Good morning. Canada’s health care system needs to work better for female doctors – more on that below, along with Europe’s mounting frustration over record-setting tourism and answers to your burning questions about the new mortgage rules. But first:
Today’s headlines
- Israel urges the evacuation of southern Lebanon and warns of ‘extensive strikes’
- The public system spent at least $1.5-billion on private nurses last year, a study finds
- The union for workers at Vancouver grain terminals has issued a strike notice
This patient is going to do great.Chris Young/The Canadian Press
MEDICINE
A numbers game
Rampant burnout is causing doctors across the country to cut back their hours, retire earlier than expected or leave the profession altogether. Yet we still have a health care system that encourages volume: Physicians are rewarded for seeing as many patients as they can, as fast as they can.
That system can be especially punishing for women, who – as The Globe’s health columnist André Picard reveals in his new report – spend more time than their male counterparts talking to patients and more time following up on their care. And female physicians don’t just have a better bedside manner; they also get better results. To take just one example: A recent Canadian study in JAMA Surgery canvassed the records of 1.3 million people, operated on by nearly 3,000 surgeons in Ontario. Procedures ranged from complex surgeries (such as cardiac bypass) to bread-and-butter stuff (a knee replacement). Whatever the operation, the patients of female surgeons were less likely to contend with adverse events.
You’d think that we’d want to smooth the path for female doctors to get – and stay – in the profession. But despite the gains of women in medicine over the past century, we’re not there yet. I spoke with Picard about this stubborn problem and the changes that could help everyone in the field.
Let’s start with the research, because it sure does seem like female physicians get better outcomes. What do the studies show?
The research shows that patients of women physicians have lower mortality, lower hospital readmission rates and lower rates of adverse events postsurgery, all of which are key indicators of quality of care. There are some caveats here, though. All the studies are retrospective; patients were not randomly assigned to male and female physicians, so we don’t know that we’re comparing identical groups of patients. But there’s no evidence either that women physicians get “easier” patients, which suggests some differences in practice.
Can we draw any conclusions about those differences?
We don’t know exactly why the patients of women physicians have different outcomes, but researchers say the most likely explanation is that women communicate differently. They spend more time talking to patients, and more time doing follow-up care.
Sounds pretty good! But women take a financial hit for that time, don’t they?
Almost three-quarters of payments to physicians are on a fee-for-service basis – they are paid for specific acts. So, the more patients you see, the more money you make. But since women physicians generally take more time with each patient, they earn less. Women are also drawn – or pushed – to lower-paying specialties like family medicine and pediatrics.
Illustration by Hannah Barczyk
Getting paid per service means it’s harder to carve out time to care for young kids or aging parents – work that disproportionately falls on women. How do we make it easier for them to stay in medicine?
The way to attract and retain physicians is to ensure the work is interesting, well-remunerated, and doable. Work-life balance matters, especially for practitioners with younger children. In Cambridge, Ont., almost all the family doctors work in group practices, a combination of family health organizations, family health teams, a community health centre, and a nurse practitioner-led clinic. Women, in particular, are attracted to group practices, in large part because they allow more flexibility. And new funding models, such as the one for B.C. family doctors, not only pays on a fee-for-service basis for patient visits, but offers an hourly stipend for things like paperwork, and a little extra for doing work like visiting nursing homes.
Those are the sorts of changes that make working conditions better for all doctors.
The rates of burnout in medicine are sky-high. The work environment is sometimes toxic. Many doctors are leaving the profession or cutting back sharply on their hours. So the changes that women, and younger women in particular, are demanding are survival mechanisms. And, increasingly, this new way of practising is not gender-specific but generational.
I’m curious: How has – and maybe hasn’t – the narrative around women in medicine changed over your 40 years in health journalism?
Women are far more present in medicine than when I started reporting in the early 1980s. That’s especially true in medical schools, where 50 to 60 per cent of students are women. Women in positions of leadership are no longer unusual. But we still haven’t hit that critical mass where there is equity in academic, clinical leadership, and in surgical suites and doctors offices across the country. Finally, we are just starting to look at the equity question beyond gender, and trying to figure how we can have a medical profession that mirrors the Canadian population in all its racial, linguistic and cultural diversity.
This interview has been edited for length and clarity.
The Shot
‘Either the city is for tourists or for people who live here’
Banners protesting tourism fly side by side with the flags of Barceloneta and Spain’s autonomous Catalonia region.Anna Liminowicz/The Globe and Mail
After yet another record-setting summer of visitors, fed-up locals in Barcelona – and Athens, and Lisbon, and Amsterdam, and Venice – are cracking down on Airbnbs, freezing new hotel construction and generally demanding that “tourists go home.” Read more about Europe’s turn on tourism here.
The Week
What we’re following
Today: Statistics Canada releases its housing price index for August – and if you have questions about how the new mortgage rules could affect your plans to buy a home, Globe reporters Rachelle Younglai and Erica Alini will tackle them at noon ET.
Today: The sexual-assault trial for former Hedley frontman Jacob Hoggard begins in Haileybury, Ont.
Tomorrow: World leaders arrive in New York City for the start of the UN General Assembly, where they’re expected to discuss the war in Gaza, Ukraine and the need for climate action.
Wednesday: Fresh off his UN visit, French President Emmanuel Macron heads to Ottawa to meet with Prime Minister Justin Trudeau.
Friday: Last chance to throw your hat in the ring for the B.C. election – nominations close at 1 p.m. PT.