The College is fortunate to have wide representation of its Board of Governors from all 50 U.S. States, Canada, Mexico, the Army, Navy, Air Force, Veterans Affairs, and Public Health. We have much to learn from one another, as there are several inherent differences between our health care systems.

Our colleagues from Canada share with us “a day in the life” in latest issue of Cardiology magazine. We learn that there are a few similarities and several differences between Canada’s health system, which covers 100 percent of the nation’s citizens, and the U.S. traditional practice system.

Cardiologists in Canada work in an independent and autonomous practice style environment which includes autonomy in diagnostic testing and treatment. Emergency and acute care, including state-of-the-art STEMI care, as well as readily available access to urgent testing and procedures are hallmarks of the Canadian health system.

The private practice in Canada is similar to the U.S., as cardiologists are responsible for their office operation, overhead, staff, professional dues, and development. There is no pension plan for private practice physicians, but there is the option of professional incorporation in some provinces, which takes advantage of the small business tax program, and taxes the first $500,000 of income at approximately 15 to 16 percent.

Billing for clinical services in the Canadian system goes to a single payer, which is a provincial government agency, with some exceptions including services rendered to armed forces. The system is electronically based, taking only two to three hours per week per physician. Correct submissions receive virtually immediate payment and there is no pre-authorization required.

While the U.S. engages in the tort debate, Canadian physicians are defended by the Canadian Medical Protective Association (CMPA) which provides medical assistance, defense, and advice to physician members in times of medical malpractice disputes. Only about one out of every 10 cases go to trial, and when they do, CMPA’s defense success is about 90 percent. Thanks to provincial reimbursement programs, the cost of CMPA coverage for individual cardiologists is extremely modest.

Canadian health care does have issues of concern. Hospital bed availability, emergency room overcrowding, and long waiting lists for some non-urgent care and testing are areas in need of improvement. To address the negative impact of long waiting lists, the Canadian Cardiovascular Society (CCS) developed a set of National Waitlist Guidelines. The Canadian Medical Association’s Wait Time Alliance has adopted these benchmarks and they are increasingly used in system planning and goal setting.

Budgetary limitations also tend to stifle the ability to introduce new programs, particularly new technology to hospitals. Program and patient needs sometime come into conflict with the limitations imposed by fixed funding streams from provincial governments to hospitals. Canadians see the need for improvements and in a survey taken by the Institute of Research on Public Policy in June 2011 of more than 1,200 citizens, working with the provinces on health care ranked highest in a list of possible priorities for the federal government.

Thanks to our friends Christopher Simpson, MD, FACC, Rodney Zimmermann, MD, FACC, and G.B. John Mancini, MD, FACC, for giving us a closer look into their Canadian health system.

View the Nov/Dec 2011 issue of Cardiology Magazine here. More information about the ACC’s Chapters is available at CardioSource.org/Chapters.