There is a doctor shortage on Fogo Island, Newfoundland, Canada. This small community of slightly more than 2200 has no physician available to it; none at all. Nor is medical help available anywhere nearby. There is to be sure the possibility of a 50-minute ferry trip to the mainland, but during the winter this is all too often more theoretical than actual.
But this failure of Canadian socialized medicine is not the real story here. Rather, it is the fact that the authorities in charge refused the offer of a fully qualified clinician from Massachusetts, who offered his services for three months, entirely for free.
Why would any doctor in his right mind make any such offer? Dr. Paul Hart has strong ties to Canada in general, and to Newfoundland in particular, and wanted to “give back” to the Fogo (“fire” in Portuguese) Island community. He originally hailed from Toronto (that’s a big city in the Frozen North), went to Memorial University in Newfoundland and Labrador. He was struck by the plight of the Fogo-ites. He stated: “It's my wish to say thank you to the province of Newfoundland for providing me with this phenomenal education and a wonderful medical career,”
Sorry, this nice guy tale still isn’t the story. The real story is that the Canadian government authorities rejected his supererogatory offer. Their excuse? According to the College of Physicians and Surgeons, such an offer could only be accepted by doctors in “active practice for at least four months in the last three years” and Dr. Hart, let me repeat that, Doctor Hart, did not qualify since he has been doing telemedicine for two of the last three years. This physician is good enough for the patients in Massachusetts, but patients in Fogo Island must be made of less healthy protoplasm.
The real reason?
The Canadian government engages in restricted entry in behalf of its medical professionals. To be fair, the US authorities would undoubtedly have acted in much the same manner were a similar offer made from outside of its borders (they did exactly that during Katrina in 2005). They are under the thumb of the American Medical Association, the strongest labor union in the US. A similar situation applies in the country to the north of us.
What is the case for occupational licensure in medicine? The obvious argument is that physicians engage in life and death decision-making, and the last thing we want is for unqualified practitioners to be involved. (Why tele-medicine would be disqualifying is difficult to understand in this regard).
However, there is a better way to obviating such a situation, rather than licensing which forbids all those not approved from practicing. It is called certification. Perhaps the best-known version of this institution would be the Certified Public Accountant. Unless you pass a series of stringent exams, you cannot call yourself a CPA. But you can still practice accountancy.
Other examples include the Good Housekeeping Seal of Approval, Consumer Reports, and the Better Business Bureau. What I am advocating here is this sort of thing for medicine. For example, the Harvard Medical School, Mayo Clinic, M. D. Anderson, Columbia Presbyterian, Cedars-Sinai Medical Center, NYU Langone Hospitals, the Cleveland Clinic, the Johns Hopkins Hospital could be the certification agencies. Why put all of our eggs in one licensing basket?
What would be the advantages of this alternative institutional arrangement? There is at present a doctor shortage in both the US and Canada. One bit of evidence for this claim is that doctors earn a multiple of the salaries of those paid to PhDs in chemistry and biology, who, presumably, have the ability and characteristics (not appalled by blood, etc.) to become doctors.
Another bit of evidence is that medical school admissions are a small fraction of applications (about 5%). Ordinary unions are weaker, since they exclude people who are patently qualified to do the job in question. Physicians’ labor unions dismiss them before they can learn the craft.
But what about foreign doctors? They are precluded by examinations in English only (English and French, in Canada). But isn’t it important that the same language be spoken on both sides of the examination table? No. Some patients are unconscious. No language overlap is needed there. Then, too, doctors from abroad could certainly treat patients who speak the same language as they do. Third, anyone ever hear of translators? No, exams in English for foreign doctors are just a further excuse to restrict entry and raise salaries.
Sick people suffer from such depredations. To the extent that the death rate from disease is higher that it would be from this free enterprise alternative, those responsible for the present system are guilty of very serious depredations indeed.