The article in the May 2 issue on the practice of psychiatry in Canada was
timely. According to a study by Aaron E. Carroll, M.D., and Ronald T.
Ackerman, M.D., in the April Annals of Internal Medicine, the
majority of U.S. physicians now favor a single-payer system, as Canada has. I
left the United States several years ago and find practice in Canada
preferable in several ways. I get paid promptly for all the time I work,
patients are not triaged by their insurance coverage, no bureaucrats make me
justify my decisions, and litigation is a less significant concern.
I just gave anecdotal reasons for preferring practice in Canada, which is
what the article in Psychiatric News consisted of—anecdotes. I
was disappointed that the article did not examine aspects of Canadian mental
health care more deeply. For instance, while psychiatric consultations may
require a wait in some places, in part because there are too few
psychiatrists, Canadians have devised a creative solution. In collaborative
mental health care, psychiatrists "adopt" family physicians for
whom they provide in-office consultations and phone support. This extends the
reach of psychiatrists and enhances the skills of family physicians.
The language of the article, with words like "dire" and"
can it be saved?," exaggerated Canadian problems. All advanced
countries are struggling with costs and access. Yes, in some regions, Canadian
hospitals have inadequate surge capacity. The anecdote about a man who needed
emergency treatment in the United States can't be disputed, but neither
can Michael Moore's vignettes in the film "Sicko!" of U.S.
citizens who had poor care, went bankrupt, or died because of inadequate
insurance or heartless insurers. That rarely happens in Canada.
Canada spends about 10 percent of its gross domestic product on health
care, slightly above average for nations in the Organisation for Economic
Cooperation and Development; the United States spends 15 percent while leaving
47 million people without medical insurance. As for the Canadian psychiatrist
who asked how to make national health care work, I in turn ask why the United
States is the only advanced country that doesn't care enough about all
its citizens to even try.