‘No Jab, No Pay,’ not here

Australia has a blunt way of getting parents to vaccinate their children called ““No Jab, No Pay.”

image: Forbes Phoenix

As the name suggests, parents don’t receive welfare payments, tax benefits, and child-care rebates if they don’t vaccinate their children. It can amount to $15,000 annually.

Not only do parents lose payments but unvaccinated children can be barred from daycare and schools during disease outbreaks. Daycares that allow unvaccinated children can be fined up to $30,000.

The exceptions to vaccinations are those children who have some medical condition such compromised immune systems or cancer. These children have a genuine reason not to be vaccinated; and these are the children who can benefit most from everyone else being vaccinated.

Australia has one of the highest vaccination rates in the world. But rates only improved slightly since the ‘No Jab, No Pay’ policy was implemented, from 90 per cent to 93 per cent. The improvement was not entirely because of the threat. A key to their success is a national registry. Health reporter Andre Picard says:

“We should not forget either that, in addition to financial penalties, Australia greatly improved its monitoring of vaccination. Having a register that shows what vaccinations children have – or haven’t – received has contributed greatly to bolstering rates (Globe and Mail, July 9, 2018).”

While it seems effective, it’s not appropriate for Canada. We are similar to Australia in that we are both former British colonies but Australia’s culture is different than Canada’s. Perhaps it’s because they were a former penal colony that the big stick approach is more accepted.

Canada has a hodgepodge of provincial systems with no consistent registry. We need to do better. We now have an immunization rate estimated (because we don’t know) to be 85 per cent. Herd immunity requires rates of 90 to 95 per cent.

There are many excuses for not vaccinating children. One is selfishness. If sufficient numbers of other children are vaccinated, herd immunity protects my child.

These parents don’t remember, or never knew, what it was like when vaccinations didn’t protect against diseases like polio. I do. I remember growing up in Edmonton during the “polio season” when epidemics of the crippling disease raged in the summer and fall. Provincial public health departments tried to quarantine the sick, closed schools, and restricted children from travelling or going to movie theatres. My uncle survived polio but walked with difficulty with the use of a cane and died prematurely because of polio complications.

Another reason is the irrational fear that vaccinations cause disease. While these hard-core anti-vaccination parents receive a lot of press, they only number about two per cent. The other 13 per cent fall into the categories of complacency, those who doubt the necessity of vaccinations, and those who just don’t’ find it convenient to get the vaccinations done.

Convenience is a big factor. Parents don’t get around to vaccinating because it takes time and effort. One-on-one attention is sometimes all it takes, such as an email or phone call reminder.

Canadians need to be encouraged, not bullied into improving or vaccination rate. We need a national registry. Improved rates will provide immunity, not only for their own children but for those vulnerable children who are unable to receive them.

New doctors need to give up sense of entitlement

There are more doctors than ever before; yet two million Canadians can’t find one.

  image: davegranlund.com

An estimated 30,000 Kamloopsians don’t have a family doctor, although only about one-half of them are looking if national averages apply.

Something doesn’t add up. Why can’t Canadians find a doctor if there is a surplus? It’s complicated.

First, recent graduates of medical schools can’t find the residency they want. Without a residency, they will never become doctors.

This year, 2,980 will graduate from Canada’s 17 medical schools. They will compete for 3,308 residency spots. That would seem like every graduate should get a spot. However, 917 of those spots are in Quebec which means that there is a shortage for English-speaking graduates.

Then there is the arcane process of matching graduates to residencies which leaves some out. Health reporter André Picard says:

“But matching a graduate to a residency spot is a complex process, overseen by the Canadian Resident Matching Service (CaRMS). Medical students apply to CaRMS in one or more specialties; committees select who they wish to interview and rank them; graduates rank the programs and, finally, an algorithm spits out a match, and the student is legally bound to take that residency spot (Globe and Mail, May 1, 2018).”

Graduates have become pickier. They get assigned in residency specialties where they don’t want to work. As a result of preferences and the complexities of CaRMS, 115 graduates are unmatched this year. Jobs are waiting for them -there are 78 unfilled positions, 65 of them in family medicine.

The unmatched graduates have invested a lot. They have accumulated an average debt of $100,000 during four years of training. Taxpayers have invested a lot. We are on the hook for their subsidized education. The cost of training a medical student is $250,000.

Also, some graduates want a regular job where they work only 40 hours a week as in a hospital in a so-called “hospitalist” position. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. Compare that with a doctor in his own private practice. After paying staff and rent, a doctor would have to earn $400,000 a year to take home that much -and they’d work longer hours with less medical equipment and fewer support staff such as nurses. But there are only so many hospitalist positions.

One-half of Canada’s physicians focus on sports medicine or palliative care says Dr. Danielle Martin on CBC’s the Current:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

Doctors need to abandon their sense of entitlement says Picard. We need more general practitioners, especially in small cities and rural Canada. Enrolling in medical school doesn’t entitle graduates to jobs wherever they want, in the speciality of their choice.

“Becoming a doctor is hard,” says Picard, “It’s also a privilege. We need a system that ensures the right doctors are working in the right places, not on where personal desires can trump societal needs.”