

But when he compared the cost of a physician assistant plus the space and staff to run two operating rooms at once to simply hiring a second surgeon to work in a second room, he found the province could save $1 million in today's dollars.

A full-time surgeon at the QEII is paid an average $432,521 a year under a contract with the province, meaning the doctor would get no extra pay for doing twice as much surgery.

"I'm a young surgeon; I like operating," Dr. Sigurdson said. "And I'd like to operate more. You don't train 14 years to do something and then you only get to do it a day or a day and a half a week. It's frustrating."

He said it's much too late now to hope that increasing the number of doctors trained in Canada can meet the mushrooming demand for care. The country is just now experiencing the leading edge of a huge group of aging baby boomers who will not accept years-long waits for health care.

"To take business concepts and bring them into the public system is a strategy that we really should be thinking very strongly about before we throw the baby out with the bathwater and bring in a parallel private-care system," Dr. Sigurdson said.

Physician assistants work well in the private American system and could easily be incorporated into the public system, he said.

And there are trained physician assistants in Nova Scotia eager to work, he said. Those employed by the military frequently take early retirement and are left with few work options save providing care on oil rigs.

SEE

Ex Pat Attacks Medicare

Privatizing Health Care

Socialized Medicine Began In Alberta

Laundry Workers Fight Privatization

Two Tier Alberta

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Put Doc's On Salary

It's time to proletarianize these petit-bourgeoisie self employed businessmen, and put them on salaries in community based medical clinics. Which would include pharmacists, and other complimentary workers like nurse practitioners.

This is not as far fetched as it may seem. Without such a radical grassroots reform expect the CMA businessmen to continue to lobby for contracting out and user fees as their ideals of Medicare reform.

Medical user-fee motion vote narrowly fails

doctors narrowly defeated a controversial user-fee motion at the annual Canadian Medical Association meeting.

The motion, which proposed that patients should help fund their care with "co-payments and health savings accounts," drew support from 48 per cent of voting doctors. Fifty per cent were opposed and two per cent abstained.

"Co-payments" mean patients would pay a fee when they see their doctors or obtain hospital services. "Health savings accounts" would act like registered retirement savings plans, enabling people to stash savings in tax-sheltered accounts, to be spent on medical items like home care, long-term care and prescription drugs.

CMA president wants public and private health care

"My support for universal health care is unequivocal, but I believe the [Canada Health] Act must be revised, reformed and updated," said Day, a founder and owner of the private Cambie Surgery Centre in Vancouver.

He said there could be a role for private health care in our public system.

"I realize it will surprise some of you that I raise this topic," he said. "Let's be clear. Canadians should have the right to private medical insurance when timely access is not available in the public system.

"Contracting out public health services to the private sector to reduce wait lists is not a new idea and does not spell the end of universality."

Prescribing a health-care revolution

The entire health-care system has to be examined with two aims in mind: To offer excellent health care as it is provided now, but using different professionals at a much lower cost.

Let's start with the drug companies. They spend tens of millions on research and promotion and bring out new drugs at an inflated price that are only marginally, if at all, better than the drugs being used. It is estimated that only about one in 20 drugs released for use is of major importance. The government should appoint pharmacists to check these new drugs against what is in use for a particular patient to see if the higher price is reflected in a healthier patient.

All the work done by doctors, dentists, pharmacists, nurses and optometrists must be examined to see if their jobs can be inter-changed at a lower cost. As an example, the Ontario government will soon license dental hygienists to practise independent of dentists. This could change the way basic preventive oral care is offered in Ontario, surely at a lower cost.

In the North, where doctors are scarce, nurse-practitioners do the job of the GPs very successfully.

SEE:

Laundry Workers Fight Privatization

Two Tier Alberta

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Still Waiting On Wait Times 1

The most important priority of the Harpocrite government was wait times, and well we are still waiting to see what will be done to reduce them.

So far the New Government gets a big F for failure from those in the know.

A survey of Canadian doctors has given the battle to reduce health-care waiting times a marginal or failing grade. The combined efforts of governments to address wait times in targeted areas earned a D (poor) or F (very poor) grade from 57 per cent of respondents. Only 13 per cent felt the effort was producing excellent (A) or good (B) results.

And the result of the Tories jigging wait times is this;

Patient's choice: Wait 14 weeks or pay $5000

"In other words, the priority in some areas is causing ... less priority in other areas," says association president Dr. Colin McMillan.

See:

Medicare

Healthcare


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