Good morning. Alberta, Ontario and Quebec all have unique takes on fixing the health-care crunch \u2013 more on that below, along with a potential Air Transat pilot strike and Spotify Wrapped\u2019s most-streamed artist. (Sorry, Swifties.) But first:<\/p>\n
Today\u2019s headlinesOpen this photo in gallery:<\/a><\/p>\n Alberta wants to boldly go where no province has gone before.Todd Korol\/The Globe and Mail<\/p>\n Health careThree solitudes<\/p>\n It\u2019s no secret<\/a> that Canadian health care is in rough shape. We may shell out $399-billion each year<\/a> on hospitals, drugs and physician services, but our return on investment is far from ideal. At least 6.5 million Canadians don\u2019t have a family doctor. Wait times for surgeries now average 30 weeks. Emergency rooms are either overcrowded or straight-up closed<\/a>, and new drugs can take years<\/a> before they\u2019re available here.<\/p>\n Patients need better care, and some provinces have very different ideas about how to go about it. Let\u2019s take a look at three recent approaches to clear doctors\u2019 queues. <\/p>\n Ontario\u2019s model: Give doctors a carrot<\/p>\n What that means: Money, mostly. In September, Premier Doug Ford\u2019s government inked a deal with Ontario physicians to deliver a 7.3-per-cent pay bump over the next three years, plus new compensation for all the admin work that family doctors take on. Ford also promised $2.1-billion earlier this year to tackle the shortage in primary care, and he\u2019s had some success getting people off the wait list<\/a> for a family doctor. As of Jan. 1, there were approximately 235,000 people on Ontario\u2019s Health Care Connect list; the government says 65 per cent of them now have a medical provider. <\/p>\n What could go wrong: That Health Care Connect list is just the tip of the iceberg. Last year, the Ontario College of Family Physicians estimated<\/a> 2.5 million Ontarians had no family doctor \u2013 and there will soon be far fewer of them to go around. A new survey from the Ontario Medical Association found that 52 per cent of primary physicians are eyeing retirement<\/a> in the next five years. At the same time, only 42 per cent of Ontario medical students say they\u2019re even considering family medicine as a career. Ford might want to reverse his new rule<\/a> limiting international medical students from applying for residency spots.<\/p>\n Quebec\u2019s model: Show doctors a stick<\/p>\n What that means: Dramatically changing the way they\u2019re paid. Quebec\u2019s Bill 2, meant to take effect in January, dispenses with the current fee-for-services system and instead ties compensation to the number of patients<\/a> a doctor enrolls. And if the province\u2019s physicians, as a collective, fail to hit certain targets \u2013 ensuring every Quebecker has a family doctor by next summer, for example, or that 75 per cent of ER patients are seen within 90 minutes \u2013 the government will claw back as much as 15 per cent of their pay. Oh, and if doctors protest the new law with work slowdowns or stoppages? They\u2019ll face a fine of up to $20,000 a day.<\/p>\n Open this photo in gallery:<\/a><\/p>\n Montreal family doctor David Rothstein with a young patient.ROGER LEMOYNE\/The Globe and Mail<\/p>\n What could go wrong: You could have a bunch of Quebec doctors threatening to resign, find other work or leave the province altogether \u2013 which is exactly what\u2019s happened<\/a>. They argue Bill 2 amounts to a drastic pay cut that will also hamper their ability to provide adequate care. Quebec pediatricians, for example, point to a potentially disastrous loophole<\/a>: Healthy children, even newborns, have been classified as among the least vulnerable patients, bumping them down the priority list and compensating doctors relatively little for taking them on. <\/p>\n Alberta\u2019s model: Let doctors double dip<\/p>\n What that means: They can toggle between the public and private health care systems. Late last month, Alberta introduced a bill that allows physicians to offer their services in both markets<\/a>, a hybrid model that the government argues<\/a> has shortened wait times in Denmark and France. Premier Danielle Smith said that surgeons would be the focus<\/a> of the new approach, though her Minister of Hospital and Surgical Health Services, Matt Jones, told reporters the scope could be \u201cbroader than surgical activity\u201d and include family doctors.<\/p>\n What could go wrong: It\u2019s hard to know yet, because no other province has actually tried this before \u2013 doctors have to choose whether they want to bill the public purse or privately charge patients for care. Physicians who study Alberta\u2019s work force believe that the model could prove lucrative for some providers, but it\u2019s unlikely to create much new capacity<\/a> in the system. And critics like Alberta NDP Leader Naheed Nenshi warn the changes amount to \u201cAmerican-style medicine,\u201d where wait times will get longer for those who can\u2019t afford to pay. Although, as Robyn Urback points out<\/a>, Canada\u2019s single-tier health care is already a mirage: If you have time and resources, you can usually buy your way out of the queue.<\/p>\n The Shot\u2018The U.S. right now is just totally toxic.\u2019Open this photo in gallery:<\/a><\/p>\n Karon Sinning and Roy Bennett are ditching the Florida trailer park for a new winter home.Nick Iwanyshyn\/The Globe and Mail<\/p>\n Canadian snowbirds are scouting further afield for their vacation homes<\/a> \u2013 maybe Portugal, maybe Costa Rica, maybe Mexico.<\/p>\n The WrapWhat else we\u2019re following<\/p>\n At home: Revised Statistics Canada data show the Canadian economy was on a stronger footing<\/a> heading into the U.S. trade war than previously reported.<\/p>\n Abroad: Immigration Minister Lena Metlege Diab warned foreign nationals about abusing Canada\u2019s asylum system<\/a> as the U.S. and Britain tighten their rules.<\/p>\n Off the job? Air Transat pilots voted overwhelmingly to strike<\/a> if contract talks fail next week.<\/p>\n Off the books? Foreign Affairs Minister Anita Anand won\u2019t say if Canada will block the export of armoured vehicles<\/a> earmarked for U.S. ICE agents.<\/p>\n In your ears: Bad Bunny has dethroned Taylor Swift<\/a> this year as Spotify Wrapped\u2019s most-streamed artist. <\/p>\n