Hundreds of doctors are lured from Canada to the United States every year by extravagant promises of professional freedom and a lavish lifestyle. But some of those who become disillusioned with the American medical environment return to Canada—and in their ranks are Americans who trained in Canada but found they did not like practising in the United States. David Kirkpatrick, Missouri-born and a graduate of the Medical College of Georgia, did four years of postgraduate study at the University of British Columbia in Vancouver to qualify in psychiatry, finishing in 1977. His goal was to open a mental health
clinic there and share the practice with his wife, a psychiatric nurse. But instead, in the fall of 1981—’’after hearing that I could practise medicine in the United States with greater freedom”—Kirkpatrick and his family moved to Ashland, Ore. In 1995, fed up with aggressive and intrusive medical insurance companies and “cutthroat competition among hospitals,” he happily returned to British Columbia and the Canadian health-care system.
His 14 years in Oregon began agreeably enough, says Kirkpatrick, now 57, but the insurance-driven health system was soon contesting patients’ claims and burying him in paperwork. “They were always cutting back on paid services, and mental health seemed to be the first thing to go,” he recalls. “You could get your toothache taken care of before you could get counselling for a suicidal depression.” Certain insurers, he says, would only pay for 10 visits to a psychiatrist in a year. Some patients needing more psychotherapy offered to pay him in kind—cleaning services, art lessons for his children, original poetry and home-made purses. In the end, says Kirkpatrick, he wrote off thousands of dollars in bills.
Nor was that all, he says. Insurance company case reviewers sometimes questioned the need for psychotherapy and suggested that “I should prescribe antidepressant medication to speed up the process and thus save the company money. ‘Has this patient been tried on Prozac?’they would ask. ‘Why not?’ "At the same time, he says, companies started poking into confidential patient files “putting already worried and anxious patients in an impossible bind—keep records private and risk insurance denial or open them up to get relief from a company that still might not pay.”
In 1991, Kirkpatrick’s wife, Betsy, died after a long bout with cancer, and her death, he now says, “just compounded my anguish and frustration” over trying to practise U.S.-style medicine. “I limped through for a couple of years and then we packed up and moved back.” He says he has a message for Canadian doctors “tempted to respond to the slick marketing ads” of corporate medical and surgical headhunters based in the United States: “Before calling Mayflower, call me.”
Not all returning physicians leave behind disillusionment. By almost any yardstick, Toronto-born Sheldon Pollack had it made in American medicine. He was 29 years old, a certified specialist in dermatology, and skilled in the advanced surgical treatment of skin cancer. He was also an assistant professor of medicine at the Duke University Medical Center in Durham, N.C., which he reckons is one of the top five teaching, research and clinical complexes in the United States. But in September, 1990, after 11 years at Duke, he quit and returned to Toronto with his wife and children. “I had a phenomenal career, became well-known and all that stuff, but it was never home,” says Pollack, now 47 and practising in midtown Toronto. “So it was about coming home.”
But for Pollack, the homecoming had a price tag. While he declined to say how much he earned at Duke, large U.S. medical centres pay leading specialists in comparable jobs as much as $400,000 a year. Under Ontario’s health insurance plan, dermatologists are paid at the same rate regardless of experience; their average annual billings, before taxes, malpractice insurance and office expenses, are about $240,000. Taking on 50 to 60 patients a day in order to make a living did not appeal to him, Pollack says, “so I had to find something else.” The answer: lucrative cosmetic surgery that patients have to pay for.
Now, five years after he returned to Canada, Pollack says he is happy to be back, although he sometimes misses the excitement of working among competitive, profit-driven medical centres. “But our kids were starting to talk with a southern accent so it was time to get the hell out of there,” he adds. “Now, it feels like we’ve never been away.”
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