I write from two perspectives: as a colleague and the wife of a
psychiatrist, Curtis Steele, M.D., formerly living and working in the United
States and now in Canada; and as a member of an extended family living mostly
in the United States.
In the November 7, 2008, issue, Dr. Steven Sharfstein accurately presented
the situation for psychiatrists in Canada. Curtis and I practiced in the
United States for several decades before moving to Canada. For our
professional situation, the move has been excellent. In the United States, we
had to have a full-time, well-trained, highly competent employee whose time
was almost entirely spent collecting our fees from insurance companies. In
Canada, as Dr. Sharfstein said, billing for the psychiatric practice takes
about 10 minutes a week and requires no office staff—which means less
office space, less equipment, and so on, saving money for everyone including
the provincial health insurance fund.
Furthermore, provincial insurance pays enough for group therapy that Curtis
can afford to pay me to serve as cotherapist with him. We are able to see in
our groups not only fully employed people, but also people whose incomes are
very tiny, people who are between jobs, people whose jobs carry no insurance
benefits—many people we would never have been able to see in the United
As I am not a medical doctor, the services that I provide on my own are not
covered by provincial health insurance; therefore, for that part of my
practice, I continue to see only people who can pay out of pocket or who have
private insurance with one of the companies that recognize my registrations.
(They pay as they go; no office staff for me either.)
As for our family members: there are at least two of our relatives living
in the United States who have suffered permanent impairment as a result of
being unable to afford the medical care they needed when they needed it. This
kind of tragedy seems to be underrecognized.