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Friday, December 3, 2010

Not out of the woods yet

Last year, Canada saw the biggest increase in new physicians in 20 years. About 2,700 extra practitioners brought the national total to around 68,000, according to figures released by CIHI, the Canadian Institute for Health Information.

Most of the new physicians, about 2,300, were graduates of Canadian medical schools. A few more doctors returned to Canada than went abroad in 2009, perhaps partly due to the weakening of the US dollar. And about 300 new doctors were international medical graduates.

Until about 2004, the number of physicians was barely keeping pace with the rising population. From 2004 to 2008, the rate of increase in physicians was double that of the general population. The 2009 increase was three times faster than the rate of increase of the population.

Clearly, steps are being taken to address Canada’s chronic physician shortage. But a crunch is still coming, and this may not be enough to divert it.

For the first time in decades, the average age of physicians didn’t increase in 2009. But it didn’t decrease either, hovering at 49.7 years. Is there any other job on earth where the average age is 50? Maybe being a nun. Meanwhile, the population ages apace. Older patients mean greater need, older doctors mean less provision.

This is not to suggest that older doctors work less. On the contrary, many do longer hours than their younger colleagues. And many are delaying retirement. Quite a few may have been burned in the stock market collapse, and the 2009 figures may partly reflect their decision to work a few more years to replenish the retirement fund. Others aren’t retiring simply because they can’t find a replacement to take on their patients. Of physicians aged 70-79 in 2004, most were still working in 2008, a feat of endurance surely unmatched in any other profession.

But retirement must come eventually. And with an average professional age of 50, the numbers leaving are going to be significant.

At the same time, their young replacements appear to be working shorter hours. Doctors today want a life as well as a career. And the dramatic increase in female doctors means more family responsibilities – women doctors average about 8 hours less work per week. They have also proved more likely, in the past, to drop the profession altogether. Of the new class of 2009, 52% of general practitioners and 45% of specialists were women.

(Ratios of women to men, strangely, vary quite sharply from one province to another. In Quebec, for example, the numbers are almost even, while in Manitoba male doctors outnumber female by 2-to-1.)

Family practice continues to get short-changed, though the picture is improving. In 2004, just 23% of medical students said they wanted to go into family practice. In 2009, that had jumped to 33%. But it needs to be 40% to meet the actual need.

And why is the need growing faster than the population? Because, of course, of the ageing of Canada. In 1921, one Canadian in 20 was aged over 65. Today, it’s one in eight. In 2026, it will hit one in five. And the “oldest old”, the 85-plus, is the fastest-growing group of all. Consumption of healthcare is astronomically higher in these age brackets. We’re not out of the woods yet.
Owen Dyer

70 comments:

  1. sharon [aka purley quirt]December 4, 2010 at 8:23 AM

    RE: the difference between "census" and "survey" data

    http://www.statcan.gc.ca/conferences/symposium2010/abs-res-eng.htm#a4

    paste

    02A-3 - Cycle 2 of the Canadian Health Measures Survey: Combining Census and administrative data to improve the efficiency of the survey frame

    Suzelle Giroux, Statistique Canada
    France Labrecque, Statistique Canada

    The Canadian Health Measures Survey (CHMS) uses a multi-stage sample design. For each sampled collection site, dwellings were selected from the 2006 Census using the household composition to better reach the target age groups. This sample design was a success for Cycle 1, hence was used again for Cycle 2 of the survey. Cycle 2 targets people aged 3 to 79 years old. Since its collection is taking place from fall 2009 to fall 2011, the 2006 Census frame deteriorates and must be updated to cover new dwellings and to be able to identify dwellings with youths 3 to 5 years old that are no longer identifiable using the Census. This presentation will begin with an overview of the survey design of the CHMS. Next, the update of the frame with the Address Register and the T1 Family File to improve coverage and reach the target population will be explained. Finally, results on the efficiency of this approach will be presented based on completed sites of Cycle 2.

    end of paste

    key phrase...... Since its collection is taking place from fall 2009 to fall 2011, the 2006 Census frame deteriorates......

    [ we are getting windshield survey data( qualitative) in some of the ? news ... not quantitative data]

    Seniors to date are not the highest users of the health dollar. For many decades even their rate of institutionalization hover around 3-5% of their own population.

    RE: use of physicians

    The new Family Health Team ( FHT) concept in Ontario has birthed an expansion of the long-standing " herding" of physician-visit disease categories.
    At present the classify and sort process is being handled by the wrong people ( designer medicine)and physicians ( of any age) simply plug in their diagnostic skills at key points in the treatment process. Follow up is performed by para-professionals.
    Remember McLuhan's tetrad? this ? innovation will result in the " aged" shunning the medical provision structure... and entering medical care settings at higher levels of care.

    Think of it( FHT) as the politician thinking this FHT model is like " the boy putting his finger in the dyke to prevent leakage" ... whereas.... in reality..... it is a blockage in the main flow which will cause flooding at a higher level of care need.

    Saddest of all for the physician is that the FHT structure is ideal IF managed under the authority of the individual physician ( remeber the Z ) ....NOT some conglomerate using the physician as little more than a " locum"....

    :(

    ReplyDelete
    Replies
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  2. sharon [aka purley quirt]December 4, 2010 at 8:24 AM

    RE: the difference between "census" and "survey" data

    http://www.statcan.gc.ca/conferences/symposium2010/abs-res-eng.htm#a4

    paste

    02A-3 - Cycle 2 of the Canadian Health Measures Survey: Combining Census and administrative data to improve the efficiency of the survey frame

    Suzelle Giroux, Statistique Canada
    France Labrecque, Statistique Canada

    The Canadian Health Measures Survey (CHMS) uses a multi-stage sample design. For each sampled collection site, dwellings were selected from the 2006 Census using the household composition to better reach the target age groups. This sample design was a success for Cycle 1, hence was used again for Cycle 2 of the survey. Cycle 2 targets people aged 3 to 79 years old. Since its collection is taking place from fall 2009 to fall 2011, the 2006 Census frame deteriorates and must be updated to cover new dwellings and to be able to identify dwellings with youths 3 to 5 years old that are no longer identifiable using the Census. This presentation will begin with an overview of the survey design of the CHMS. Next, the update of the frame with the Address Register and the T1 Family File to improve coverage and reach the target population will be explained. Finally, results on the efficiency of this approach will be presented based on completed sites of Cycle 2.

    end of paste

    key phrase...... Since its collection is taking place from fall 2009 to fall 2011, the 2006 Census frame deteriorates......

    [ we are getting windshield survey data( qualitative) in some of the ? news ... not quantitative data]

    ...to be continued....

    ReplyDelete
  3. sharon [aka purley quirt]December 4, 2010 at 8:25 AM

    ...continued..

    Seniors to date are not the highest users of the health dollar. For many decades even their rate of institutionalization hover around 3-5% of their own population.

    RE: use of physicians

    The new Family Health Team ( FHT) concept in Ontario has birthed an expansion of the long-standing " herding" of physician-visit disease categories.
    At present the classify and sort process is being handled by the wrong people ( designer medicine)and physicians ( of any age) simply plug in their diagnostic skills at key points in the treatment process. Follow up is performed by para-professionals.
    Remember McLuhan's tetrad? this ? innovation will result in the " aged" shunning the medical provision structure... and entering medical care settings at higher levels of care.
    Think of it as the politician thinking this FHT model is like " the boy putting his finger in the dyke to prevent leakage" ... whereas.... in reality..... it is a blockage in the main flow which will cause flooding at a higher level of care need.

    Saddest of all for the physician is that the FHT structure is ideal IF managed under the authority of the individual physician ( remeber the Z ) ....NOT some conglomerate using the physician as little more than a " locum"....

    :(

    ReplyDelete
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  17. I hadn’t seen anything like that anywhere else

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  18. Chronic cerebrospinal venous insufficiency (CCSVI), or the pathological restriction of venous vessel discharge from the CNS has been proposed by Zamboni, et al, as having a correlative relationship to Multiple Sclerosis. From a clinical perspective, it has been demonstrated that the narrowed jugular veins in an MS patient, once widened, do affect the presenting symptoms of MS and the overall health of the patient. It has also been noted that these same veins once treated, restenose after a time in the majority of cases. Why the veins restenose is speculative. One insight, developed through practical observation, suggests that there are gaps in the therapy protocol as it is currently practiced. In general, CCSVI therapy has focused on directly treating the venous system and the stenosed veins. Several other factors that would naturally affect vein recovery have received much less consideration. As to treatment for CCSVI, it should be noted that no meaningful aftercare protocol based on evidence has been considered by the main proponents of the ‘liberation’ therapy (neck venoplasty). In fact, in all of the clinics or hospitals examined for this study, patients weren’t required to stay in the clinical setting any longer than a few hours post-procedure in most cases. Even though it has been observed to be therapeutically useful by some of the main early practitioners of the ‘liberation’ therapy, follow-up, supportive care for recovering patients post-operatively has not seriously been considered to be part of the treatment protocol. To date, follow-up care has primarily centered on when vein re-imaging should be done post-venoplasty. The fact is, by that time, most patients have restenosed (or partially restenosed) and the follow-up Doppler testing is simply detecting restenosis and retrograde flow in veins that are very much deteriorated due to scarring left by the initial procedure. This article discusses a variable approach as to a combination of safe and effective interventional therapies that have been observed to result in enduring venous drainage of the CNS to offset the destructive effects of inflammation and neurodegeneration, and to regenerate disease damaged tissue.
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