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Marcia Sirota

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A Canadian Psychiatrist in the U.S. Health Care System

Posted: 09/26/2012 5:23 pm

Many of my medical colleagues fuss and gripe about the health care system, and my patients occasionally do the same. It's not a perfect system by any means, but having practised psychiatry in the United States as well, I have an pretty good idea about the differences between the Canadian and American health care systems.

When I began working in the States, I was a new graduate and my only option at the time was hospital-based work, as I wasn't eligible to sign on to any public or private insurance plan. My first job was in the far reaches of Brooklyn at an outpatient medication clinic.

I saw dozens of patients each day, many of whom were desperate to have someone to talk to about their problems. Because of the volume of patients, I had to tell these people that there simply was no time for us to talk. It broke my heart.

I'm sure that a lot of these people would have been able to reduce or even discontinue their medications if they'd had access to good quality psychotherapy, but this population was out of luck. At the same time, the government had put in place an extensive system for documenting our work. Unfortunately, all the time we had to spend on paperwork cut into any extra time we might have used to actually talk to these patients.

Soon afterwards, I returned to Canada to set up a private practice. I'd maintained my license while away in the States, and was immediately re-inscribed in the health care system. I was able to start building a psychotherapy practice right away -- the kind of work I really wanted to do.

Since I've returned to Toronto, I've seen the benefits of the Canadian health care system up close. The great majority of my patients are people who couldn't have afforded to pay for psychotherapy and whose private insurance wouldn't cover more than a handful of sessions.

Our government is wise enough not to put limits on how much care any one patient can receive, and therefore, my patients and I are able to take the time we need in psychotherapy to do good quality work. We've been able to deal, not only with their immediate crises but with the long-term issues that have interfered with their ability to function in their personal, professional and academic lives.

In the past 11 years, I've seen a number of my patients return to school, get off welfare and disability insurance and re-enter society as productive citizens. This was directly attributable to the fact that they could take the time they needed to deal with their issues in therapy.

Gina* was working as a cocktail waitress and suffering from anxiety, depression and ADHD when she began psychotherapy. She has since been able to complete a Master's degree and is now a consultant in a major firm. She married last year and is about to have her first child.

Abbie* is currently doing her PhD. She's the top student in her program and the recipient of several research grants. Suffering from PTSD, she'd been a heroin addict and was living beneath the poverty line. Today, she's engaged to be married and is planning a career as a university professor.

When I first began working with Beth*, she was living in a rooming house in a small town in Ontario and was on disability insurance for Bipolar Disorder. Today, she rents a lovely apartment in mid-town Toronto and has been gainfully employed for several years. She completed the Bachelor's degree that she'd abandoned when she first became ill, and is currently back in school, upgrading her skills.

Caitlin*, who suffered from extremely poor self-esteem, was living in a basement apartment when we first began working together. She had a dead-end job and hadn't been in a relationship for six years. After a few years of therapy, she'd found a wonderful new job, was in the process of purchasing a home with her fiancé and had lost 35 pounds.

Emma* is an ex-alcoholic, drug abuser and high-school drop-out with a history of severe childhood trauma. Therapy has enabled her to begin university where she's winning awards and completing her first novel.

These are only a few examples of the changes that are possible when people are free to engage in meaningful, long-term psychotherapy. I'm grateful to be able to provide these services to my patients on the Ontario Health Insurance Plan, and I'm proud to be a Canadian, knowing that my tax dollars are being put to good use in subsidizing this plan.

When the government invests in health care they're saving money in the long-run, as many previously impaired individuals can get off the unemployment, welfare or disability rosters and become not only happier individuals but productive, high-functioning members of society.

*All names and some details have been changed.

 

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