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November 1991

Practicing Medicine Above and Below the 49th Parallel: One Physician's Experience: The Fiction, the Facts

Author Affiliations

111 Third St Ashland, OR 97520

Arch Intern Med. 1991;151(11):2150-2153. doi:10.1001/archinte.1991.00400110014004

At the time our family left Canada in the fall of 1981 to move to Oregon, I practiced psychiatry with little outside interference. I dealt with only one insurance carrier, the Medical Services Plan of the Province of British Columbia. But, somewhat homesick, needing more clinical challenge, and wanting to practice with my psychiatric nurse wife, Betsy, who could not practice with reimbursement in British Columbia, I decided to move back to the United States. I had heard I could practice there with "greater freedom."

I had a lot to learn. In fact, American physicians' criticisms of the "socialized medicine" I experienced in Canada might be more appropriately directed at the accelerating bureaucratization of American medicine (and at the attendant loss of clinical, social, and political autonomy in American medical practice). But I did not know that then. In practicing in both Canadian and American medical systems, I have learned