Spring 2017 (Volume 27, Number 1)

Redefining Happiness: My Experiences in American and Canadian Health Systems

By Ashley Sterrett, MD, CCD

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Is the grass always greener? As an American-educated and trained physician you are taught your healthcare system is the best in the world—why else would so many migrate from other countries to train and practice in the United States (U.S.)? However, while I worked in an academic and government setting in the United States’ Veteran’s Health system, I began to question that presumption. I attended medical school in the state of Georgia and then completed my training in internal medicine, followed by rheumatology at the University of South Florida (USF). After graduation, I joined as a staff rheumatologist with the Veteran’s Health Administration (VHA) in Tampa, Florida, which is affiliated with USF. In my role, I had the privilege of caring for my nation’s veterans, as well as training medical students, medical residents, and rheumatology fellows. My medical billing was simple: Only veterans could receive care at VHA. Thus, if they were referred to me, they had medical coverage. The coding was based on Medicare guidelines, and the formulary for medication and testing coverage was based on a national formulary, rather than the myriad of insurance plans most physicians struggle with in private practice. The electronic medical record (EMR) system used by the VHA has been active since the 1990s—it is the original EMR. It is also accessible from any Veteran’s Affairs (VA) centre in the country; if a veteran who lives and receives care in Tampa presents to a VA medical centre in Texas for care, his or her records are accessible through a secure link. The only exception was Department of Defense and active duty veterans’ medical records, as these were protected and not open to all healthcare providers with VA EMR access.

Seems too good to be true? Every system has pitfalls and the United States’ Veteran’s Health system is not without its share of issues, many of which have been publicized. For example, there are common issues you would expect with a massive healthcare system: not enough providers or services lead to long wait-times for appointments, tests, and even standard care, such as colonoscopies and surgeries. Another pitfall is the reliance on a national formulary, which does not account for regional disease needs—for example, one regional pharmacy used its entire annual budget within four months after a new Hepatitis C drug was approved for use, affecting all the other departments’ access to medications. But I don’t want to focus on the negative as this article is not about that, and honestly my experience as an employee of the VA for seven years was very positive.

Canada called to me with the promise of a better, safer life for my family, smaller student loans for my children when they attend university, and a seemingly similar system to the Veteran’s Health system—a single payer with a provincial formulary. However, I soon found that the similarities ended there. My five months of practice in Ontario have been quite an adjustment. As expected, there are similarities as well as differences between both systems: the formulary is more liberal than I previously experienced at the VA in Florida; the wait-time for tests such as magnetic resonance imaging (MRIs) is similar in Ontario to the VA, but longer than in private practice in the United States; the access to complementary services such as physiotherapy is less in Ontario than in the VA, but not compared with private practice in the U.S. However the VA benefits were limited to veterans only, and I have ultimately found the healthcare system in Canada very good both as a physician and as a patient. While I was not in private practice during my time in Florida, I am well aware of the average pay for a rheumatologist in the U.S. From what I have learned from recent Ontario Rheumatology Association (ORA) stats, the pay in Ontario is similar. As I am no longer part of a massive interconnected healthcare system, I do not have access to my patients’ records from their family doctor, their hospital visits, etc. without a lot of requests and waiting. This does not differ from any physician in private practice in most countries, but both Canada and the U.S are testing options that create a comprehensive health record that is accessible from any site using the Internet.

In the U.S, some foreign-trained physicians are required to repeat training or pass the U.S. Medical Boards for their specialty, but once this is done, they can practice without restriction. In general, Canadian-trained physicians do not require any additional testing or training as their training is considered equivalent to the U.S. While Canada considers U.S. physician training equivalent, the College of Physicians and Surgeons of Ontario requires a year of supervised practice in your specialty to assist one with the transition to the Canadian system. While obtaining a supervisor was initially difficult, I have greatly appreciated Dr. Mary Lee’s guidance and expertise as I learn about the Canadian medical system, and I could not imagine trying to care for patients without her assistance.

In summary, I have found the Canadian system similar to the United States’ Veteran’s Health system, but with some differences as I mentioned and others you are more familiar with than I am. However, while I cannot determine this for you, for me and my family, the grass is greener in Canada.

Ashley Sterrett, MD, CCD
Associate Professor of Medicine,
University of South Florida, Tampa, Florida
Licensed in the State of Florida
Certified in Clinical Bone Densitometry
Currently practicing in Toronto under a restricted license while under supervision
Toronto, Ontario