6 All of these factors are blamed for a relative shortage of physicians in Canada in nearly all specialties. Changes in the emigration patterns of Canadian-educated physicians are not believed to have had a profound effect on workforce reduction; however, this view usually compares yearly emigration with the total physician workforce. 6 , 7 Between 1981 and 2004, Canada had an annual net loss of Canadian-educated physicians, in large part due to immigration to the United States. 1 , 4 The Association of American Medical Colleges recently pronounced an impending physician shortage in the United States and called for a 30% expansion in medical school enrolment over the next decade and similar expansion in residency training programs. 8 Given the porous nature of the CanadaUS border for physician migration and pronouncements by both countries of a physician-workforce shortage, we chose to study the effects of migration on the Canadian and US physician workforces. Our objective was to examine and quantify the migration of Canadian-educated physicians to the United States, particularly those who chose to remain in the United States, in relation to their school of training, specialty, rural status and practice type. Previous Section Next Section Methods We performed a cross-sectional secondary analysis of the 2006 American Medical Association (AMA) Physician Masterfile to identify and locate all graduates of Canadian medical schools who had immigrated to and were working in the United States. 9 The AMA Physician Masterfile includes data on all physicians who reside in the United States, including AMA members and nonmembers and graduates of foreign medical schools. The AMA Physician Masterfile data includes physician name, medical school and year of graduation, sex, place and date of birth, geographic location and address, type of practice, present employment and practice specialty. 10 We obtained data about the Canadian physician workforce from the Canadian Medical Association Physician Masterfile (2003) and the Scott’s Medical Database (2005; reported by the Canadian Institute for Health Information). Summary data about the number of graduates from Canadian medical schools and their residencies were obtained from the Association of Faculties of Medicine of Canada and the Canadian Post-MD Education Registry (2005); Canadian medical school and residency graduation volumes were averaged over the most recent available decade (19962005). 11 , 12 Summary data from the Scott’s Medical Database about practising physicians who annually emigrate from and return to Canada were available from the Canadian Institute for Health Information. 13 , 14 The number of physicians emigrating from and returning to Canada were averaged from 1995 through 2004 (physicians in residency training were excluded from these data in 1995 so that only physicians eligible to practise were included). Data on the number of graduates who specifically immigrated to and emigrated from the United States were received from the Canadian Institute for Health Information.
US physician practices spend 4 times Canadian practices
Sometimes the offensive behaviour is overt: bullying, yelling and swearing; throwing things and demeaning people in front of others; and uncontrolled outbursts of anger that can leave people feeling constantly on edge. Other times itas more passive-aggressive: not responding to pages or emails; skipping meetings and anot behaving as part of the team,a Sproule said. In one U.S. study, 77 per cent of doctors surveyed in 2011 said they were concerned about badly behaving doctors at their hospitals. Whatas more, aAn overwhelming 99 per cent of doctors believe that disruptive behaviour affects patient care,a the CMPA paper says. Sprouleas analysis of closed CMPA cases shows clearly that Aaweave seen increasing number of cases, and increasing medical-legal costs associated witha doctors behaving badly. Complaints come from not just co-workers and hospital staff, but also patients and their families. Sproule didnat break the disruptive doctor files down by gender. aBut the literature is clear on that: itas generally males,a he said, and most often male doctors working in high-stress, high-tension areas, such as surgery, emergency medicine, intensive care and obstetrics. Stress, burnout, cynicism, frustration over health-care cuts and other triggers can exacerbate the problem. According to the College of Physicians and Surgeons of Albertaas 2010 document on managing disruptive behaviour in the health-care workplace, 78 per cent of doctors displaying disruptive behaviour may suffer from a major psychiatric disorder; up to 40 per cent may suffer from depression. And while the unruly behaviour can compromise patient safety, studies from the United States suggest that many doctors have kept quiet rather than confront a aknown intimidator.a Colleagues might ignore them, or work around them. Some doctors lack any kind of insight into the impact of their behaviour, experts say.
Doctors behaving badly: ‘Disruptive’ physician cases increasing in Canada
Dante Morra, medical director of the Centre for Innovation in Complex Care and assistant professor of medicine at the University of Toronto. As a result, say the investigators, per capita health spending in the U.S. is 87 percent higher than in Canada — $7,290 vs. $3,895 annually. Administrative costs incurred by U.S. physicians and staff are estimated to be at least $82,975 per physician each year. “If U.S. physician practices had administrative costs similar to those in Canada, the total savings for U.S. health spending would be about $27.6 billion per year,” says senior author Dr. Lawrence Casalino, chief of the Division of Outcomes and Effectiveness Research in the Department of Public Health at Weill Cornell Medical College. “Many factors contribute to the high cost of health care in the United States, but there is broad consensus that administrative costs are high and could be reduced,” Dr. Casalino continues.
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