Intended for healthcare professionals

Rapid response to:


Hamster health care

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1541

Rapid Response:

Hamster Health Care

Dear Editor - In your recent editorial you mention the Canadian
health care system, suggesting that it suffered from shortcoming similar
to that of the NHS.

I work both in Canada and the UK, so am familiar with the two

I would point to significant differences.

Although now there is monetary penalty for a new graduate if he
wants to open an office in an overdoctored area, a physician in Canada
sets up his practice as and
where he wishes and is free to move about.

More importantly, in Canada a physician is free to work to whatever
pitch he/she wishes. Nobody forces patients on you, as happens here.
With fee-for-service, it is
perfectly possible to run a general practice at less than full power
whilst earning a very decent living. It is you who decides when your
practice is full and how much time
you wish to devote to your patients. Your patients, in turn, can decide
whether they are satisfied with your services or whether they wish to
attend another doctor. Under
this system physicians have a sense of control over their working
conditions which is unknown here. They are not burned out by the time they
reach their 60th birthday,
most do not think of retiring then, but remain productive members of the
community. Naturally, you are paid according to how hard you work.

You mention the limit on earnings, but you put no monetary figure to
it. The limit is a pretty respectable sum and to reach this you have to
work very hard indeed. Once
you reach this yearly total, to take off extra days of holiday on top of
what you had planned is not a bad alternative. It is clear that the
provincial governments in Canada are constantly trying to pare away
healthcare budgets but so far the system there still seems to work to the
benefit of patients and doctors.

I fully agree with you that the most important shortcoming of the
system in the UK is the absolute lack of control healthcare providers in
the NHS have over their future,
destiny and working conditions. To my mind lack of healthcare provider
satisfaction undermines morale here more than anything else. At the very
least, one should be
given the option to refuse additional work. Until, as a starter, that is
introduced I think we shall see this system continue to slide downhill.
You cannot expect people to
work well and happily when they are simply pawns in the hands of the
regulators, whether these are politicians or administrators.

Nicholas Koleszar MB BS.

Competing interests: No competing interests

17 January 2001
Nicholas Koleszar