Health Care in U.S., Canada

Your reporter is correct in pointing out that the Canadian system, which provides universal health coverage for all at a significantly lower cost but with better outcomes than the U.S., is based on a delivery system in which at least 50% of the physicians are family physicians. This is in contrast to the high-tech, high-cost U.S. system where only 12% of physicians are family physicians. In fact, the U.S. is out of sync with not only Canada, but with all other industrialized democracies where family physicians compose 55% to 70% of the total physician population.

Your writer is also correct in reporting that many medical students elect to go into the highly paid specialty fields because of escalating medical school debt. While the government is not doing enough to train generalists to meet the needs of the country, it does have a program that addresses medical student debt.

The National Health Corps was established in 1972 to provide scholarships for health students in exchange for practicing in inner-city and rural shortage areas. The present-day corps, reauthorized by President Bush in 1989, continues to offer scholarships but has shifted its major emphasis to a loan repayment program. Under this incentive system, primary care physicians, especially family physicians, can join the corps upon completion of their residency training. After selecting a site from a list of shortage areas, which includes two-third of our nation’s counties, they will not only receive a salary but also an additional $35,000 in both the first and second years for loan repayment. If they elect to stay for a third and fourth year, the loan repayment amount increases to $49,000 per year. This program is designed so that students with a debt of $100,000 to $125,000 upon graduation could be out of debt within four years while providing health care to an inner-city or rural shortage area.

PATRICK T. DOWLING MD

Chairman, Dept. of Family Medicine

L.A. County Harbor-UCLA Medical Center