medicineman
Army.ca Legend
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We have similar folks here in Manitoba called "Clinical Assistants" - they're all Foreign Medical Grads, many of whom are attempting to get lincensure in Canada. They're legally recognized (as are Physician Assistantslike myself and a few others here) as a Regulated Health Profession under The Act and the College of Physicians and Surgeons of Manitoba. They work largely in hospitals doing in patient and sub-specialty patient care and have a codified scope of practice.
Small rant here...Many of you may/may not know, but my first job out of the CAF was family medicine in a small town in Manitoba that I did for about 3 years - my supervising doc was 35km away, we did stuff by phone/text and electronic chart review. They'd do in person stuff for me for my patients on long term controlled substances I couldn't prescribe or weird stuff I didn't think needed an immediate specialist consultation but could possibly benefit from a second set of eyes/ears for management at our level. I was largley working just as I did in the CAF if were remoted somewhere. I also looked after residents in a small PCH attached to the clinic, and I also had some priveliges at the hospital my Supervising doc was attached to, as that's where my patients would likely be admitted to and I worked some ED shifts there as well. I provided fairly comprehensive care - cradle to grave as it were, though I didn't do the delivery to the cradle. My wait times for appointments were reasonably short - within 2-3 days usually unless I was on holidays for a week - there'd be about 5-7 day catchup period. I accomodated same days for minor injuries/emergencies - something in the eye, lacerations, etc, even if the day was full. I often had people coming from places well outside my catchement area due to availability (and I hope general reputation). I also did house calls for folks, especially older folks ( a large majority of the population) to see if any red flags, check on them if they couldn't get in, etc.
This was all done on salary...which leads me to things that pissed me off. I'd see sometimes more patients per day, including daily rounding on my PCH residents, than some of the MD's at a nearby RHA town clinic/hospital did (not affilitated with the other town I worked with), who were also salaried. Because I wasn't an MD, I never got to benefit from the non-insured services I had to do, both on and off the clock. So things like social assistance and insurance paperwork - which are quite time consuming - driver medicals, even the occasional medical clearance for CAF enrollment, etc where an MD get a cheque or cash in hand to do the service, I'd see a cheque but have to hand it over to the Regional Health Authority, to
allegedly go into my clinic's budget. I was enttitled to only 1 half day every two weeks for administration - so to do all this stuff which often added up to significantly more than 4 hours work by then, so it either had to be done after hours (ergo unpaid) or during an appointment slot which would have to be arranged as a full hour for some of these complex forms...which takes away up to 45 minutes of other appointment slots that day. Also, waiting too long to do those forms could serioiusly affect someone's life - so sooner done and off the better. As a for instance- medicals for a professional driver's permit were charged at a rate of $50 at our clinic...the first 6-9 months I was working there, I'd estimate I did about $15k worth of driver medicals, as the average going rate was $85-150 in private or RHA clinics (the MD's doing the deed got the money and charged ad lib)...do the math. I was supposed to charge for sick notes, but stuck it to the man by not doing that - if I thought the patient needed one, I gave it to them, however, I wouldn't if they came in demanding one, particularly if was for time prior to me seeing them. I justified it by if a person was paying me for the note, they'd tend to expect it would be for what they wanted, not what they actually needed. I did start sending employers invoices for BS notes though.Other things - many of you may know of my general disdain for health care administrators. Don't get me wrong, worked for some great ones, but they're largely the minority. I feel the ratio of admins to operators is completely out of proportion to what it should be. My scheduling regarding admin and expected daily patient load was already mentioned. I found that there was an unreasonable amount of micromanaging by people not providing care to those doing it in the primary care side of things, and similar BS I'd seen in the CAF regarding everyone paying for one moron's fuckup. For example, I wasn't allowed to keep drug samples in my clinic because "it might affect your prescribing habits to one company or other" - BS, I worked off a codified formulary, so no it didn't. I was literally told by my "manager" that "People should have no problems affording their medications"...this coming from someone with a 6 digit salary and high end benefit package. I asked for dictation software for my electronic medical record - there was one available. However, the Region decreed that, because it was a shared/linked EMR, if one person had it, everyone had to be asked if they wanted it and had to obtain the number of licenses required...when they did, they didn't like how many people said yes because they didn't want to pay for the licenses. My first year there saw a running battle regarding my paid leave - I was told I'd be earning it from day one...then they said I couldn't take any of it for 10 months, "because the computer program won't let you". I told my boss that was BS -I just left a job with 25 paid days + stats for less time off that I was actually earning but couldn't take, despite my family being 3 provinces away. I talked to the Geek i/c of said computer program - I was told categorically that "the program doesn't allow you to take leave until the next leave year starts". My late dad programmed computers when 1K memory took up a skyscraper of magenetic tape...when I countered "Computers only do what you tell them to do, so you're either too dumb to manipulate the program, too lazy to do it, or you've been ordered not to. Which is it?" Crickets. "You answered my question"...they managed to sort things out surprisinly, eventually.
There are other things that were embuggerances, but many of these are part and parcel with family practice in many parts of the country...hope some of this helps. Thanks for listening too.
