Notes from this year’s psychiatry meeting in Canada

By David Drake, D.O.
The Iowa Psychiatrist, June 2015

From a Physicians for a National Health Program (PNHP) poster board its booth at the American Psychiatric Association Annual Meeting:

“This is what we could have in the USA if we had single payer:

Psychiatrists in British Columbia get:

  • 50 min psychotherapy $162
  • 50 min inpt psychotherapy $180
  • 25 min med visit $92
  • Geriatric consult to Medicine $300

“'I collect 99.5 percent of what I bill.’” (quote by a Canadian psychiatrist in British Columbia)

So ... just back from Toronto and the APA. Great city. Great time. While there I had the opportunity to sit down over lunch with a Canadian psychiatrist who practices in Toronto.

When was the last time you heard a colleague say he/she loved their practice and the health care system?

First, we have no system. And more we have to deal with co-pays, co-insurance, and deductibles. When I review this with Canadian physicians there is disbelief.

My lunch partner, S. Udaya Shankar, M.D., who goes by “Sachi,” treated me to an Indian lunch and beer. Our Canadian colleague showed me his Health Canada insurance card that looks like a credit card and is simply run by the provider's office for billing purposes.

As a health care provider, he gets paid two weeks after the service is provided. No money exchanges hands.

Referrals to our Canadian colleagues come through a general practitioner. Some GPs have extra training in counseling and may provide the service themselves. It can take 3-6 months to see a psychiatrist for an evaluation and medication alone versus 6-9 months to see a psychiatrist like Sachi who does the medication and psychotherapy himself. His own experience is that it is not uncommon for a psychiatrist in Toronto to provide psychotherapy. He told me the long waiting times reflect an intentional move by the government to keep costs down by limiting access through a shortage of physicians.

Sachi's malpractice is only $2,000 - $3,000 per year. He described Canadians as “not litigious.”

Physicians can opt out of the government plan and can offer some services as self-pay, e.g., some plastic surgery, if these are not covered by Health Canada.

Of course providing health care to every Canadian comes at a cost. After reaching of an income of around $79,000 and higher Canadians pay around 40 percent in taxes compared with some 30 percent in taxes that most of we physicians will pay in the U.S. at higher income brackets.

Our Canadian colleagues and Health Canada have much to teach us in the U.S. It's not a perfect system but it is a system. Canada needs more physicians to cut down on waiting time and of course this could mean higher taxes. But the cost of providing health care coverage for every citizen should not scare us away. It's simply the right thing to do.

David E. Drake, D.O., DFAPA, FACN, is in private practice in Des Moines, a clinical professor at Des Moines University. He can be reached at