There’s a scene in Michael Moore’s documentary Sicko that takes place in the waiting room of an emergency department of a Canadian hospital. Patients wearing winter jackets sit in vinyl chairs and wait, remarkably cheerfully for people in an emergency department. One by one, Moore asks the patients how long they’ve been waiting.
“Twenty minutes?” guesses one young woman, looking at her partner for confirmation.
“About 45,” from a lady in a purple parka.
And from a guy in a ball cap: “Oh, I got help right away.”
The documentary, which was criticized for its simplistic portrayal of Canada’s medical system, puts our country’s health care in a glowing, rosy light. Just ask anyone who visited one of Calgary’s hospitals on a long weekend this past spring – when wait times to see a physician at the city’s emergency departments, according to Alberta Health Services, ranged from one hour and 27 minutes at Foothills Medical Centre to three hours and 13 minutes at the South Health Campus – and you’ll get far different responses.
Certainly, the concept behind Canada’s health-care system is a winsome one: a universal program designed to protect, promote and restore the physical and mental well-being of residents of Canada, a system that facilitates access to health-care services, regardless of a person’s ability to pay.
The reality, however, is more muddled. Public insurance covers a hodgepodge of medical services. Many services are covered while others – things like dental care, ambulance rides and prescription drugs – are not. Wait lists to see specialists are often measured in months, rather than weeks. At least one in five Calgarians doesn’t have a regular family doctor.
Calgary’s Dr. William Ghali knows the inner workings of the local system as well as anyone. Ghali is a researcher who studies ways to improve patient access in his role as scientific director at the University of Calgary’s O’Brien Institute for Public Health. He’s also a practicing internal medicine physician who cares for hospitalized patients with non-surgical medical conditions. That includes critically ill patients on the “life-threatening end of the spectrum” and patients who need discharge to a long-term care facility.
In any week, he’ll find himself on the phone trying to track down family doctors who can take on his patients once they’ve left Foothills, or he’ll be searching for long-term care beds for patients who are too sick to go home but too healthy to remain in hospital. And, Ghali points out, he’s also the family member of patients and is a patient himself.
In all these roles, he sometimes bumps up against barriers in the health-care system. “There’s always a sense in the public that there are access problems, and I think it would be Pollyanna to say, ‘It’s all good, it’s all perfect,'” Ghali says. “It’s almost a situation where, on the surface, it can be daunting and confusing. If you listen to the word on the street, there can be a sense that there’s a big crisis, there’s no access.”
He says most of the access issues in Calgary are typical of access problems faced in other big Canadian cities and fall into three categories: lack of family doctors, too few long-term care beds and long waits for specialist services.
“There’s a lot of uncertainty involved with these [categories],” Ghali says. “The uncertainty is the most frustrating thing for people.” But, Ghali argues, Calgarians can take steps to improve their own access to health care. “It’s one of those situations where individuals need to be proactive, or the system needs to be proactive, especially to help people find a family doctor,” he says. “I don’t think that it’s impossible to do.”
You’ve heard it before and every expert interviewed for this story said it again: get a family doctor, ASAP. Your family doctor is your entry point into the health-care system, says Dr. Raj Bhardwaj, a physician and CBC Radio medical contributor.
Find a good family doctor while you’re healthy and your doctor will be able to coordinate the best available care for you when you’re sick, he says. People often postpone getting a doctor until they’re ill. Then, they find themselves calling around to clinics in a panic or joining the queue of coughers and sneezers at walk-in clinics. Or, worse, they end up in emergency because they have nowhere else to go.
“I think of it this way,” Bhardwaj says. “People don’t go shopping for beds when they’re sleeping well. They go shopping for beds once their beds are busted or their sleep is busted. But then, it’s too late. It’s the same thing with shopping for a family doc.”
A good family doctor will keep on top of your screenings and monitor things like weight gain, cholesterol levels or mental-health issues, as well as treat minor ailments before they turn into something necessitating a high-stress emergency room visit.
There’s psychological benefit, too, to having a doctor before you need one, Bhardwaj adds. It’s better for your relationship with your physician if he or she gets to know you and your family under healthy conditions.
“You don’t want your kid’s first experience with the doctor to be when the kid is in pain because they’ll associate going to the doc-tor with being in pain,” he says. “You want to have some regular visits and checkups when the doc doesn’t need to do a whole lot, but can play around a little. You want your kid to get used to the idea that this doctor isn’t a scary person.”
And, when you need a specialist physician, that’s when you need your family doctor most of all, says Bhardwaj. Family doctors understand the ins and outs of Calgary’s complex health system. They know where to refer you when you have a sore knee or need a rheumatologist. They can direct you to diagnostic centres, to dietitians, psychologists and kinesiologists, and they typically – but not always – provide some after-hours service that could spare you a cranky wait in emergency.
“A family doctor who knows the system can often speed you through, not because they are pulling strings for you, but because they know how to access the available services,” Bhardwaj explains.
How to Find a Family Doctor
Great, you think, I’ll just get a family doctor. It may be easier said than done.
Calgary’s growth has outpaced the opening of family medicine clinics, leaving many residents struggling to find doctors. In fact, even physicians can have trouble locating family doctors for their patients. Ghali says he and residents will sometimes call multiple clinics that are officially listed as accepting new patients before they’ll actually find one with room for new patients.
The shortage of family physicians is a problem throughout Alberta where only 80 per cent of people have a regular doctor – about 4.5 per cent lower than the rest of the country, according to statistics from the Canadian Institute for Health Information. In a city-by-city comparison, 80.2 per cent of Calgarians say they have a regular family doctor, below the 81.1 per cent of Edmontonians and 84.4 per cent of Torontonians.
If you’re looking for a doctor, Ghali suggests starting with the College of Physicians and Surgeons of Alberta, which keeps a list of physicians who are accepting new patients. The College provides information like a physician’s gender, languages spoken and any specialties they may have.
And, in June, the Primary Care Network Calgary and Area launched calgaryareadocs.com to help connect Calgarians to doctors who are accepting patients. That said, physicians sometimes fill up their practices before their names can be taken off the list. Or physicians – who are autonomous entrepreneurs working in a publicly funded system – may place some restrictions on their practice. They might only take patients with, for instance, sleep disorders, or people who are friends or family of their patients.
If you’re stuck, Bhardwaj recommends calling Health Link Alberta, which provides around-the-clock advice and general health information.
“They will go through a set of questions about whether there is anything right now that’s concerning you and then they’ll hook you up,”
he says. “A lot of times there is a waiting list, though, so it is still a matter of planning ahead.”
How To Find a Great Family Doctor
You don’t just want a family doctor – you want a family doctor you connect with, says Bhardwaj. Every practicing physician in the province meets standards for knowledge and professionalism, but a good patient-physician relationship is about far more than an MD’s credentials. It’s about things not listed on a person’s CV – things like personality traits, nuances in the way they speak with you and brick-and-mortar things like what quadrant of the city their clinic is located in and their hours of availability.
“It has to be the right relationship and it has to be a two-way relationship,” says Dr. Rohan Bissoondath, medical director at Preventous Collaborative Health. It goes beyond ‘Oh, I have a cough, I’ll see you later.’ There has to be a connection. You have to have that feeling that a person cares about you and takes the time to listen to you.”
And how do you find that kind of doctor? Experts recommend the time-honoured common-sense approach: ask your friends and family who they see. “That’s the best place to start,” says Bhardwaj.
Next, interview doctors. “Tell them, ‘I’d like to meet you first.’ And that’s what they’re doing to you, too,” says Bhardwaj. “As an independent-business person, they’re looking to see if you’re going to click, if your needs would be best served elsewhere. You need to do that, too.
“Do they sit and make eye contact with you, or do they sit and type into the computer the whole time? Things like that are important when you’re dealing with very potentially life-changing things going on with you or your kids.”
In fact, feeling a connection to your doctor is incredibly important when it comes to your health outcomes. In a study published in the Annals of Internal Medicine, researchers at Boston’s Massachusetts General Hospital looked at the physician-patient connection and found, to no surprise, that patients with the strongest relationships to specific primary-care physicians were also more likely to receive recommended tests and preventive care. Indeed, this sense of connection with a doctor had a greater influence on the kind of preventive care received than the patient’s age, sex, race or ethnicity.
Things to ask when looking for a family doctor
Do you have any special areas of interest?
What happens if I’m late or miss an appointment?
Do you work in a primarycare network?
Will you communicate with me by telephone and/or by e-mail?
Do you have anybody on call after hours for your clinic, or do I just go to emergency?
If you have specific health concerns, ask about the doctor’s experience treating patients with your condition.
Should I Use a Private Clinic?
That depends on what you’re looking for, say experts.
Calgary is home to a number of private or semi-private “boutique” clinics that offer their paying clients bundles of services with things like in-depth total health assessments, telephone consults, on-site kinesiologists, skin care and dietician services. Costs and services vary from clinic to clinic.
Often, clients pay an annual membership fee that gives them access to a multidisciplinary group of health-care providers and for longer, detailed health consultations. In many cases, the clinic charges medicare for services covered by public health insurance and bills clients separately for uninsured services.
Chris Nedelmann, Calgary-based CEO of Copeman Healthcare Centres, says the advantage of a private clinic is that patients receive coordinated care, including both insured and uninsured treatments, carried out by a multidisciplinary team under the same roof.
“For me, the important thing for people to get from a centre like this is that comprehensive care, regardless of whether they are young or old or very complex,” he says.
At Copeman, located on 12th Avenue S.W. in the Beltline, patients can sign onto a “Life Plus” program at $4,325 for the first year, and $3,325 thereafter. For that, they get access to 24/7 telephone access, an online health-management system, a unique psychological and brain-health surveillance program, a personal health coordinator, a dedicated family health nurse and fitness and dietary counselling.
Similarly, at Preventous, a two-storey clinic on 17th Avenue S.W., patients pay $3,300 annually for round-the-clock access to a health-care provider, access to fitness training and dietary services, customized weight-loss programs, travel clinics and psychological counselling. On the clinic’s main level, clients can train in the gym with personal trainers, or they can undergo la carte cosmetic procedures on the lower level.
“Our patients are not paying for access to our physicians. They are paying for our uninsured services,” says Bissoondath. “We’ve developed a system in Canada that focuses on illness and focuses on sick people. The difference here is we want to see people when they are healthy and educate them … It’s about seeing where your weak spots are, where your targets are and making a plan to move forward.”
In Canada, health care – specifically, how it’s paid for and delivered – is a sensitive topic. For people who believe Canada should bolster its public health-care system, the emergence of private or semi-private centres threatens to erode the public system. Opponents of private care argue that the more Canadians are asked to pay out of pocket for medical care, the more the government’s commitment to medicare decreases.
But others argue private clinics ease the burden on public health services and help ensure health-care access for Canadians. “Access – that word is a hot topic,” says Bissoondath. “It’s a hot-button word for many reasons. According to the [Canada] Health Act, everyone should have equal access to similar standards of health care. Health care should be portable across the country. But it’s not.”
So You Need an MRI?
Studies have shown that, generally, Albertans rank access to diagnostic imaging as quite good in the province – with 83 per cent of respondents saying they found services easy to access in 2014, according to a Health Quality Council of Alberta survey. However, satisfaction levels drop markedly when patients rated their access to publicly funded magnetic resonance imaging (MRI) tests, which are only performed in hospitals. For these tests, only 58 per cent of respondents said they had easy access.
And with just cause: the median wait time to undergo a non-urgent MRI at a Calgary hospital this spring was 10.4 weeks, according to the Alberta Wait Times Reporting website. There are some options to pay for private MRIs in the city. Calgary ranks among the top five cities in the country in terms of private diagnostic centres, says Tom Ladd, who works with the online directory Find Private Clinics, a directory of Canadian private medical resources.
At Canada Diagnostic Centres and Mayfair Diagnostics, patients can arrange private MRIs or computed tomography (CT) scans within 24 to
48 hours. Costs vary depending on the kind of test. For example, an MRI at Canada Diagnostic Centres starts at $770, while CT scans range from $375 to $795, says radiologist and medical director Dr. Robert G. Davies. (A heads up: you’ll need a referral from a doctor or another approved health-care provider for an MRI or CT scan.)
For some, paying hundreds of dollars for diagnostic tests is prohibitively expensive. Others are opposed on principle to paying for tests and services covered by the Canada Health Act. In these cases, publicly insured MRIs and CT scans are available at hospitals. Davies acknowledges that many people cringe at the idea of paying for diagnostic-imaging tests.
“It’s one of the odd things about health care in Alberta. We have a relatively well-to-do population with people or families who wouldn’t necessarily think twice about taking their family for a skiing weekend in Lake Louise and spending over $1,000 … but those same people will still often balk at the idea of paying for their own health care or any component of their own health care,” says Davies. “As the province looks to ratchet down public spending on health care, there may be a necessity for greater private access to care, as is currently the situation in British Columbia and Quebec.”
When You Need Surgery
Good news: Alberta is home to surgeons on par with the best in the world. The catch? You may need to wait for surgery, depending on what procedure you require.
For instance, if you need knee-replacement surgery, you could wait up to 32.7 weeks to have an operation in Calgary. In February 2015, that’s how long it took for 90 per cent of knee-replacement patients in Calgary to undergo their surgery, according to figures published online by the provincial government.
Is it worth that wait? The answer depends on your personal priorities. If it’s extremely important to you that you undergo surgery nearby and have it paid for by public insurance, there are high-quality local options if you’re willing to wait. For others who don’t want to wait or feel they can’t, a handful of private surgical clinics in Canada offer a limited range of surgical services.
Of these, Vancouver’s Cambie Surgery Centre – you may have seen its giant billboard at the Calgary International Airport – is arguably the best known. If you prefer to have a surgeon who can provide pre- and post-operative care here in Calgary, local orthopedic surgeon Dr. Ian Lo travels to Turks and Caicos with patients to perform arthroscopic shoulder surgery. Finally, patients can work with hospitals and doctors in other countries – often the United States, Mexico or India – to arrange surgery. Some companies, like B.C.-based Timely Medical Alternatives, will facilitate medical tourism surgeries for patients who don’t wish to organize it themselves.
Bhardwaj cautions Canadians to be careful when selecting medical care abroad. “There are definitely some huge disadvantages,” he says. “The person operating on you might not be up to Canadian standards, and the stuff they are using might not be up to Canadian standards. That’s a risk you take.”
Other risks include exposure to multi-drug-resistant infections that aren’t commonly seen in Canada or overtreatment by undergoing a surgery that may not be beneficial in the long term, he says.
Get Some Added Insurance
According to Bhardwaj, one thing everyone should consider is investing in supplementary health and dental benefits.
“Once you’re sick, it’s hard to qualify for that sort of stuff,” he says. “It’s a game of risk-management. Do you have life insurance? Do you have disability insurance? Do you have health insurance? It’s all in that same kind of pie. I would get that coverage because I see people all the time who say, ‘I can’t afford that kind of medication, but I can’t afford not to have it.'”
Calgarians and Health Care
Calgarians’ perceived health – an important predictor of future health care use and mortality – is higher than the Canadian average: 65.3 per cent, compared to 59.4 per cent.
Our life expectancy at birth is higher than that of Canada, overall, at 82.3 years versus 81.1 years. We have lower rates of smoking and obesity. We do more physical activity. We also drink more.
Albertans and Health Care
According to a survey by the Health Quality Council of Alberta, of Albertans who received health-care services in 2014, 77 per cent rated the quality of care as excellent or good, the same as shown by the 2012 survey.
Also, similarly to the 2012 survey, 52 per cent of Albertans rated access to health-care services as “easy.” However, significantly fewer respondents in 2014 said access was “very difficult.” Meanwhile, 76 per cent rated ease of access to family doctor services as “easy” in 2014.