From WXXI news.

This is connections.

I'm Evan Dawson.

Our connection this hour was made ten years ago when I sat down on the show to talk with a doctor who was choosing to leave Rochester and move her family to Canada.

She said at the time that the American health care system was crushing her soul.

She loved Rochester.

She loved her patients.

She was torn up about the move.

But ultimately, Doctor Emily Queenan said that when she went to school to become a doctor, she did not envision spending so much time on paperwork and wrestling with insurance companies and struggling with reimbursement questions.

She wanted to spend more time with patients.

She wanted to build long term relationships.

She wanted to be a doctor and a colleague in a medical business.

During that conversation on connections, Doctor Queenan said it was not impossible that she could someday return to the United States to practice.

That could happen if American health care changed.

At the time, the Affordable Care Act was still relatively new, just a few years old, and she had cheered its passage, hoping it would make medicine more accessible.

In this country.

But it wasn't enough.

Not long ago, a listener recalled that conversation and asked me, whatever happened to that doctor who went to Canada?

And so I reached out.

The answer is doctor Queen and is still practicing in Canada, and she is still generous with her time, generous enough to come back to connections, to review her monumental decision a decade ago, and to maybe diagnose current problems that she sees in health care.

We are glad to welcome back to the program Doctor Emily Queenan.

Doctor Quinn, it is so nice to talk to you.

How are you?

I am doing well.

It's such a pleasure to talk with you again.

And I appreciate your asking me to to join.

I want to make sure I've got, you know, your professional titles.

Correct?

you are a family physician at Queen and Family medicine and Maternity Care in Midland, Ontario.

Is that correct?

I am, well, I have a comprehensive, family practice, meaning cradle to grave, primary care, along with primary care, gyn care.

And part of that practice involves transgender or gender affirming care for transgender and non-binary folks, along with reproductive health care involving medication, abortions and palliative care both at home, hospital and and at hospice, also involving medical assistance and dying, all under the aisle under the umbrella of that Queen and family medicine and maternity care, and president of the Professional Staff Association and chief of obstetrics at Georgian Bay General Hospital.

Is that right?

Yes.

We are a mid-sized hospital in, Midland, Ontario, in Sturgeon Bay.

I've been the, president of our professional staff.

association, meaning I represent the physicians, midwives and dentists at the hospital.

and working with the hospital administration and the like.

I've done that for the past five years, and then I've just recently stepped into the position of chief of obstetrics of our hospital.

Okay, so very busy and just to kind of give people a geographical location, from what I can tell, Midland looks like you're what are you about an hour and a half north of Toronto.

Well, it depends where you're going in Toronto.

About an hour and a half from the airport, but a couple hours from downtown directly.

If you take there's a highway that everyone knows who's coming up from Toronto called the 400.

If you take the 400 til it ends at Georgian Bay, you'll find us.

So you are at the boy, the northern end of, where Canada feels bearable this time of year to me.

But, you know, I'm.

I'm, I'm and I'm barely not quite northern Canada.

Most definitely.

Where we are is central Ontario.

so listeners, if you've got questions, comments this hours we talk about maybe the differences that doctor Queen sees between Canadian health care and American health care.

her decision to leave the United States for Canada ten years ago, what that has been like.

If you've got questions, comments, there's lots ways to do that.

You can email the program connections at cyborg.

You can call the program toll free 844295 talk.

It's 8442958255263 WXXI.

If you're going to call from Rochester 2639994.

If you are following on the Sky news YouTube page, hello, you can watch the show there and you can join the chat there if you want to offer thoughts or questions or comments for Doctor Queenan.

We're going to start with sort of the broad question, and then we're going to get much more granular.

Doctor Queenan but I'm sure a lot of people want to know ten years later, any regrets?

Do you regret moving to Canada?

What do you tell people?

Not once.

I moved for a values proposition.

And the values proposition is that in Canada, health care is valued as a human right.

And, in my view, unfortunately, in the United States, health care is rarely viewed as a human right, but treated as a commodity.

And it was that value proposition that brought me to, Ontario, Canada.

And while certainly, there are struggles in our system that I'm sure we will get to, that values proposition is never questioned.

So, boy, I, we already see the phone ringing.

usually connections listeners have this pattern where we kind of talk for 20 or 30 minutes, and, and it's such a wonderful and growing audience.

And, and then the second half hour, we get a lot of comments.

But if you've got comments throughout the hour, we'll take them.

I want to make sure people do understand a little bit about doctor Queen Anne's background.

Now, you had lived in Rochester when when we spoke.

In the end of 2014, almost exactly ten years ago.

Now, at the beginning of 2015, you had lived here for about ten years.

You had your own practice for five, but not from here originally.

Is that correct?

Yeah.

I'm from so I am American.

I have no connection to Canada other than our move for health care.

neither my husband nor I are Canadian, but we're both from the Mid-Atlantic.

I'm from outside of Philadelphia.

He's from Delaware.

We came to Rochester for the wonderful family medicine residency program where I trained.

And then we loved Rochester, so we stayed here.

have three or sorry, stayed there, have had three kids who are now teenagers.

and I when I graduated residency in 2008, I opened my practice the next year and had the first version of Queen and Family Medicine Maternity care from 2009 till 2014.

When did you start thinking about making them?

I went back and listen to our conversation ten years ago and I don't.

That's the one question I don't think I asked you.

We covered a lot of ground, but but I'm curious to know, you know, when you made that decision ten years ago to move to Canada to practice how long that had been sort of bubbling up in you, this idea that this you couldn't keep doing this.

Do you remember?

Yeah, I do, because I had actually quite long considered grappled with the decision whether I could keep on, keep on keeping on in my practice, delivering comprehensive primary care in Rochester because it was that era of accountable care organizations, where small practices like mine, I was in solo practice were being eaten up by the hospital systems.

And it was in many ways very uncomfortable, scary, full of uncertainty is so much of life is and I was feeling really weighed down by the, commercialization of, of health care.

Yet at the same time, I wasn't willing to be taken over.

I really prided myself, on the practice that I had developed at Queen of Family Medicine maternity care.

So I grappled with that decision for probably a year or more.

the feeling this yoke around my neck of my practice, yet not wanting to give it up, really, for the sake of my patients, and because I actually loved the doctoring part.

and then, eventually I did reach a breaking point and, in with, within a matter of of weeks, I was it had reached that breaking point and was trying to decide my next steps.

And it was actually one night, one night in April, 2014, where, I think it was 2014.

In any case, I, where I attended a, physicians for a National Health Care Program meeting and then a virtual town hall meeting with the RFP.

And both meetings, led me to realize that the arc of history is long and that health care in the United States would be a long time in reformation, if, if at all.

And I realized I wasn't willing to wait it out, I thought I might wait out the American health care, evolution by spending time in urgent care or perhaps working for university health care.

But I wasn't willing to do that for the entirety of the prime of my career.

And that particular evening, I sat down at my home computer and googled American physician to Ontario and turned to my husband and said, what do you think about moving to Canada?

And he said, sure.

And I said, no, really this time, because I think we had joked about it every time a Bush was elected.

and and so we started the process that, that evening.

listeners, it's your show.

So we're going to get calls right away here.

as I go to your phone calls and your feedback, I want to set some of the parameters that Doctor Queenan gave us ten years ago on this program, doctor Queen, and told us on connections ten years ago that goals as a doctor provide excellent care to patients, build long term relationships with patients, spend more time with patients, focus primarily on patients, not paperwork.

Get away from the difficulty of overhead reimbursements and everything that makes health care not feel like health care.

And we're going to talk to Doctor Quinn and throughout this hour about whether each of those parameters, not only has it been checked working in Canada instead of the United States, but you know what?

Those differences really do look like in practice, because I know listeners want to know, let me grab a couple of phone calls here.

This is Heidi in Fairport first.

Hello, Heidi.

Go ahead.

Hi.

How's it going?

Evan?

Hello, doctor Queenan.

Hello.

I just want I just want to call in because you're our family physician.

When we had our first two sons here in Fairport.

you had.

I wanted to thank you.

Yeah.

And I just remember the time and the care that you took.

It is the gold standard for how I measure every other, care provider.

Like, you were an amazing physician, and you made me feel good as a mom, and I could tell that you cared about us.

You cared about our family.

You cared about our kids, and every time I see you pop across my newsfeed on social media, I'm like, oh, I'm so glad she's doing well.

But I we do miss you very much.

As a as a health care provider.

So I want to say thank you.

And I was super excited to hear that you were coming here on Evan Dawson today.

So thank you.

Thanks so much.

Heidi, thank you for that, doctor Queen.

And I mean, I don't know that there's a better endorsement that you can get.

I mean, you've been gone from this area for a decade now, and you've got people lining up to call this show just to thank you for the work that you did.

That's pretty good.

Yeah.

It's really I mean, it literally, it brings tears to my eyes.

That's what family medicine is about.

that's why I went into family medicine was to, make a difference in people's lives.

It sounds a bit trite, perhaps, but it is the truth.

That is why I do this work.

Which which certainly can be, really difficult is not for the meek.

so.

Yes.

Thank you.

Heidi.

It makes the biggest difference in the world to me.

Heidi, that is a really generous phone call.

That's, We appreciate that call.

Thank you.

Keith in Bloomfield, next on the phone.

Hi, Keith.

Go ahead.

Have an interesting show.

I just got a couple of comments to see what they say.

time and time again, you know, we have health care professionals, and you referred to, health care in this country as they do the problems with the health care system.

The biggest issue is we don't have a system.

We have a health care industry.

so much so that you go to Syracuse and there's a different health care industry there where I'm assuming health care, across Canada, the same requirements exist from east coast to West Coast within the Canadian health care system.

The second thing is, doctors, if they were to act together as one unit, could get changes very quickly by just start slow treating politicians.

So if you got a politician or a federal politician who has the stomach for.

Yeah, we'll see you in a month, you will get changes really fast.

That's it.

Oh, it's, Keith, thanks for the phone call, Doctor Quinn.

And you want to weigh in on that?

Absolutely.

first, addressing the first comment about, wondering about, Canada wide treatment, or, sorry, Canada wide system.

Our, our, health system is provincially regulated.

So you'll find, the the same, regulations, guidelines and billings within provinces.

But I really can be quite different province to province.

And unless there's been a, it must it comes from the federal can, health health Act.

that being said, I think that there is, much more of a development of a system here in Ontario than I observed in and unfortunately, even Rochester, which is, you know, near and dear to my heart.

But I saw two hospital systems dividing the, the, the city and and really quite separate from one another without sharing.

the same medical record or or really anything, you know, here in Ontario, unfortunately, there's so much to be desired in terms of collaboration across the systems.

We still have different medical records from one facility to another.

We still have to request records from one city to another.

but there is much more collaboration across the silos and in a few ways, one, when it comes to making sure that the patient is is in the right place at the right time, receiving the right care, there's a coordinated effort to be sure of that.

So in a smaller, town like, like ours, where we don't have most, specialists or inpatient specialists, often patients might need to be transferred for specialized care in the hospital.

And there's a system called critical to, to support that.

And, and so there's much more of a sense of, collaboration, across facilities.

I've observed it's not perfect.

It's certainly still different.

The facilities are still often, going after the same health care dollars when it comes from, in terms of provincial funding.

But, but there is much more collaboration and then.

Yeah.

Go ahead.

Oh, sorry.

No.

Go ahead.

Yep.

Yeah.

And then, in terms of yeah, I thought his comment I know is a bit facetious about slow, treating or whatever the politicians, but it brings up for me a real tension that comes, that we encounter as, physicians, as professionals in the health care system because, you know, one might say we could strike.

We could take some sort of organized action to enact change.

Yeah, that is really ethically untenable.

but for most of us, I mean, I think we're really almost all like, it's just built into our training to, uphold our professional, ethics of, of of of of treating all folks who, who need it.

And so I think that, it's, it's can be very hard for physicians to enact political change in health care because sometimes that, what the the push that may be required to do so it is incompatible with, professional ethics.

I think it's a it's a tough situation, a tough thing to grapple with.

Keith, thank you for the phone call.

we're going to come back to phone calls, shortly here at 844295 talk.

If you want to call the program toll free.

(844) 295-8255.

We're talking to doctor Emily Queenan, who is a family physician at Queen and Family Medicine and Maternity Care in Midland, Ontario.

That's 90 minutes plus north of Toronto.

And she moved there with her family, with her husband and three children ten years ago from Rochester.

After a lot of wrestling with.

Do we make this change?

Doctor Queenan is not Canadian.

Her husband is not Canadian.

She's an American.

She'd practice health care in the United States here in Rochester, but then decided that she'd really just felt a soul crushing weight by the American health care system and chose to move to Canada to practice.

And so, ten years later, she's back with us talking about that decision, what she's learned, the difference that she sees and systems and taking your questions and comments throughout the hour as well on our various platforms here.

So if you want to email the program, it's connections at Dawg.

And if you want to join the chat on YouTube, we are streaming live on YouTube every day, noon to two.

So there we are in the sexy news YouTube channel.

Hello, if you're watching us.

and so a lot of places that you can get on in the conversation, let me just extend off Keith's, comments in two different ways.

Doctor Quentin, first of all, when when he talks about health care being more of an industry than, you know, a working system in this country, I, I'm thinking back to ten years ago when you told us that when you practiced in the United States, you could not tell your patients what individual procedures might cost, not even labor and delivery and it was different with every insurance plan.

It was extremely frustrating, understandably so for patients.

Not just frustrating, but real concerns about whether they felt like they could even afford procedures planned or and planned.

And so I wonder if that is different in Canada.

Can you talk to I mean, is there conversation about what stuff cost?

Is there, is there much cost?

I mean, again, forgive my ignorance here, but can you talk about the difference you see in that way?

Well, certainly our provincial health insurance covers the intention is to cover all medically necessary, assessment and treatment, other medically necessary care, and so delivered by physicians, in hospitals and in the community.

And so that means that the vast majority of medical expenses and it's delivered in that context, will be covered by the provincial insurance so that physicians know how much they are compensated and hospitals know the formulas by which they're compensated.

But but we can go to the emergency room.

I have teenage boys.

We've been to the emergency room a number of times, and we meet when our care is done.

There's no, signing, invoices or the like, our insurer and similarly goes for, advanced imaging, I think is one place that I often, ran into frustration in Rochester.

Now, the, ordering of a CT scan or MRI or nuclear study, the appropriateness is between physicians.

I as a primary care doc, I may mis order a study where actually a seat would be a better study than the MRI that I initially ordered, so that if it is declined or rerouted, it is done by the one physician to another, and it's not done for cost reasons.

It's done for medical appropriateness.

While in Rochester, in order to order any advanced imaging, I had to fill out prior authorizations and obtain, permission from a nameless medical bureaucrat, insurance companies.

And, of course, there's a different way of obtaining that authorization from every different insurance company.

So I often just didn't order.

I kind of gave up on ordering advanced imaging.

So very different experience in Ontario.

We do still don't actually have coverage for medications.

we don't yet have a universal pharmacare that we're moving in that direction.

And then we also don't have a provincial coverage for, therapies.

And it's a it's covered for the old and the disabled, but otherwise physical therapy or what we call physio is, is, is not covered and is often covered by employer sponsored insurance.

So there are along with medications so that there are still some medical costs that, that Canadians and specifically Ontarians need to bear.

All right.

Alex emails the program and says, Evan, a common refrain from conservatives is that state funded health care in Canada is hampered by inappropriately long wait times for procedures and appointments.

He says this conveniently ignores the length of time it takes to receive procedures through private insurance plans in the States.

But he wants to know directly.

Doctor Queen Anne, what's your sense of the timeliness and care is primary care generally fine annual visits, medication check ins.

But, specialty care, does that happen with more wait times or does that happen further out?

That's from Alex Quinn in so it has Alex access is really important to talk about.

and there was just an article I read that I can't remember which, newspaper it was in, but that, you know, Canada was at the bottom of the list of, developed countries regard it with health care systems in terms of access over, only the United States, which was actually still below Canada.

But we are not content to be at the below at the bottom of of a list regarding access.

And in fact, certainly that is the biggest struggle that, Ontarians are having.

in, in health care right now is access.

We, don't have enough family doctors.

And so too many, too many folks are when we call orphaned or without primary care doctors so that they're needing to seek their primary care through walk in clinics, through the emergency room, and sometimes through stopgap measures, organized through, locally cited family health teams.

so there is a problem for primary care access because we don't have enough boots on the ground.

Of course, we're looking at a number of ways of solving that, but it has not yet been solved, you know, including, drawing upon the, the work of nurse practitioner, nurse, and then, wait times for specialists are, also often too long.

There are individual as scenarios, certainly our this locally our cancer care is very good folks get in to see the for necessary diagnosis and treatment.

very quickly same thing with cardiac care.

But say to see a neurologist is, inordinate or wait wait time, which is, which is not okay.

And then advanced imaging, ebbs and flows.

sometimes we have long wait times for MRIs.

The difference is that, it is addressed, provincially in a coordinated fashion, reallocation of funds and such.

It is not addressed, behind closed doors at a boardroom of a private company, talking to Doctor Emily Queenan about the differences in United States and Canadian health care.

one more email on that will.

Then what we'll do is we'll take our only break of the hour, and I've got a couple of phone calls lined up that I think, are right in your wheelhouse to kind of talk about, maternal medicine, single payer system.

So, Bruce will a hang there.

We'll get you on the other side of this very short break.

Coming up, I just want to read this email from David, who's listening in Vancouver, Canada.

he says, I'd say she's very lucky.

One of my graduate students of 20 plus years ago was an immigrant to Canada.

After practicing medicine for over five years in Iran, despite scoring very highly on the licensing exam here in British Columbia, he was never allowed to practice here.

He ended up after getting his master's degree in my lab, moving to LA, where he was welcomed to practice.

He does not like the system he's stuck in now, but he's thankful to be able to practice medicine at all.

That's from David in Vancouver.

was it any struggle for you to get licensed to practice in Canada?

Doctor Queenan gosh, this is such a timely conversation because it's, right now in Ontario, in Canada wide, but especially in Ontario, we're talking about how to smooth the way for immigrant, graduates, because it is just not okay that a, fully competent, well-trained, graduate, is coming to Canada and working as a part of you or you or would not in the health care system at all.

So, David, thank you for bringing this up.

And it's certainly something that, and, and but tell us that they are addressing we have three new physicians in my community through this practice ready Ontario program.

for myself, the Ontario makes it, quite a smooth process for American family physicians.

Our training is very similar.

certifications are very similar.

And so I wasn't required to go through any extra training.

I only, had to submit my application for licensure.

Went through a period of what was called minimal supervision with another, physician in town for the first year I was here, in which I did chart reviews once a month and then have an assessment of my practice a year into the but with an outside reviewer.

and and now I'm a fully, unrestricted, licensed, practicing physician in Ontario.

David, thank you for that.

Sydney on the YouTube chat tells us on the Sky news YouTube chat says, I would definitely move to Canada if I could for many of the same reasons.

I am dismayed about the many ways that the United States has declined.

I waited too long, and now I'm too old to be accepted as an immigrant.

That is from Sydney.

And, Jean is an who says hello to Emily.

Evan, please give Emily my regards.

It is a treat to turn on the radio and hear doctor Queenan.

Today we were on the Integrative Health Committee together, a subcommittee of the Monroe County Medical Society from 2004 until she left town.

I have missed you, Emily, as many others do, as well.

Our committee dissolved some years ago, but many of us remain connected.

It's been a challenge for all Rochester teams to work within a two system health care city.

Thank you for all your hard work in Rochester and Ontario.

Again, that's from Jean Doctor Queenan.

thank you, Jean.

a lot of love for doctor Queen and apparently a very popular doctor here in Rochester.

And ten years later, after moving to Canada, if you're just joining us, we're talking about the decision that she and her family made at the end of 2014 and 2015 to move to Canada so she could practice medicine at a place where she felt like she would have more time with patients, wasn't crushed by a system that she just didn't really believe in.

And now, ten years later, we're talking about that decision, what she's learned.

The difference is she sees on the other side of this break, more of your phone calls and questions for Doctor Emily Queenan.

Coming up in our second hour with fires raging in the LA area, a number of conservative commentators have complained that the disaster briefings, the televised briefings include sign language interpreters.

They said the interpreters are just distracting.

Do we even need them there?

Next hour we talk in our dialog on disability about how disasters are often even worse for the disability community.

Elon Musk helped president elect Trump return to the white House.

Now, car safety advocates are worried that Musk will influence federal agencies regulating businesses like Tesla.

Tesla has been overselling the effectiveness of its technology for years, and a lot of people buy into that because it's tweeted about that way.

The fight over crash reporting requirements on All Things Considered.

From NPR news this afternoon at four.

This is connections.

I'm Evan Dawson.

Thanks for being with us on this Wednesday.

And let me get a couple of phone calls.

Folks have been waiting.

This is Bruce.

Hi, Bruce.

Go ahead.

Yes.

first off, Doctor Cleveland, thank you very much for taking the time to share your experience with us.

And my question is about, payment systems here in the United States.

We have a multiple payment system where our health insurance plans, all different policies.

What is your experience in Canada with a single payer system?

How has that impacted your practice?

Well, thank you, Bruce, but really, I think the biggest there's a several differences.

One, billing is, much simpler so that I do choose to, to pay a biller to, to submit my bills, and especially because it was a lot to learn when I first moved here.

But I pay her 2% as opposed to 8% of my, payments.

And so, it's made, more complex only by various bonuses and extra payments that are, that are given in order to, encourage one type of care or another.

I think the bigger difference in my clinical care is that I'm not forced to segment, artificially segment my patient population.

In Rochester, there may be one program for Excel is Blue Cross Blue Shield employees of the university.

And there may be another program for, you know, employees of Kodak.

and, it so it made it very hard to do meaningful population health work because, at least is covered by, payments to physicians, health insurance.

While, my, in my practice here in Ontario, everyone is the same.

I don't have to segment out my population.

I can know that if I need to make a certain effort on the folks who are working with the folks with diabetes, the, the I will receive the same, bonus or payment or a fee for for everyone.

so it was an artificial segmentation of the population that really drove me crazy in, in Rochester.

thank you for the phone call, Bruce.

Let's get Willa in Rochester on the phone next.

Hi.

Will I go ahead?

Hi.

Allen and Doctor Queenan.

the doctor and I know each knew each other from the Rochester area birth network.

Before she left.

And so, I wanted to focus on maternity care for a minute.

You know, New York state, was one of the most progressive in terms of, maternal rights, to, to health care of their choosing.

but, back then, but since disintegrated because of insurance companies basically figured out how to get around New York state was and with the Dobbs decision, things were even worse than you'd think.

So, you know, birthing mothers are different than aborting mothers, right?

Well, it's just not true.

Because if when the courts decide that they can decide what's best for, a woman, when she's looking to end a pregnancy, they also then, have the right to decide for a woman how and where and when she chooses to, to give birth.

so things have gotten very bad.

since since the doctor left.

can you tell us a little bit about the, what birthing mothers have a right to in in Canada?

Thank you.

Will go ahead.

Doctor Queenan.

Thanks.

So it's good to hear your voice.

Of course.

I remember you from the birth network.

your question, gosh, is right.

There's there's so much to explore in that question.

as I'll take it in a couple different ways.

One, from a reproductive health care perspective, including abortion care and contraception in the, Canada.

I nationwide, federally, has decided to stay out of legislating it.

And so it really is, regulated through, all medical procedures, through the health professions, through our or through our, our colleges.

And, and that has kept abortion out of the courts, you know, most recently I can't predict the future, but but certainly now.

And so, we, it is regulated as should all be.

All, medical procedures are for appropriateness.

And, but the court turn involved.

So that is that is huge.

Secondly, in terms of the rights of birthing people, we, I've one really dramatic difference for me in my, in my birthing practice here in Ontario is I work much more closely, clinically with midwives.

because, the midwives that our hospital work right alongside me.

So certainly there are wonderful midwifery groups in Rochester, and I admire them, but we, at least in my clinical practice, we were a bit more separate while in my, small husband, my mid-sized hospital here in Midland, we work very closely together.

And one thing that I've noticed that's so different from Rochester is that, birthing people have a, choice of, a birth place.

it is a part of their initial conversations, regarding risk, benefit and alternatives and in making informed consent as to whether they birth at home or in the hospital.

And the midwives have privileges, at the hospital and for home birth, and so that the transfer to home, sorry, transferred to hospital from a home birth is really seamless.

and as it should be, well, unfortunately, I didn't see that happen.

in Rochester often often that transferred from our home birth midwives in Rochester to hospital was a much more, disjointed, not at any fault of the providers, but the system, that in which they worked.

and so those are probably the biggest difference that I've noticed in our birthing systems.

Well, thank you for the phone call.

It's 844295 talk.

It's toll free.

8442958255263 WXXI.

If you're calling from Rochester.

2639994, you can email the program connections a cyborg.

You can join the chat on our YouTube channel where this show is streaming every day on the Sexy News YouTube channel.

Hello to viewers there.

And, I want to just let you know that the reason we're having this conversation this hour is we're marking ten years since Doctor Emily Queen and made the decision to leave Rochester, to leave the United States to practice medicine in Canada, for for quality of life, for philosophical and values based reasons.

so her soul was being crushed by American health care.

She made that move, not just her, her husband and three children.

And they've been there for ten years.

And she said, no regrets.

It's not perfect, but we're talking this hour about how she sees the differences.

So let me work through some of the points you made to us ten years ago.

And then you can you can give me a no difference, small difference, big difference.

How's that, Doctor Quinn?

And you ready for this?

That sounds great.

All right.

You said one of your goals.

Spend more time with your patients when you moved to Canada.

Then you were able to spend time with patients in the United States.

No different.

Small difference.

Big difference.

Gosh, that is an interesting one.

I wish I could do that.

Big difference, but not in the direction that I would have anticipated.

I actually feel I have less time with with patients and in my current practice.

And that's because when the barrier to accessing care is through the accessing physicians, I live on a day by day basis with an extraordinary pressure to accept more patients into my practice.

again, we have too many, patients who do not have family physicians are so-called orphan physicians.

And, I've, I try to close my practice, but, of course, you know, practice is really closed, and I still accept newborns and household family members and trans folks and the occasional other person.

So I think that the time I have with each person, I still, schedule 20 minute visits, but I feel, I often feel pressured to, work faster, see more in order to provide more care to those who need it.

Okay.

you said you wanted to focus on the patient, not the paperwork.

Small difference, no difference.

Big difference.

Big difference in terms of, finance.

you know, in terms of, billing and stuff.

unfortunately, the world over, primary care is going through crisis.

UK, Australia, US, we all are, struggling with the, paperwork that is providing, health care in this day and age.

there is and it's, obviously often digital paperwork, but we are, living in an onslaught of data, a deluge of, documents and labs and reports and emails and and all the, like, messages.

tasks.

and so I would say that I probably spend as much time on non patient facing, care as I did in Rochester, but it's more on clinical care than it is.

And systems work, working on various committees.

Then, then the business.

You said you wanted to be part of a system that values patients as people, not you do not want to be part of a profit.

Profit seeking industry.

No difference.

Small difference, big difference, big difference.

And it's that values proposition that has led me to stay.

and before I come back to phone calls, you told us ten years ago that that you were, you know, you were someone who wanted to see the Affordable Care Act when it was, up for debate that that you were hoping it would make positive changes.

and then it wasn't the ACA that forced you to leave the United States.

But what you told us on that program was the ACA was like a Band-Aid on a hemorrhaging patient.

Well, now, ten years later, it's it is not possible to predict what the next four years will bring in health care.

but I wonder how much, you know.

Do you still feel connected enough to what's going on in American health care that you can weigh in on what you see here and whether it would be attractive to come back?

You know, I have been dispirited by how little has changed in American health care.

if anything, as Willow was pointing out, some of the legislation regarding what, health care is allowed to be delivered, and, every day, I'm grateful that I practice in, Canada when it comes to, that legislation of health care.

So, you know, I, I don't I don't know if the United States will ever move forward on working to ensure health care is a human right.

the Affordable Care Act was one step in the right direction, except for in terms of ensuring greater access to care.

But it was really no more than a subsidization of the private insurance industry that allowed my husband to stop working in a job that he was primarily working in to, offer our family health insurance.

yet at the same time, it, made lives like mine ever more difficult.

And, primary care.

All right, Christopher in Rochester on the phone.

Let's get a couple of phone calls here.

Chris and Jim.

Christopher first.

Go ahead.

Good afternoon.

thank you, doctor, for being on the show today.

It's awesome.

And good to see you.

live on, YouTube.

Have everybody, good to be on YouTube.

Yes.

so in the world of gatekeeping, what are you seeing for in Canada with regards to mental health care?

You know, when folks come in to your practice in Rochester, it takes six months to get an appointment that strong behavioral health.

And our governor is talking about some of the explosive issues about mental health care.

But you're the first line of defense.

You're going to you're you're talking to patients one on one.

You will start.

You notice when things aren't quite right.

You know, we spend a lot of focus on the we know how to repair a broken leg.

And there's a high reimbursement rate in this country for it, but there's a low reimbursement rate in Rochester for folks who may struggle, psychologically.

What is the difference between the Canadian model of dealing with care in your practice when you come across mental health issues versus what you saw in Rochester?

Right.

Well, thank you so much for for that question.

You're right.

Unfortunately, mental health care is often undervalued when it comes to compensation.

And that is you know, it again, has led to kind of challenges in accessing care.

I would say that the major difference that I experience here in Ontario in particular, there have been a number of measures taken over the last several years to open up access to care that is covered by our provincial health insurance.

and there is, again, more kind of coordination across across silos.

So I may I'll see a patient in my office who is struggling with depression or anxiety, for example.

And one of my first steps will be giving them the phone number to my, family health team, which is nurses, social workers, occupational therapists and the mental health team.

As part of that, that, family health team is fully covered by OHA and will offer, counseling and then also, connection with local resources.

And then we also have, provincially covered, structured psychotherapy, cognitive behavioral therapy, for example, DBS and then trauma based therapies.

And and that happens because the province decided this is important and it needs to be addressed.

And, you know, politicians were influenced by those who who told them so.

And so they directed money in that way.

In terms of psychiatry consultations, there are a number of different options, and some have long wait times.

No one was six months.

I think that that's that's that's super challenging.

but and so some of it is the virtual care, some of it is local, and so that I think there are more options and more covered options that I really am more confident at getting, accessing mental health care for my, for my patients.

It's not perfect.

And, it's much easier to get to have a psychiatrist consult, once or provide consultation for the primary care physician to continue care.

Then, nurses certainly effort to access psychiatry care for ongoing care.

but our local, psychiatric facility has been working hard at improving their access to the community at waypoint.

have and so, I think things are improving, not perfect, but things are improving and certainly much better than I experienced in the United States.

That answer your question, Chris.

Yep.

Would you say that's a qualitative, qualitative difference?

Because we struggled very much here like I'm on South that I do where there's double stabbings outside, I deal with a lot of issues with folks.

You know, I'm just a little tack shop on South Hollywood, little and catbird see what's happening and people are struggling with mental health, and it doesn't seem that they're not getting connected.

I mean, I've talked to people who run, urgent cares here, and they tell me, but we don't want to deal with psychiatric.

We don't get paid for that.

You know, we'll deal with a broken heart, broken leg, but not a broken mind.

So it is it is a challenge of of compensation.

Yeah.

Go ahead.

Christopher.

Yeah.

Oh, thank you very much, Christopher, for that phone call.

And, you know, I, I take that last point that he's making there, doctor Queen, that, the way health care gets categorized and what happens to psychiatric care, that is, it's a crisis.

Certainly still a crisis here.

I mean, no surprise to you, he's.

Christopher is not wrong about that.

Jim in Rochester has been waiting.

Hey, Jim.

Go ahead.

Yeah.

So, it was mentioned that, there's a lack of primary care in Canada or in Ontario, and I was wondering what the Canadian Medical Society felt regarding, those vacancies being filled by nurse practitioners or physician assistants, whether they were promoting that or whether that was something that was, on the front burner in terms of trying to fill those vacancies to get more primary care providers available to see patients.

Yeah.

Good question Jim.

Thank you.

Doctor Queenan.

Absolutely.

I won't speak to the CMA's, official, stance on this because truthfully, I'm not I'm not sure of it, but I'll speak more to my own and my general gestalt.

certainly I, I think that there is a broad recognition that we need more boots on the ground and absolutely some of those boots on the ground with nurse practitioners.

We're newer in Canada, in Ontario.

About you.

For physician assistants, their role is growing and we're seeing them more, working in hospital settings and emergency rooms and, and on inpatient floors.

So I, I can't speak to the role of, of PA in primary care, but certainly the role of nurse practitioners is growing, significantly.

Absolutely.

And I think, just to well, let me see if Jim wants to jump back on that, because I've got a question myself.

But go ahead, Jim, anything else you want to add?

There?

Well, I guess, so that means that within Ontario, at least, your experience is that there are there are schools that are turning out nurse practitioners and or physician assistants and, are they directing them?

more you mentioned physician are more in the hospital and clinics, but are they trying to train them and direct them more toward primary care, or is it just sort of, you know, that's where they sort of gravitate to, and nurse practitioners, for some reason, gravitate more to primary care?

Well, I think there's practitioners really can go into a wide variety of areas where you have a nurse, for example, in our local hospital, really valued nurse practitioners working on the inpatient floors with our medical teams.

And so they certainly can, you know, quite certainly do a variety of different go into a variety of different fields in the health care system.

I think the, is certainly being encouraged.

Is it in the same way that in medicine, graduates are being encouraged to go into family medicine and primary care?

The problem is, is that the, the the field is.

So it's such a challenge right now, with too many, so many patients requesting care, this deluge of data that we are on site, on a daily basis, that it sometimes just feels like more is being as asked of us as primary care providers, both nurse practitioners and physicians, more as being asked of us can than any human can deliver.

And so it really is taking a step back and looking at the system and looking to see how we can make primary care a more attractive field for physicians and nurse practitioners to go to, rather than kind of a direction or a kind of pushing them into just about our last minute here.

Then the extension to that, maybe there's a good way to close program.

I think some listeners would be surprised to hear that, you know, you have a very strong endorsement of making this move.

Ten years go from the United States to Canada, that you feel that the mission and the values of Canadian health care are more reflective of where you want to be.

And yet it's still tough sometimes to get enough time that would make you comfortable, that you've got enough time with patients.

And it's there's apparently a shortage of doctors at some levels here.

And so is it, because there aren't the people to fill those slots, is it?

There isn't the money.

The money is now short.

There's enough money to hire.

So what's the final diagnosis?

What?

What would change this equation?

Doctor Queenan well, I think primary care is in crisis the world over.

and essentially our systems have not yet caught up with the complexity that is the current human who is being, kept alive much longer, but often with many more chronic illnesses, impacted by the foods we eat.

And, our often sedentary lives, making the practice of primary care very, very different than it was in decades past.

So I think that the prescription is recognizing that and moving towards, what we are doing in Ontario while preserving continuity that is so important with primary care, bringing in teens.

I just want to say Doctor Quinn and I mean, I, I could have spent the hour just reading emails from your former patients in Rochester who love you.

you have to forward some of them, you know, it's really lovely.

I miss everyone, and there is such love for what you did in this community when you practice medicine here.

And I'm really glad you took the time.

Let's just do this every ten years.

How's that?

Every year it sounds like a plan.

Or maybe.

Maybe more often.

I appreciate it.

Doctor Quinn, and thank you for the time.

You are generous with that.

I wish you well and thanks for being on the program today.

Thanks so much, Devin.

I appreciate it.

Doctor Emily Queenan is a family physician at Queen and Family Medicine and Maternity Care maternity care in Midland, Ontario.

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