Four million Canadians lack family doctor
TORONTO — Four million Canadians do not have a regular doctor, and recent immigrants are the most likely by far to be without one, says a report released Wednesday by Statistics Canada.
According to the Canada Community Health Survey, while 86 per cent of those who were born in Canada or immigrated more than five years ago do have a doctor, just 65 per cent of more recent immigrants can say the same. That trend held even when the statistical agency controlled for age, to take into account the fact that recent immigrants are disproportionately young.
Only 73 per cent of Quebeckers have a regular doctor, the lowest rate in the country, while the highest is in Nova Scotia at 94 per cent.
Though the overall proportion of Canadians with a regular doctor has risen slightly over the last ten years, Vincent Dale, a survey manager for the study, said that the figure has been “relatively stable.”
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Millions without family doctors
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Those figures suggest that local clinics and community health centres are carrying a considerable load of the primary care burden. Seventy-six per cent of Canadians without a doctor use one or the other for basic medical attention. Emergency rooms are the destination of choice for a further 12 per cent, and 10 per cent seek care through telephone lines, doctors' offices, and hospital outpatient clinics. All told, “eight in ten people without a doctor do have a regular source of care,” Mr. Dale said.
While these statistics may seem alarming, Dr. Raisa Deber, a professor of health policy at the University of Toronto, said that they do not represent significant cause for concern.
Statistics about clinics and community health centres show that Canadians without doctors “will be able to get care if [they] need it,” Dr. Deber said. She added that Canada's overall rate of doctor access of 85 per cent is “damn good.”
But Dr. Deber is concerned that non-traditional primary care venues like clinics and health centres can be an imperfect substitute for a regular doctor in many cases.
“What you really worry about,” she said, “is not having someone able to manage a chronic condition,” as a doctor with personal knowledge of a patient's medical history might.
Dr. Ken Arnold, president of the Ontario Medical Association, is similarly wary of relying too heavily on clinics. “While the patient will be receiving adequate care for the problem they present with, nevertheless there's a great loss of continuity of care using that system,” he said. “It tends to be a matter of band-aiding issues rather than really dealing with them.”
Dr. Arnold's national counterpart, Canadian Medical Association president Brian Day, was more forceful in his criticisms of the primary care system's shortfalls. Doctor availability in Canada is “a big problem,” he said, and one difficult to improve since “family physicians simply aren't paid enough.”
Nonetheless, there are signs that those seeking to shift their medical care from clinics and health centres to regular doctors could soon have an easier task. A report issued this year by the College of Physicians and Surgeons of Ontario noted that the rapid decline in the percentage of family doctors in the province accepting new patients — from 38 per cent in 2000 to just 9 per cent in 2006 — seems to have halted.
In 2007, 10 per cent of Ontario primary care doctors reported they were open to new patients.
Dr. Day, for his part, is not sure that availability of doctors accepting patients is the only relevant barrier. “There's a communication issue,” he said, one that makes it difficult to connect patients to doctors with free space in their practices.
While provincial medical colleges sometimes provide lists of available doctors online, Dr. Day said that such information is often “inaccurate,” sending those looking for a doctor to practices which are not actually taking new patients. He added that immigrants might find the task of navigating the system to find a doctor particularly onerous due to language difficulties and general unfamiliarity with Canadian medical practices.
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We don't just want the best immigrants
CECIL FOSTER
From Thursday's Globe and Mail
June 19, 2008
http://www.theglobe
Every Canadian generation seems destined to face the same excruciating decision: Should we search the world for workers or for citizens?
Since the 1960s, the standard answer has been that Canada's immigration policy is about choosing citizens. People from around the world compete for 260,000 spots annually and are chosen through a points scheme that ranks their abilities to fit into the Canadian way of life. After three years of on-the-job training, they can become citizens.
In the process, it is hoped the newcomers will help fill holes in the job market. But, over time, it is expected their real job would be to become traditional Canadians: to shop, vote, pay taxes, respect the law and, through their participation in Canadian life, become just like other citizens. Job No. 1 is to be a good citizen.
Oh yes, they would also look for traditional jobs -- otherwise, how would they do all those things expected of them? But some might become self-employed. Or artists and other producers of what is generally called Canadian culture -- the forms associated with the leisure classes and that we see in the production of books, the theatre, cinema, paintings, music and the like.
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As citizens, the biggest gift of the newcomers to Canada is to reproduce themselves, helping to supply the country with the next generation of citizens. This job, incidentally, is going largely vacant in Canada.
The wisdom of the existing policy is often questioned. Such is the case now as we hear of another push in some quarters for a wider guest-worker program. There is also government fiddling with the mechanism that regulates the flow of foreigners into Canada.
For at least two generations, Canada has been importing temporary workers from the Caribbean and Mexico to fill jobs most Canadians will not take. This is the case in the agricultural sector, particularly in Ontario and Nova Scotia. The migrant workers "visit" Canada and, at the end of their working season (technically, when no longer needed), they simply disappear from the Canadian scene. There is talk of extending such programs to other sectors, and to Alberta and elsewhere with an abundance of low-skilled jobs.
Although deemed ideal for agriculture or work that is difficult, dangerous and dirty, these workers are not considered good enough to be landed immigrants - i.e., citizens in training. Canada's immigration policy is not aimed at these workers. Instead, the approach is focused on what is called the brightest and the best, those already in the middle and upper classes in their homelands and who are deemed to be the best material from which to make future Canadians. Ironically, as if trying to put proverbial square pegs into round holes, we de-skill the brightest and the best so they end up in low-skilled jobs and as unhappy Canadians.
The question is not whether Canada should turn to Mexico and elsewhere for temporary workers. Why mere workers? Why not just citizens who work at any job?
Canada's position has been that, if anyone is good enough to build the country, he or she should be good enough to own a share of the country - to be a citizen. This policy is still morally sound. After all, what is a country but a place where the people that belong work and play together in the hopes of producing a happier life for themselves and their children?
The questions we face do not call for fundamentally different answers from those given previously. Instead of bringing in more disposable "guest" workers, let's amend our immigration and citizenship policies to attract the right kinds of citizens. We would still choose from among the brightest and the best, and the best would be those most suited for the jobs of keeping Canada working.
This would mean sticking with a moral argument that is as old as the West: Good citizens are good workers; good workers should be full citizens. This is still a good moral foundation for citizenship and working in Canada.
Cecil Foster is a professor of sociology and anthropology at the University of Guelph
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