It's been over 10 years since I
moved to the States. I left after the closure of Montreal's
Queen Elizabeth Hospital by the separatist PQ government
in 1996. I saw no purpose in staying in a place where
healthcare was treated like a political piñata.
Now a new CMA survey wants to know what it would take
to make doctors like me come home ("Most
Canadian MDs in the US staying put: CMA survey,"
page 17).
I've been accused of leaving for
the money (as though money were a four-letter word).
But for those of us in primary care the motivation was
a little more complex. In Canada, physicians are subject
to a government master and the dictates of social policy.
In the US, the market is master. When I came in the
mid-1990s, the country was in the midst of an unprecedented
push to expand primary care and integrate it into hospital
networks. By the late 1990s that entire idea had collapsed,
managed care was in retreat and primary care incomes
began to decline in real terms.
That's OK. The market decided it,
not a government functionary with less education and
accountability than my administrative assistant.
The US is not a bad place to be.
I work with low-income individuals, an area where a
patchwork of government and community players are gradually
improving care. I've had to work harder than I would
have in Canada and sometimes I miss the recreation time.
But I guess I wasn't put on this earth to enjoy the
lifestyle.
Neither country's system has really
achieved its goals. I predict the two models will converge
over time, allowing both to achieve better compromises
between social prerogatives and the interests of capital.
In the final analysis, the only
thing that could get me to return to Canada is the guarantee
that I'd be more independent and would have the option
of working harder to earn more money — all without
undue interference from (well-meaning) government. —
Dr Dino Ramzi, Rockville, MD
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