Anecdotal but I run a specialists clinic in Canada and a six month wait time is about right….. because we stop accepting referrals once appointments will be more than six months away. More than a few patients get aggressive about the wait time, others will just no show and waste time we could have given to someone else. It’s not worth bo…
Anecdotal but I run a specialists clinic in Canada and a six month wait time is about right….. because we stop accepting referrals once appointments will be more than six months away. More than a few patients get aggressive about the wait time, others will just no show and waste time we could have given to someone else. It’s not worth booking a new referral unless we can offer a decent appointment. This of course exacerbates the problem for the system as a whole but what we need is more specialists to reduce wait times. That doesn’t happen when a. We don’t train enough (med school spots, residency placements) and make the process for foreign doctors coming to work as specialists almost impossible and b. The single payer (government) sets compensation at a rate that leads to brain drain. I think the single payer system works better in Europe lol
I am Canadian and can also confirm about a 6 month wait for specialist referral. I waited about 5 months for a rheumatologist, for example.
However, what I think gets lost in the nuance is that those are non-emergency referrals and associated triage. If you’re in dire need, you get seen quickly. My father had a preventative primary care scan confirming cancer and was seen by an oncologist and nephrologist, and received cancer surgery, within about 14 days.
Maybe ultimately relevant to POD discourse, the “walking well” seem to have the worst time accessing care in Canada while the greatest sickness is addressed quite well.
That's still crazy to me as an American (with basic health insurance). What counts as an emergency? I was having trouble walking and needed to see a podiatrist. Is that an emergency? Technically I could walk but it was painful. I had to go to a new psychiatrist for refills on medication. Is that an emergency? Maybe these weren't life threatening but it would be pretty bad if I had to wait months to see someone.
I don't know about Canada, but this concern is spot on for Italy. IF you can get your primary care doc to declare that whatever you're dealing with is "urgent," and IF you live up north, you can usually get in fairly quickly.
But Italy's entire health care system in its wealthiest region only works because anyone who can afford to, pays to go private (which is still way less expensive than most American doc visits -- a private rheumatologist visit outside Milan cost me €100 paying in cash so they could shirk the taxes, in the US a comparable appointment was upwards of $300). Chronic, scheduled disease care is usually decent, emergency care is a total crapshoot. My husband had to wait a cumulative 18 hours in 3 different ERs (zero private options for urgent matters) before he was finally admitted for a gallbladder that was so far gone they had to fry him with nonstop IV antibiotics for days before it was safe enough to do a cholecystectomy.
I live in Pennsylvania, and my gallbladder ruptured last fall. I drove to a hospital 10 minutes away, got pain meds, IV antibiotics and the thing removed in less than 24 hours. And my copay was $0.
I have Highmark Blue Cross Blue Shield and I love my insurance.
Medication refills can be seen through various expedited systems including telehealth or even walk-in clinics. Those don’t take very long. You could get the medicine in probably 48 hours.
Pain when walking but can still walk? That would not be triaged and you might wait several months. (Unless you had like, an ulcer or something infected that posed a more urgent risk.) MSK pain and associated delay is sometimes used as a measure of efficiency in Canadian provincial healthcare— how quickly can you get a hip or knee replaced?
As an American I’ve had to book appointments months ahead for most specialist visits.
Sometimes they call you back because someone cancels. But if you’re not in dire need you’ll be at the end of the line and the line will be long if the provider takes most insurance (I’m guessing the line is pretty short for docs who don’t take insurance at all).
Not typically. I know of at least one clinic where people pay out of pocket to be members but they advertise access to specialist care that is actually just the regular access (ie they refer to us and their referrals are treated the same as any other, no special access). There are some third party navigators that claim to offer better access but again in my experience they just call around to the regular specialists and ask about wait times, then refer to the one with the shortest list. People who want real special treatment go to the US or Mexico.
Ya, I have a bleeding disorder and I tend to not experience the waiting problem for injuries or imaging if there is something urgent.
It's annoying to wait 6 months for a non-emergency MRI, but... I can get an CT scan in 15 minutes if I hit my head falling off a bike, or if my Hemophilia clinic doctors make the case that it's actually important to get something done ASAP.
Even for non-emergency stuff, I got an MRI for some transient, non-critical neck/spinal issues that were happening during the pandemic within 30 days. Different than being able to walk to an MRI clinic and get one the same day... I wish we had a slightly different model, but in Ontario the yearly health premium I pay is ~$1500CAD per year so ......... I'm not bankrupt
Edit: my girlfriend reminded me while reading my comment that she got an ultrasound of something worrying within a very short time, as well. There are so many ultrasound clinics in Ontario that if you have something that needs imaging like that, you can often get something done within a week.
“MRI within 30 days” is still pretty bad. I tore my ACL (hurt like hell but I could still walk) and was MRI’d, diagnosed, treated surgically, and back to work and in PT within 30 days. And at the time it only cost me $200 in copays (pre-Obamacare before high deductible plans were heavily incentivized).
If someone tears their ACL I'm sure they get an MRI immediately. I don't have all the data. Actually, it would be really cool to do a cross border comparison of people's experience!
A friend's father had a torn quadricep and had surgery within 2-3 days to repair it. I'm just one guy so when I said "within 30 days" it's in my non-critically immediate case where I didn't have stroke symptoms.
I’ve actually heard different specifically for non-emergency knee repair, but it’s purely anecdotal and who knows how representative it was. Given my surgeon actually said rehab-only was an option (as long as I was willing to give up golf and skiing) I doubt I would have gotten high priority.
I would love to see what American surgeons could do for my royally destroyed ankles, maybe I'd get double ankle replacements with incredible technology and pay nothing if I had the right job and insurance coverage. We do replacements here and they're good from what I've heard. I haven't looked into the difference between Canadian and American care at the level I would need though.
I needed to get a specialist intake appointment for my spouse recently (using American employer-based insurance), and the receptionist apologized to me because the closest appointment she had was ten days out.
Obviously, it's complicated and very region/plan dependent. I have other complaints about my insurance coverage. But the idea that American insurance companies always screw you over drives me nuts.
Agreed! I've been considering an intra-US move and am currently disinclined in part because I'm worried about navigating healthcare in the other location.
I’m in the US and need to see an endocrinologist; when I first tried to make an appointment, the wait time was longer than six months. Certain specialists can be difficult to get in to see, even if you live in a major metro area. I think that there is an endocrinologist shortage, in part because they don’t do billable procedures. The health care systems near me are hiring a lot of endocrinology NPs, but if there is anything unusual about your case, they aren’t able to help that much.
Generally I am pretty happy with my health care and my health insurance, but in my experience in the US it is still possible to encounter long wait times.
Becoming an actual endocrinologist requires at bare minimum, a bachelor's degree, a medical degree, three years of modestly-paid overworked residency training in medicine that is not endocrinology, and two more years of fellowship training in endocrinology. Thirteen years out of an adult life before you even start, never mind any other degrees or work one might do. It's no wonder that if every person who has a condition that falls within the scope of endocrinology wants to see one, there is a shortage, and thus a long wait.
That's going to be true regardless of what model of payment is in place.
How much of our brain drain problem is a side effect of how crazy the American system is, and how much money is sloshing around down there? Your point remains correct either way.
I'm not sure about the rest of Europe, but everything you said could apply to the UK... well, except the part about you running a specialist clinic here. Other than that, every point you listed is frequently made about the NHS.
I live in the DMV, have good insurance, and cannot see my GP without scheduling an appointment six months out. Used to be able to see a GPN in a couple of weeks but now I'm waiting over a month to see one of them, as well. The last time I tried to see a specialist, pre-COVID, was either a six or seven month wait.
Anecdotal but I run a specialists clinic in Canada and a six month wait time is about right….. because we stop accepting referrals once appointments will be more than six months away. More than a few patients get aggressive about the wait time, others will just no show and waste time we could have given to someone else. It’s not worth booking a new referral unless we can offer a decent appointment. This of course exacerbates the problem for the system as a whole but what we need is more specialists to reduce wait times. That doesn’t happen when a. We don’t train enough (med school spots, residency placements) and make the process for foreign doctors coming to work as specialists almost impossible and b. The single payer (government) sets compensation at a rate that leads to brain drain. I think the single payer system works better in Europe lol
I am Canadian and can also confirm about a 6 month wait for specialist referral. I waited about 5 months for a rheumatologist, for example.
However, what I think gets lost in the nuance is that those are non-emergency referrals and associated triage. If you’re in dire need, you get seen quickly. My father had a preventative primary care scan confirming cancer and was seen by an oncologist and nephrologist, and received cancer surgery, within about 14 days.
Maybe ultimately relevant to POD discourse, the “walking well” seem to have the worst time accessing care in Canada while the greatest sickness is addressed quite well.
That's still crazy to me as an American (with basic health insurance). What counts as an emergency? I was having trouble walking and needed to see a podiatrist. Is that an emergency? Technically I could walk but it was painful. I had to go to a new psychiatrist for refills on medication. Is that an emergency? Maybe these weren't life threatening but it would be pretty bad if I had to wait months to see someone.
I don't know about Canada, but this concern is spot on for Italy. IF you can get your primary care doc to declare that whatever you're dealing with is "urgent," and IF you live up north, you can usually get in fairly quickly.
But Italy's entire health care system in its wealthiest region only works because anyone who can afford to, pays to go private (which is still way less expensive than most American doc visits -- a private rheumatologist visit outside Milan cost me €100 paying in cash so they could shirk the taxes, in the US a comparable appointment was upwards of $300). Chronic, scheduled disease care is usually decent, emergency care is a total crapshoot. My husband had to wait a cumulative 18 hours in 3 different ERs (zero private options for urgent matters) before he was finally admitted for a gallbladder that was so far gone they had to fry him with nonstop IV antibiotics for days before it was safe enough to do a cholecystectomy.
Geez!
I live in Pennsylvania, and my gallbladder ruptured last fall. I drove to a hospital 10 minutes away, got pain meds, IV antibiotics and the thing removed in less than 24 hours. And my copay was $0.
I have Highmark Blue Cross Blue Shield and I love my insurance.
Medication refills can be seen through various expedited systems including telehealth or even walk-in clinics. Those don’t take very long. You could get the medicine in probably 48 hours.
Pain when walking but can still walk? That would not be triaged and you might wait several months. (Unless you had like, an ulcer or something infected that posed a more urgent risk.) MSK pain and associated delay is sometimes used as a measure of efficiency in Canadian provincial healthcare— how quickly can you get a hip or knee replaced?
As an American I’ve had to book appointments months ahead for most specialist visits.
Sometimes they call you back because someone cancels. But if you’re not in dire need you’ll be at the end of the line and the line will be long if the provider takes most insurance (I’m guessing the line is pretty short for docs who don’t take insurance at all).
Is there an option to access privately paid care in Canada, if you don't want to wait?
No, it’s mostly legally forbidden to offer private healthcare due to Canadian law.
Whoa. To an American that sounds insane - but I can understand the reasoning behind it for sure.
Not typically. I know of at least one clinic where people pay out of pocket to be members but they advertise access to specialist care that is actually just the regular access (ie they refer to us and their referrals are treated the same as any other, no special access). There are some third party navigators that claim to offer better access but again in my experience they just call around to the regular specialists and ask about wait times, then refer to the one with the shortest list. People who want real special treatment go to the US or Mexico.
Ya, I have a bleeding disorder and I tend to not experience the waiting problem for injuries or imaging if there is something urgent.
It's annoying to wait 6 months for a non-emergency MRI, but... I can get an CT scan in 15 minutes if I hit my head falling off a bike, or if my Hemophilia clinic doctors make the case that it's actually important to get something done ASAP.
Even for non-emergency stuff, I got an MRI for some transient, non-critical neck/spinal issues that were happening during the pandemic within 30 days. Different than being able to walk to an MRI clinic and get one the same day... I wish we had a slightly different model, but in Ontario the yearly health premium I pay is ~$1500CAD per year so ......... I'm not bankrupt
Edit: my girlfriend reminded me while reading my comment that she got an ultrasound of something worrying within a very short time, as well. There are so many ultrasound clinics in Ontario that if you have something that needs imaging like that, you can often get something done within a week.
“MRI within 30 days” is still pretty bad. I tore my ACL (hurt like hell but I could still walk) and was MRI’d, diagnosed, treated surgically, and back to work and in PT within 30 days. And at the time it only cost me $200 in copays (pre-Obamacare before high deductible plans were heavily incentivized).
If someone tears their ACL I'm sure they get an MRI immediately. I don't have all the data. Actually, it would be really cool to do a cross border comparison of people's experience!
A friend's father had a torn quadricep and had surgery within 2-3 days to repair it. I'm just one guy so when I said "within 30 days" it's in my non-critically immediate case where I didn't have stroke symptoms.
I’ve actually heard different specifically for non-emergency knee repair, but it’s purely anecdotal and who knows how representative it was. Given my surgeon actually said rehab-only was an option (as long as I was willing to give up golf and skiing) I doubt I would have gotten high priority.
I would love to see what American surgeons could do for my royally destroyed ankles, maybe I'd get double ankle replacements with incredible technology and pay nothing if I had the right job and insurance coverage. We do replacements here and they're good from what I've heard. I haven't looked into the difference between Canadian and American care at the level I would need though.
100%
I needed to get a specialist intake appointment for my spouse recently (using American employer-based insurance), and the receptionist apologized to me because the closest appointment she had was ten days out.
Obviously, it's complicated and very region/plan dependent. I have other complaints about my insurance coverage. But the idea that American insurance companies always screw you over drives me nuts.
Yeah I recently wanted a dermatology referral and they called me the same day to set something up for the next week.
I’ve had to wait months for specialists in the US. So I don’t think this is some universal thing.
Agreed! I've been considering an intra-US move and am currently disinclined in part because I'm worried about navigating healthcare in the other location.
I’m in the US and need to see an endocrinologist; when I first tried to make an appointment, the wait time was longer than six months. Certain specialists can be difficult to get in to see, even if you live in a major metro area. I think that there is an endocrinologist shortage, in part because they don’t do billable procedures. The health care systems near me are hiring a lot of endocrinology NPs, but if there is anything unusual about your case, they aren’t able to help that much.
Generally I am pretty happy with my health care and my health insurance, but in my experience in the US it is still possible to encounter long wait times.
Becoming an actual endocrinologist requires at bare minimum, a bachelor's degree, a medical degree, three years of modestly-paid overworked residency training in medicine that is not endocrinology, and two more years of fellowship training in endocrinology. Thirteen years out of an adult life before you even start, never mind any other degrees or work one might do. It's no wonder that if every person who has a condition that falls within the scope of endocrinology wants to see one, there is a shortage, and thus a long wait.
That's going to be true regardless of what model of payment is in place.
How much of our brain drain problem is a side effect of how crazy the American system is, and how much money is sloshing around down there? Your point remains correct either way.
It’s a factor but we also lose people to other provinces.
I'm not sure about the rest of Europe, but everything you said could apply to the UK... well, except the part about you running a specialist clinic here. Other than that, every point you listed is frequently made about the NHS.
I live in the DMV, have good insurance, and cannot see my GP without scheduling an appointment six months out. Used to be able to see a GPN in a couple of weeks but now I'm waiting over a month to see one of them, as well. The last time I tried to see a specialist, pre-COVID, was either a six or seven month wait.
American healthcare is rotten.