Canada to USA as a Dr.

[OneBadSkwerl]

Once completeing residency in Canada is it possible just to work in the USA? Are there more tests/exams required? Are there only certain states one can work in?

Thanks!

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[OneBadSkwerl]

 

[BlondeCookie]

It's not as bad as you think. The problem isn't getting a residency in the US. The problem is getting a long-term visa to stay in the US. You have to pass the American licensing exams (USMLE) and you can apply for residency in any state. It's all accredited under LCME so you just have to make sure you pass the USMLEs. Good luck.

 

[ssc_396]

It's not as bad as you think. The problem isn't getting a residency in the US. The problem is getting a long-term visa to stay in the US. You have to pass the American licensing exams (USMLE) and you can apply for residency in any state. It's all accredited under LCME so you just have to make sure you pass the USMLEs. Good luck.

If you decide to practice in the USA you should be forced to pay back the entire cost of training you in Canada (~90K remaining even after the tuition you've paid). Canadian trained docs who leave make me mad. If you want to be in the US get your MD there as well.

 

[docbill]

If you decide to practice in the USA you should be forced to pay back the entire cost of training you in Canada (~90K remaining even after the tuition you've paid). Canadian trained docs who leave make me mad. If you want to be in the US get your MD there as well.

I strongly agree. I will offer to pay 45-50$K a year in tuition to stay in Canada.

BUT, now that I will be going to the US for med school. I am surely going to think twice before running back here to practice. And if I do come back, you better believe that tuition repayment compensation will be on the negotiation table (If I am in that position of course).

 

[BlondeCookie]

If you decide to practice in the USA you should be forced to pay back the entire cost of training you in Canada (~90K remaining even after the tuition you've paid). Canadian trained docs who leave make me mad. If you want to be in the US get your MD there as well.

Strongly disagree. There are other mechanisms to retain and even recruit extra doctors to areas of need in Canada, but a rule requiring repayment of tuition based on not working in Canada smacks of total socialism. And I disagree with socialism as the basis for any governmental policy.

 

[cheer_up]

It's not as bad as you think. The problem isn't getting a residency in the US. The problem is getting a long-term visa to stay in the US. You have to pass the American licensing exams (USMLE) and you can apply for residency in any state. It's all accredited under LCME so you just have to make sure you pass the USMLEs. Good luck.

Duplicate

 

[cheer_up]

If you decide to practice in the USA you should be forced to pay back the entire cost of training you in Canada (~90K remaining even after the tuition you've paid). Canadian trained docs who leave make me mad. If you want to be in the US get your MD there as well.

Agree.

 

[trustwomen]

a rule requiring repayment of tuition based on not working in Canada smacks of total socialism. And I disagree with socialism as the basis for any governmental policy.

You must not be Canadian - it is the basis for MOST governmental policy here...

I likes me the socialism. I'm happy to pay the taxes.

 

[cheer_up]

You must not be Canadian - it is the basis for MOST governmental policy here...

I likes me the socialism. I'm happy to pay the taxes.

 

[f_w]

> Once completeing residency in Canada is it possible just to work in the USA?

If you are graduate of a canadian medical school, most states will recognize the LMCC as equivalent to the USMLE for licensing purposes. Also, most hospital credentialing boards will take passing of the RCPSC exam as the equivalent of the respective US board certification.

There are plenty of canadian trained MDs in the US. They generally have excellent prospects of finding jobs. As someone mentioned, it requires some paperwork to obtain a long-term work visa or permanent residency. But if you have a skill a practice needs, these paperwork hassles can be overcome.

> Are there more tests/exams required? Are there only certain states one
> can work in?

About 10 states don't recognize the LCME (don't ask me which). In those states you would have to write the USMLE 1-3 in order to be eligible to practice.

Also, if you are not a graduate of a canadian medical school, you will in all likelihood need the USMLE (the wording in the federal law is that if you didn't graduate from a US or canadian school you have to pass an evaluation by the ECFMG which uses the USMLE. So the LMCC won't help).

Hope that helps.

(as for the rest of the noise on this thread: canada has exactly the physician shortage it deserves. for decades, overseas graduates where p*##^d upon by the provinical colleges and the canadian immigration authorities. now that the #*$# hits the fan I have a hard time to feel sorry for you guys. canadian physicians moving south is an expression of free trade. if your goverment wanted to impair this free flow of the workforce, they would be free to impose a mandatory pay-back period)

 

[trustwomen]

canada has exactly the physician shortage it deserves. for decades, overseas graduates where p*##^d upon by the provinical colleges and the canadian immigration authorities. now that the #*$# hits the fan I have a hard time to feel sorry for you guys. canadian physicians moving south is an expression of free trade. if your goverment wanted to impair this free flow of the workforce, they would be free to impose a mandatory pay-back period)

I actually kind of agree with the first part. Overseas graduates still have a hard time, although for some there are questions of real equivalency in training (many overseas graduates are from developing countries), as well as language skills and communication skills (yes, they are different skills). Overall, I'd rather see the government invest in opening up more med school spots than importing more MDs. Although I'd be OK with making these med school spots more accessible to immigrants who plan to stay/practice in Canada.

I agree with you that doctors moving south is an expression of free trade. I am not a huge fan of free trade, actually. It has its place to an extent, but I think we have gone too far with it (though that's another discussion entirely). Though I've heard about a recent trend towards doctors coming back to Canada, because of skyrocketing malpractice insurance costs, shrinking physician salaries (due to HMOs), and quality of life issues.

I don't like the idea of making doctors work X number of years in a certain place as a condition of training (leads to angry/resentful doctors and therefore poor medical care). But I do like the idea of making them financially liable for the cost of their education if they work elsewhere (retroactive student debt, if you will) - although I think it winds up being more than 90K/student when you factor in the cheap undergrad.

Being the only socialists on the block (i.e. North America) does have its inherent problems... This actually happens interprovincially too. Quebec, where I live, is more socialist than other provinces, so we get people actually moving here because welfare is more generous. And tons of professionals leaving Quebec because they make more (and pay less tax) in other provinces. Kind of a microcosm of the Canada/U.S. thing.

 

[BlondeCookie]

You must not be Canadian - it is the basis for MOST governmental policy here...

I likes me the socialism. I'm happy to pay the taxes.

Don't get me wrong. I'm happy to pay taxes too like everyone else. Doesn't mean that I feel that we should go to a completely socialist society. IMO, there are more fair and effective policies that can work at getting docs in rural areas than the extremist "pay us back if you don't practice here" view. I'm a fan of free trade. I'm probably in the minority here, but I think a lot of socioeconomic problems can be solved by minimising socialist policies like the ones suggested in this thread. I'm not a huge supporter of such initiatives.

 

[trustwomen]

IMO, there are more fair and effective policies that can work at getting docs in rural areas than the extremist "pay us back if you don't practice here" view.

Oh, I wasn't talking about rural areas. I just meant staying in Canada - as long as Canadian-trained docs are contributing to this society and this economy, they're cool with me. The rural areas problem could probably be solved by just increasing the "rural pay bonus". I think it would go over much better than the "urban penalty" they did here in Quebec (30% LESS than standard reimbursement if you work in the city - it was a disaster).

It would be interesting to discuss the pros and cons of free trade, but I suspect that would require a new thread.

Sorry if I sounded judgemental, that wasn't my intent.

 

[f_w]

although for some there are questions of real equivalency in training (many overseas graduates are from developing countries), as well as language skills and communication skills (yes, they are different skills).

Isn't it funny how the US seems to overcome these problems. Overseas trained doctors are required to pass the same exams as the locals and they are (for the most part) required to repeat their clinical training. When it comes to training positions, they are required to compete with US grads on a fairly even field. While residencies still prefer US grads, well qualified FMGs find their way into clinical training every year.
While some xenophobic right wing radicals might disagree, nobody has ever been able to show a difference in the quality of care delivered by FMGs vs US or canadian medical graduates within the US medical system. It is a non-issue.

Canada on the other hand didn't give overseas docs an opportunity to compete on an even footing with the locals. FMGs where (and in most provinces still are) forced to take the scraps, the family practice slots in the backwoods and the psychiatry positions.

Also, there is a tremendous amount of protectionism at work to keep US trained physicians with foreign medical school diplomas out of canada. (Unless you limit your practice to some idyllic place like '100 mile house, BC', it is extremely arduous to get your foreign medical school and US residency training recognized for a unrestricted license in any of the canadian provinces). The blame for this restriction in the flow of well trained physicians from the US to canada falls squarely on the provincial colleges of physicians and surgeons.

I don't like the idea of making doctors work X number of years in a certain place as a condition of training (leads to angry/resentful doctors and therefore poor medical care).

How about paying competitive salaries or making modern equipment available ?

Being the only socialists on the block (i.e. North America) does have its inherent problems...

I have seen and lived under socialism, and it isn't pretty.

 

[BlondeCookie]

Oh, I wasn't talking about rural areas. I just meant staying in Canada - as long as Canadian-trained docs are contributing to this society and this economy, they're cool with me. The rural areas problem could probably be solved by just increasing the "rural pay bonus". I think it would go over much better than the "urban penalty" they did here in Quebec (30% LESS than standard reimbursement if you work in the city - it was a disaster).

It would be interesting to discuss the pros and cons of free trade, but I suspect that would require a new thread.

Sorry if I sounded judgemental, that wasn't my intent.

Oh, I got ya now. No biggie. All docs are cool with me. I like the idea of attracting docs to the rural areas with an inc. in rural pay bonus as opposed the urban penalty. I think once you get docs out in the rural areas and living there for a while, they begin to appreciate the beauty and positive aspects of being in a smaller community.

 

[trustwomen]

Overseas trained doctors are required to pass the same exams as the locals and they are (for the most part) required to repeat their clinical training. When it comes to training positions, they are required to compete with US grads on a fairly even field. While residencies still prefer US grads, well qualified FMGs find their way into clinical training every year.
While some xenophobic right wing radicals might disagree, nobody has ever been able to show a difference in the quality of care delivered by FMGs vs US or canadian medical graduates within the US medical system. It is a non-issue.

Canada on the other hand didn't give overseas docs an opportunity to compete on an even footing with the locals. FMGs where (and in most provinces still are) forced to take the scraps, the family practice slots in the backwoods and the psychiatry positions.

Also, there is a tremendous amount of protectionism at work to keep US trained physicians with foreign medical school diplomas out of canada. (Unless you limit your practice to some idyllic place like '100 mile house, BC', it is extremely arduous to get your foreign medical school and US residency training recognized for a unrestricted license in any of the canadian provinces). The blame for this restriction in the flow of well trained physicians from the US to canada falls squarely on the provincial colleges of physicians and surgeons.

It sounds like you know a lot about this, so I'll simply nod my head. I do agree that we should let in more doctors overall. However, you say that IMGs have to repeat clinical training in the U.S., so why not have the same requirement here (i.e. must redo residency in Canada)? Maybe we just need more residency slots overall.

How about paying competitive salaries or making modern equipment available ?

Good idea. Although I think our salaries are already competitive with every country except the U.S., no?

I have seen and lived under socialism, and it isn't pretty.

I live under it right now (dare you to find anyplace more socialist than Quebec, except Cuba) and it's real purty to me. Yep, my tax dollars are paying for junkies' drugs on the first of every month (I work at a homeless shelter so I know whereof I speak), and I don't like that, but I still want to stay for, like, ever. I'd much rather complain about lefty policies than righty policies (lived in the U.S. for 4 years, working in health care - nearly had several dozen aneurysms).

 

[ssc_396]

I like socialism and everything that goes with it. Hence I will do my MD and stay in Canada (and I do currently have the option of going south ). But ignoring all the pros and cons of socialism here's my big issue with docs leaving...

If you are a Canadian trained doc and you head south then MY tax dollars paid for YOUR education and I am not able to access what I paid for.

Would you feel good about paying to build a road in the USA out of Canadian tax dollars? I doubt it.
It's the exact same thing. End of story.

I don't care if you're unhappy with how the government treats you etc...
You should not have the RIGHT to leave if you were paid for by me and my 30 million or so Canadian brothers and sisters. You are my road and I want you here.

If you want that right pay for it yourself.

 

[BlondeCookie]

Wow. Lots of hate and judgemental attitudes going around. Listen, you guys don't even know the original poster. So, don't hate.

To the OP, keep your head up. Canada is a fabulous place and so is the USA. If you want to go to the US, they will welcome you with open arms. Don't worry about the people that are going to pass judgment on you. Stay true to yourself and to the profession of helping people. You will have to pass the 3 parts of the USMLEs to practice in the US. Also, each individual US State has different rules on how much post-graduate training they will accept from non-USA residencies. So, you would have to contact the US state licensing board for their requirements. Good luck.

 

[ssc_396]

Wow. Lots of hate and judgemental attitudes going around. Listen, you guys don't even know the original poster. So, don't hate.

To the OP, keep your head up. Canada is a fabulous place and so is the USA. If you want to go to the US, they will welcome you with open arms. Don't worry about the people that are going to pass judgment on you. Stay true to yourself and to the profession of helping people. You will have to pass the 3 parts of the USMLEs to practice in the US. Also, each individual US State has different rules on how much post-graduate training they will accept from non-USA residencies. So, you would have to contact the US state licensing board for their requirements. Good luck.

No ... where's the hate and judging? There's nothing like that here. And there's nothing meant to be directed to the OP. He/She just opened a can of worms on something I feel strongly about.

I love the USA and I love Canada. On an individual basis there is little difference between us in my experience. As I've said before Canadians are just unarmed Americans with healthcare.

ie social healthcare is one of the only things that makes Canada different. And I am a firm supporter of this small difference. I see retaining Canadian docs as just one way that we can preserve this difference. Yes, there are a zillion others but perhaps another thread should be opened if you want to argue about those.

 

[BlondeCookie]

No ... where's the hate and judging? There's nothing like that here. And there's nothing meant to be directed to the OP. He/She just opened a can of worms on something I feel strongly about.

I love the USA and I love Canada. On an individual basis there is little difference between us in my experience. As I've said before Canadians are just unarmed Americans with healthcare.

ie social healthcare is one of the only things that makes Canada different. And I am a firm supporter of this small difference. I see retaining Canadian docs as just one way that we can preserve this difference. Yes, there are a zillion others but perhaps another thread should be opened if you want to argue about those.

OK, that's cool. I don't agree with such policies, but I respect what you are saying. Retaining docs is a big deal. Moreso I think is retaining docs in areas of need, like the rural communities that are sorely in need of primary care.

 

[trustwomen]

As I've said before Canadians are just unarmed Americans with healthcare.

I love this quote! Though I would say "unarmed secular Americans with healthcare and good public schools".

 

[cheer_up]

I like socialism and everything that goes with it. Hence I will do my MD and stay in Canada (and I do currently have the option of going south ). But ignoring all the pros and cons of socialism here's my big issue with docs leaving...

If you are a Canadian trained doc and you head south then MY tax dollars paid for YOUR education and I am not able to access what I paid for.

Would you feel good about paying to build a road in the USA out of Canadian tax dollars? I doubt it.
It's the exact same thing. End of story.

I don't care if you're unhappy with how the government treats you etc...
You should not have the RIGHT to leave if you were paid for by me and my 30 million or so Canadian brothers and sisters. You are my road and I want you here.

If you want that right pay for it yourself.

Hey Blondecookie,

I don't think ssc_396 is expressing a hate and judgemental attitude at all. He/she has got a point. What he/she is saying is very true, even though it may sound harsh to you.

 

[docbill]

Wow... I get up to see all of these exchanges.

I line up more behind trustwomen (prob because I lived in Quebec) and ssc_396 (prob cause we have the same amount of training thus far).

I like socialism... or better yet.. what we have in Canada a socialism-capitalism system. One can make money. Germany's physicians make 60k/year.. that is why they are on strike now... that is socialism.

I don't know if they should open the flud gates for all IMGs. Canada has to be selective. But opening the door for some and not the other causing calls for rasism or discrimination. I know some E.Indians that are great doctors.. others that I would not trust in my kitchen. The american's use there residency (repeat) to retrain doctors... canada doesn't have as many spaces availabe to do that. (however, I find it interesting that there are so many spaces available for paying fellows/residents from the gulf states... ) so it comes down to money, Canada does not put enough money into residency positions, and med schools.

I would pay to stay here. Like I said 40-50K US$/year.

 

[docbill]

Blondcookie, what is your background.. meaning east cost.. west coast... undergrad ... grad... etc... just wondering where you are coming from and where you may of gotten some of your ideas (just a thought since sometimes it depends about location).. I am BC raised, then Quebec, then finally Ontario... and I notice a huge difference in thinking in every place.

 

[ssc_396]

Blondcookie, what is your background.. meaning east cost.. west coast... undergrad ... grad... etc... just wondering where you are coming from and where you may of gotten some of your ideas (just a thought since sometimes it depends about location).. I am BC raised, then Quebec, then finally Ontario... and I notice a huge difference in thinking in every place.

Further to that are you Canadian Blondcookie? Not to attack you or anything at all. I think it's great to have all opinions floating around here, but like docbill says, it helps to know where people are coming from.

Further to what docbill was saying, in addition to having docs leave after their training it bums me out to see ones leave who do want to stay, like docbill. I'd be willing to guess that many Canadians who are forced to head south pre-MD would rather stay in Canada, get their MDs, and practice in rural places for a few years than not do an MD in Canada at all.

 

[trustwomen]

it bums me out to see ones leave who do want to stay, like docbill. I'd be willing to guess that many Canadians who are forced to head south pre-MD would rather stay in Canada, get their MDs, and practice in rural places for a few years than not do an MD in Canada at all.

I agree completely. Especially since once you are 200-300K in debt, you kind of have to keep practicing in the U.S. for several years...

We really need to open up more medical school slots. And install retroactive student debt for those who leave the country afterwards. I bet that would ease the competition at some schools!

 

[f_w]

I don't know where that nonsense idea that canadian medschool graduates owe anything to the canadian people comes from ? By that twisted logic, electrical engineers should be restricted from leaving the country as well. Canada funds higher education because they know that you can't live on natural gas alone. An educated workforce is what the subsidies are for, not neccesarily a suply of any particular profession.

The healthcare sector is part of the economy. Most of the canadian economy lives in a symbiontic relationship with the US economy, why should the healthcare sector be any different ? If the canadian medical system wouldn't put up the type of protectionist barriers they have at the time, there wouldn't be a shortage of physicians.

 

[f_w]

However, you say that IMGs have to repeat clinical training in the U.S., so why not have the same requirement here (i.e. must redo residency in Canada)? Maybe we just need more residency slots overall.

Yes. The US has something like 18k medical school graduates and 23k residency positions every year. Instead of increasing their medical school enrollment (and with a fluctuation in the market potentially creating an oversupply of physicians at some point in time), they rather rely on US citizens going abroad for medical school and well qualified foreigners to fill the remaining slots. As a result, they have a medical workforce second to none.

Good idea. Although I think our salaries are already competitive with every country except the U.S., no?

But the US is the country you have to compete with due to social and geographic reasons. I don't think you are bleeding physicians to Brasil.

In some areas like primary care, incomes in canada are actually competitive with the US. If you factor in things like lifetime basic healthcare and some of the retirement and social programs canadian citizens enjoy, the salaries are actually comparable.

What the canadian docs I have worked with so far in the US where complaining about the most was the inability to practice 1st world medicine for their patients. The goverment just doesn't provide the resources to get timely surgical or diagnostic appointments. This is not an issue of canadian docs being stupid or too few to go around, it is an issue of not enough ORs, not enough MRI scanners and not enough angio-suites (and the ancillary staff to run them).

 

[ssc_396]

I don't know where that nonsense idea that canadian medschool graduates owe anything to the canadian people comes from ? By that twisted logic, electrical engineers should be restricted from leaving the country as well.

I feel the same way about engineers, teachers, nurses, trades people… but this is the SDN

In the US you pay for your own education. It's an investment in yourself. You therefore don't owe anyone (other than banks) anything. That is the US way in more walks of life than just education. Fine.

Canada views education as more of a right. There are currently no expectations placed on your degree but I believe there should be. I'm prefectly happy with establishing two streams of education in Canada. One where you pay 100% and therefore have no restrictions on your degree and another where if you leave you pay back what was invested.

If you borrow money from banks to pay for your US education do you need to pay them back? Yes. Why do you think that owing a country who paid for your education is any different.

 

[f_w]

If you borrow money from banks to pay for your US education do you need to pay them back? Yes. Why do you think that owing a country who paid for your education is any different.

Because

Canada views education as more of a right

. You get an education because your parents paid for it with sky-high taxes. What you do with it is up to you.

 

[ssc_396]

Because . You get an education because your parents paid for it with sky-high taxes. What you do with it is up to you.

Then this because an argument of the nitty gritty of how our high taxes break down. These also pay for welfare, social support, healthcare and a number of other services. I’d guess that the fraction of high taxes which go to education paid by our parents don’t even come close to the 40K/year it costs to train an MD.

I also think it boils down to a bit of dishonesty if you have every intention of going to the US after your MD. If you answer the usual question in a Canadian med interview of “where do you see yourself in ten years” with “raking in the big bucks in the good ol’ US of A!” I can assure you that an acceptance will not materialize.

You do not need to worry though because my views are not likely to become a part of government policy any time soon.

 

[trustwomen]

Most of the canadian economy lives in a symbiontic relationship with the US economy, why should the healthcare sector be any different ?

-Because the Canadian health care system is public and single-payer and the U.S. health care system is private and profit-based. They are fundamentally different. The other sectors of our economy are capitalistic and therefore can compete adequately with the corresponding sector in the U.S. (Although that is another debate, namely that of free trade, which I do not adore either). We have made the decision that capitalist health care, on the other hand, is not in our collective best interest. And having seen U.S. health care up close, I can vouch that we are right.

-Because U.S. doctors earn what they do partly because they have such massive (200-300K) student loans, and that's just the tuition. That is certainly the way they justify it to the public. The extra education deserves the extra salary not only because of the years invested, but because of the debt incurred. I cannot justify the same salary for a physician with 60K in tuition debt (max).

-Because an electrical engineer is not getting as heavily subsidized (although I'll agree with you that they are getting subsidized.) Actually, come to think of it, I'm not entirely against the idea of making electrical engineers pay it back also.

I'm sick of Canadian doctors complaining that they can't do everything that American doctors do (fancy equipment, procedures, etc.). Newsflash: only the doctors who treat the wealthy get to do that down there. Those who deal with the uninsured and underinsured just WISH they could vaccinate a child without taking food money from his parents, i.e. they wish they were you. That's why there is a fairly large American group called "physicians for universal healthcare" (I think that's the name).

I agree that we need to invest more in equipment. I'm not even against a two-tier system, as long as that lower, single-payer tier is of very good quality (European-style). But if we consider "first-world medicine" to be only the cutting-edge stuff seen by those who treat the wealthy in the U.S., then it's worth noting that most Americans have no access to "first-world medicine" either.

It is really a problem being a socialist country so close to, and sharing a language with, the U.S. However, some would say that this means we need to abandon our values and principles - I disagree. We need to find creative ways to stay afloat. The "two-track" tuition (for those who stay and those who leave) is one.

 

[ssc_396]

-Because the Canadian health care system is public and single-payer and the U.S. health care system is private and profit-based. They are fundamentally different. The other sectors of our economy are capitalistic and therefore can compete adequately with the corresponding sector in the U.S. (Although that is another debate, namely that of free trade, which I do not adore either). We have made the decision that capitalist health care, on the other hand, is not in our collective best interest. And having seen U.S. health care up close, I can vouch that we are right.

-Because U.S. doctors earn what they do partly because they have such massive (200-300K) student loans, and that's just the tuition. That is certainly the way they justify it to the public. The extra education deserves the extra salary not only because of the years invested, but because of the debt incurred. I cannot justify the same salary for a physician with 60K in tuition debt (max).

-Because an electrical engineer is not getting as heavily subsidized (although I'll agree with you that they are getting subsidized.) Actually, come to think of it, I'm not entirely against the idea of making electrical engineers pay it back also.

I'm sick of Canadian doctors complaining that they can't do everything that American doctors do (fancy equipment, procedures, etc.). Newsflash: only the doctors who treat the wealthy get to do that down there. Those who deal with the uninsured and underinsured just WISH they could vaccinate a child without taking food money from his parents, i.e. they wish they were you. That's why there is a fairly large American group called "physicians for universal healthcare" (I think that's the name).

I agree that we need to invest more in equipment. I'm not even against a two-tier system, as long as that lower, single-payer tier is of very good quality (European-style). But if we consider "first-world medicine" to be only the cutting-edge stuff seen by those who treat the wealthy in the U.S., then it's worth noting that most Americans have no access to "first-world medicine" either.

It is really a problem being a socialist country so close to, and sharing a language with, the U.S. However, some would say that this means we need to abandon our values and principles - I disagree. We need to find creative ways to stay afloat. The "two-track" tuition (for those who stay and those who leave) is one.

 

[SomeGuy]

The problem is, and I'm really surprised none of the pro-free-traders brought it up yet, is that education in Canada is far more subsidized than in the USA.

And I thought the free-trade fans were supposed to be against any and all subsidies, since they're a socialist policy, aren't they?

What the provincial governments should really do is stop subsidizing medical education, and pay docs in Canada more once they're out. Why this talk about retro-active debt? Just give them real debt. They're guaranteed jobs in Canada once they graduate, so it is by no means a risky proposition for them.

So, by making this change, the net cost to docs that stay in Canada? Zero. Net cost to docs that leave Canada? They pay the costs for what they get out of it.

Heck, since getting a medical education is worth so much more than its cost due to the value of the license, why not make medical education in Canada ridiculously expensive, but pay the docs more in Canada. This way, we can profit (ie: like a real capitalist, not a phony that just complains about policies that don't benefit them) off the docs that leave Canada, while not changing the situation at all for docs that stay?

I mean, has anyone looked at the supply and demand differences for medical school lately?

 

[Wertt]

Hey Blondecookie,

I don't think ssc_396 is expressing a hate and judgemental attitude at all. He/she has got a point. What he/she is saying is very true, even though it may sound harsh to you.

That perception likely had something to do with the huge black bolded words.

 

[ssc_396]

Heck, since medical education is worth so much more than its cost due to the value of the license, why not make medical education in Canada ridiculously expensive, but pay the docs more. This way, we can profit (ie: like a real capitalist, not one that just complains about policies that don't benefit them) off the docs that leave Canada, while not changing the situation at all for docs that stay?

Why do we need to do that in Canada when it's already done in the US? And that's exactly the point. If that's what you believe in then move to the US right off the bat. I have absolutely no problem with this.

It's just as easy (some might say easier) for Canadians to get into med school in the US so if that's the life you want have at er'. Similarly, I think Canada should welcome Americans who want to practice in Canada after they receive their subsidized education.

I'll be happy to fork 1/2 of my wages over so that others have a reasonable quality of life. And I'll expect that the people whose education I contribute to remain here to give back what I gave them.

ok.... I need to write my thesis now or I won't get to be a doc at all..

 

[trustwomen]

Heck, since medical education is worth so much more than its cost due to the value of the license, why not make medical education in Canada ridiculously expensive, but pay the docs more. This way, we can profit (ie: like a real capitalist, not one that just complains about policies that don't benefit them) off the docs that leave Canada, while not changing the situation at all for docs that stay?

It's an interesting idea, and I thought about it; this is what I came up with:

-Because you'd have to start paying them more all at once, meaning that those who got the cheap education would make out like bandits at taxpayers' expense.

-Because making education of any kind ridiculously expensive makes it less accessible for the poor. Before you answer "financial aid", please note that financial aid is also available in the U.S. (one could argue more available) but almost all the med students come from rich families. As do a higher proportion of undergrad students.

-Because, and this is the biggie, paying doctors a lot more would VASTLY increase health care costs in our already strained single-payer system. Far more than would be recouped from removing the education subsidy. Just look at how many doctors we have vs. how many med students we have every year! The U.S. system has higher doctor salaries because of the debt loads, sure, but also because of its capitalist nature. Unless we give up our values, we just can't compete with that. So we might have to get a little bit protectionist. And BTW (not to the poster but to all), anyone who claims that the U.S. is really all about "free trade" and is not protectionist needs to read up on the softwood lumber dispute.

 

[SomeGuy]

-Because you'd have to start paying them more all at once, meaning that those who got the cheap education would make out like bandits at taxpayers' expense.

Why would you _have_ to? It really depends on how its structured. It could be structured as a signing bonus for new grad docs paid every year over 10/20/30 years or the like. The only losers in all of this would be those that leave to the USA. It'd even the level of the playing field for a Canadian grad choosing between Canada and the US, because now the salary gap will narrower.

New FMGs would get this bonus as well, which is a good idea on three points. Firstly, considering that more Canadian grads probably leave Canada than FMGs coming back to Canada, it should work out to our advantage monetarily. Secondly, the higher tuition fees would also give us the incentive to actually start training the number of doctors that we need rather than handing it to FMGs. And finally, we'd hopefully be able to attract better FMGs.

-Because making education of any kind ridiculously expensive makes it less accessible for the poor. Before you answer "financial aid", please note that financial aid is also available in the U.S. (one could argue more available) but almost all the med students come from rich families. As do a higher proportion of undergrad students.

What part of guaranteed jobs upon graduation for Canadian grads in Canada did you not agree with? Let alone the fact that every chartered bank in Canada will throw a nearly limitless amount of money at low rates at a medical student because their very own risk-analysts (actuaries) agree with me. I just talked with a chartered bank branch manager that does the loans for UofToronto professional student, and he said that as long as you don't have anything horribly derogatory on your credit report (like a bankruptcy), you'd get the good interest rates and the financing that you'd need.

And with regards to the comment on more students from rich families entering into medical school, its really a sociological problem. Going to medical school is quite possibly the best investment out there, especially Canadian med schools. I don't think (I hope anyway) anyone turned down a med school acceptance because it was "too expensive," especially at Canadian tuition rates. I am in no way suggesting that the road to getting in such as undergrad education (ie: the risky part that may be inaccessible to poorer families, or unacceptably risky) should be more expensive or more difficult.

-Because, and this is the biggie, paying doctors a lot more would VASTLY increase health care costs in our already strained single-payer system. Far more than would be recouped from removing the education subsidy. Just look at how many doctors we have vs. how many med students we have every year!

Well, the idea is that every dollar you save/earn by charging higher tuition, you put into reimbursements, so there is no net increase in cost to the government. This works out really well because both health care costs and medical education are paid for by the provincial governments. And like I said, it really works out well this way if you structure it in the signing bonus way I suggested before.

 

[f_w]

Because the Canadian health care system is public and single-payer and the U.S. health care system is private and profit-based. They are fundamentally different.

Well, 44% of healthcare in the US is paid by a single payor: The medicare program. In Canada that split is more 90/10, but the delivery of healthcare is still fee-for service in many provinces, a fundamentally capitalist system.

-Because U.S. doctors earn what they do partly because they have such massive (200-300K) student loans, and that's just the tuition.

I don't know where that number comes from. The average number is something like 140k which includes a good number of people with $0 who paid out of their own or their parents savings (or merit scholarships at times).

The extra education deserves the extra salary not only because of the years invested, but because of the debt incurred. I cannot justify the same salary for a physician with 60K in tuition debt (max).

Physicians make decent (in contrary to the belief of our socialist neighbours not outrageous) incomes because they manage to make their value understandable to the public and the payors. A regular average physician income in the US is not far above what a professional of similar intelectual and business acumen could make in any other field (business, management, law).

-Because an electrical engineer is not getting as heavily subsidized (although I'll agree with you that they are getting subsidized.)

Oh, so it is the degree to which you are subsidized that buys you into lifelong bondage, now I get it.

Newsflash: only the doctors who treat the wealthy get to do that down there. Those who deal with the uninsured and underinsured just WISH they could vaccinate a child without taking food money from his parents, i.e.

Bullcrap. Vaccinations in the US are paid for by the federal goverment. In fact, health insurance for children in the US is provided either free or ad moderate cost to the parents (medicaid or child-health-plus). The sob-story with the kid that can't get vaccinations or asthma meds is allways brought up when I talk to people from socialist countries, funny isn't it ?

they wish they were you. That's why there is a fairly large American group called "physicians for universal healthcare" (I think that's the name).

They represent a minority of US physicians.

And only an even smaller minority advocates for a goverment mismanaged system. 'Universal healthcare' is a status that can be achieved by other means than a price-controlled socialist benefit system (ideally by having an economy strong enough to provide every american with a job paying well enough that he can choose to purchase health insurance).

to be only the cutting-edge stuff seen by those who treat the wealthy in the U.S., then it's worth noting that most Americans have no access to "first-world medicine" either.

Again bullcrap. I work in a distinctly 1st world area of medicine and every day we treat regular working men and women, in fact they represent the great majority of our patients. Most people DO have health insurance through their employer and once they reach retirement it is provided by the goverment through the medicare program. I don't know who is feeding you this propaganda.

 

[SomeGuy]

Why do we need to do that in Canada when it's already done in the US? And that's exactly the point. If that's what you believe in then move to the US right off the bat. I have absolutely no problem with this.

Why do what the US is already doing in this regard? Because it has worked wonderfully for what we're trying to talk about here, keeping the people we paid (at a loss) to train. I'm not suggesting an all-out move to all of their systems or even pushing tuition up to a cost recovery plus system, but I'm saying that the idea of charging a high relatively unsubsidized tuition, and then paying them more after to make up for it, results in less loss of the people you trained.

It's just as easy (some might say easier) for Canadians to get into med school in the US so if that's the life you want have at er'.

The problem is that their education is relatively unsubsidized. There's a great number of doctors in the US that are practicing and benefitting off of our Canadian backs, and that's a problem. What I want here (and its not to become a doctor of any kind) is to avoid paying to train people that should benefit me that'll end up leaving.

Similarly, I think Canada should welcome Americans who want to practice in Canada after they receive their subsidized education.

I never said anything about putting up barriers to foreign grads in any way shape or form. They're good doctors, and so are we.

I'll be happy to fork 1/2 of my wages over so that others have a reasonable quality of life. And I'll expect that the people whose education I contribute to remain here to give back what I gave them.

What you expected isn't happening, and I really have no issues with paying taxes for a reasonable quality of life, but I sure am against the squandering of tax revenue.

 

[BlondeCookie]

And only an even smaller minority advocates for a goverment mismanaged system. 'Universal healthcare' is a status that can be achieved by other means than a price-controlled socialist benefit system (ideally by having an economy strong enough to provide every american with a job paying well enough that he can choose to purchase health insurance).

Exactly f_w! It's all just a matter of ideals and beliefs. You, like me, believe that better healthcare can be achieved without socialist policies. Others, believe that socialist controls have to be in place for adequate access to healthcare. While the original poster, poor guy, only wanted to get some info on if it was possible for a Canadian trained doc to work in the USA.

SSC, I respect your opinion, but seriously. You've completely taken the context of the original poster's thread and turned it into a grandiose discussion about the politics of the healthcare system in Canada. I understand you are quite passionate about that, but perhaps it's time for a actual thread with a title more apt for such discussion?

And to all those you are interested to know my background, saying it would be helpful.. Helpful for what? Can you not judge an opinion and have a discussion on a topic w/o going into the details of a user's personal history? To me, that is highly preferrable, because in the context of this post it has been assumed that I must not be a natural-born Canadian just because my beliefs are in the minority. It's a bit insulting. I love Canada. So, if you have to judge a person by where they are from and not based on their ideas, then I have no business talking to you.

 

[f_w]

You, like me, believe that better healthcare can be achieved without socialist policies. Others, believe that socialist controls have to be in place for adequate access to healthcare.

Actually, some of my comment was a bit tongue in cheek. Even if everyone had enough money to buy health insurance, it doesn't account for the fact that a measureable percentage of the population is stupid. (A socialist system is somewhat better in dealing with stupid people. In the workplace and in healthcare. They will be dragged along on a low level whether they want it or not.)

Already today we have a good number of people who COULD buy subsidized health insurance through their employer but don't. ( $200 per month is sooo much money and after the credit card and the rates on the 20' rims are paid, how could I pay for my cigarettes if I buy health insurance ??)

I think some degree of goverment intervention will be necessary to achieve near universal coverage. But that doesn't mean we have to abandon the entire private/public system in favor of a socialist distribution model. The only areas currently not properly covered are small independent contractors and low-wage employees of small corporations. A combination of subsidized state sponsored health insurance pools and tax penalties for people who choose not to get insurance (and employers who don't offer it) should help us to cover that group. We don't have to pour out the baby with the bathwater.

 

[docbill]

And to all those you are interested to know my background, saying it would be helpful.. Helpful for what? Can you not judge an opinion and have a discussion on a topic w/o going into the details of a user's personal history? To me, that is highly preferrable, because in the context of this post it has been assumed that I must not be a natural-born Canadian just because my beliefs are in the minority. It's a bit insulting. I love Canada. So, if you have to judge a person by where they are from and not based on their ideas, then I have no business talking to you.

What are you talking about blondie, no one said anything about assuming you were not natural-born candian (BTW, I was not born in CANADA, CANADA is my adopted country).

It makes a difference if you are a 1st year undergraduate student (less credibility), or 2 years med student, nurse, 28 year old trying to get accepted etc... i.e. Privatized medicine. If it came from a 1 year psychology student, I will not give it much credit... but when it came from residents and department head at UHN. Than I will give it more thought.

Cool down and take a pill. Your opinions are your own and they are not that far off. Lots of Canadians may agree with you.

 

[BlondeCookie]

I think some degree of goverment intervention will be necessary to achieve near universal coverage. But that doesn't mean we have to abandon the entire private/public system in favor of a socialist distribution model. The only areas currently not properly covered are small independent contractors and low-wage employees of small corporations. A combination of subsidized state sponsored health insurance pools and tax penalties for people who choose not to get insurance (and employers who don't offer it) should help us to cover that group. We don't have to pour out the baby with the bathwater.

I agree and it's something that I'm actually more in favour of. I think people misunderstood me, perhaps. I certainly am not in favour of the 100% complete privatization of the medical industry. It's just that the current level of excessive government intervention is not an efficient model to address the distribution inequalities between the rural and urban sectors. At least, that is my opinion.

 

[f_w]

So lets agree that :

- the US shouldn't end the public/private hybrid system of healthcare financing in favor of a goverment administered welfare program. While it has its problems including the high price, it works fairly well for the majority of US residents and it is valued by the populace as a whole.

- Canada shouldn't overthrow its single payor goverment administered healthcare system. While it has its problems including distribution inequalities and limited access to specialized care, it works fairly well for the majority of canadian residents it it is valued by the populace as a whole.