The Cost of Poor Customer Service: Is Healthcare in Canada really Free?

After complaining and complaining even more about the poor service and advice I continuously receive from my family healthcare practitioner, I decided to do a little more research to find out why and try to explore opportunities on how to fix it!

I was quite astounded with what I found. Wanted to share my research findings and my thoughts:

Firstly, let’s look at how the compensation model for doctors works:

According to The Ontario Ministry of Health and Long-term Care, the average family doctor makes $351,000/year. The compensation model is quite interesting. Forty-five (45%) percent of doctors (I believe this is all family doctors) are compensated by a fee-for-service model. Plain and simple, they make $25 per visit, regardless of how long the visit is; they also can make money through receiving a cut from referrals.

A closer look at the compensation model vs. the average annual compensation

Let’s use the average compensation number, rounded to $350,000 and dig deeper on what it takes to achieve this amount:

1) Let’s say approximately 15% of total compensation came from referrals. So, $50,000 of the total $350,000, leaving $300,000 to earn from patient visits

2) If they make $25/visit, they need 12,000 visits per year to reach $300,000
3) After vacation time, after 49 working weeks per year, working five days a week, a doctor would have to see app 245 patients a week, or 49 a day!

Based on these numbers, a doctor in Ontario needs to see an average of 49 clients per day to achieve the average compensation amount of $300,000.

No wonder I am always rushed out of the doctor’s office, no wonder it’s always full, no wonder he never does any research or provides alternatives, he doesn’t have the time!

The Improvement Opportunity
My no means do I want to sound ungrateful, I am a proud Canadian, and proud of the idea of a free healthcare system. However, there are some serious issues that need to be addressed. Because we don’t directly pay, I don’t believe that means we should be OK with receiving terrible service. Poor service from your healthcare practitioner and poor service from a cashier at Wal-mart are both irritating. However, one of them can possibly cost you your life, cause a unhealthy society, and ultimately cost the healthcare system more.

Healthcare practitioners play a vital role in the condition of our health, well-being, our futures, and our overall society. The fact that they are given hopes of a promising career, which will guarantee financial stability, seems to have led to doctors offices to over-commit to the number of patients they see to meet their sales targets, which is adversely affecting us all. They are left with little or no time to do research, talk to us to get to ensure the correct diagnosis is being recommended, speak to us about alternative medicine, perhaps even refer us to natural remedies because there’s no financial incentive in it for them. This is just scary! This is leading to misguided or the wrong diagnosis and confusion for the patient on what in fact is good for their health and what isn’t. I’ve heard many people tell me about medication they take, including medication with serious, long-term side-effects, for minor health issues. When I ask them, “why?” Their response, “My doctor recommended it.”

Aren’t we supposed to be able to trust our doctors? Aren’t healthcare practitioners supposed to help prevent illness, not just treat them? This requires more time and research, with the current compensation model, doctors may feel pressure to meet their targets, they may find it challenging to maintain the work-life balance, which is causing them to rush through seeing as many patients, causing society more harm than good!

The Ministry of Health needs to step in to introduce a metric in the compensation model that will measure the quality of service and delivery being offered.

What I did about it
I recently gave up on my family doctor for regular visits and started to see a naturopathic doctor. She reminded me of the importance of doctors and healthcare. She exceeds my expectations every time, goes out of her way to look for alternatives for me, and sends me e-mails messages, following up with me. Now, she may be an exception because of her genuine passion for her work, but my intention is to illustrate the difference and for you to imagine how our province would be with more doctors like her. The key difference: caring!
I think that there are many health practitioners that are still passionate about their vital role in saving lives and, more importantly preventing harm. They are not recognized enough for what they do. I want take this opportunity to thank them for what they do, not just for their individual patients, but for society and our world. They are truly inspiring people, and wonderful examples for entrepreneurs to emulate in terms of quality of customer service and doing your job to contribute to the common good of humankind, and think about how it impacts the world.

Copyright © Esha Abrol. Canada. September 2012

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4 thoughts on “The Cost of Poor Customer Service: Is Healthcare in Canada really Free?”

  1. Some additional considerations:

    1) You may have your fee-for-service logic backwards. It’s not that your GP is encouraged to see a lot of patients in a day, it’s that there are too many patients chasing too few doctors. Your GP likely faces an excess of demand: Health-care is free at the point of service, which means we don’t value it, and tend to overconsume, either directly because of the number of visits that turn out to be frivolous, or indirectly because the patients don’t look after ourselves. Similarly, there is a dearth of supply; only a small percentage of the population has both the book smarts and the people skills to pursue medicine, and for that minority it takes minimum six years postsecondary education to become a GP, plus additional training to become a specialist.

    2) With a greater supply of doctors, and a drop in the number of visits (not least because the patients take better care of themselves), the service will improve, as there will be a greater competition amongst GPs for patients.

    3) Naturopathy is not medicine, it’s pseudoscience. Whether or not your naturopath cares more than your GP will be irrelevant when the placebo she prescribes fails to cure your condition.

    If you want to improve the doctor/ patient relationship in Ontario, I suggest:

    a) advocating for a change in the fee model so that the patients are at least aware of the costs they incur by visiting (perhaps offering them a specified number or value of free visits per year, and requiring a contribution for all subsequent ones);

    b) advocating for other changes to discourage eg. obesity, indolence, junk food; and

    c) putting a greater emphasis on encouraging education generally, and providing financial incentives for students to pursue medicine (that the population follows pseudoscience like naturopathy suggests that we fall well short in our education standards).

    1. Thanks for your comments, Mike – much appreciated!
      1) I did not mean to imply that practitioners are encouraged to see lots of patients and over-commit, but that the model is full of holes as there seem to be no metrics to measure the quality of service. Although many practitioners are good at turning away new potential patients, I have seen doctors take on more patients than they can manage, perhaps to be able to increase fees.

      2) Love your point on patients showing more responsibility for their own health. That one should be an obvious one! Although everyone should be capable enough to take the initiative to educate themselves on health, not everyone does, having a credible medical professional guiding their patients in the right direction, would be a good start! This talk should be initiated by the doctor. Should patients fail to take preventative measures as instructed by their GP, future visits should cost the patient!

      3) Feelings on naturopathy are mixed, people either believe in it or don’t. I believe personal experiences can be the only way to convince someone. Of course, it would depend on ones medical condition and the severity.
      Although not an evidence-based medicine, in my opinion, more than a valid form of medicine, which requires practitioners to pursue the same education as a “traditional” practitioner.
      Currently I think it’s fantastic in conjunction with “traditional” medicine; however, as the holistic health movement continues to develop, it will be major competition for GPs.

      Great perspectives, thanks once more!
      Cheers, Esha

  2. Great blog Esha. While the compensation model is broken, there are more fundamental government missteps. This country’s population has been aging for a long time. Logic would dictate that there would be a conerted effort to train more doctors to keep up with increasing demand. In fact, the exact opposite happened starting in the late 90s when medical training spots in Canadian universities were cut by 10%. Consequently, many very bright would be doctors went abroad to study. And once trained, many decided to practice where they studied, rather than return to Canada. While some of those spots have been restored, we trail many OECD countries in the number of doctors per capita. Don’t quote me but I think we rank in the bottom 5 of the list.

    In case you’d like to know… that $25 gets me 7 minutes with my doctor and only one issue can be discussed during any given appointment.

    1. Fantastic comment, Paolo – thanks! I would like to see more effort and investment in medical training in Canada. More doctors would result in more competition, in fact, I believe that with more competitors in space, the current compensation model may actually work. Currently it feels like we’re are stuck with our doctor. Doctors recognize that there are no other doctors in the area accepting new patients and in this monopoly situation, the patient suffers through substandard services.

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