Dorothy: [00:00:00] Today we’re going to be talking to Dr. LJ Henderson, and she is a primary care physician who is working in Canada. Now the unique thing about LJ is she’s also my daughter in law, and she brings a unique perspective on the differences between healthcare in Canada and healthcare in the United States. But at the end of the day, she still talks about being a physician is taking care of people. So proud to have her on my show today.
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Dr. Henderson, thank you so much for being with us and for our listeners to know, Dr. Henderson is here all the way from Canada, from Richmond, Canada, just outside Vancouver. Uh, she happens to be related to me, she is my daughter in law, but today we want to talk to her about the differences in healthcare between Canada and the U. S., and also about her experience as a female, being a doctor, and I found some of the things that you’ve tell me, really fascinating. So thank you for being here. We’re just happy to have you here with the grandsons and all of that.
L.J.: Yes, finally for a long awaited visit.
Dorothy: Yes, yes. We, we haven’t seen y’all since 2019. COVID seemed to have messed up a lot of things. [00:02:00] Did it stop the world in Canada just like it did here?
L.J.: Oh yeah, oh yeah, the kids were out of school for a couple months and Chris and I had to, because Chris and I both had to work, we couldn’t work from home, so we had to juggle our schedules so that someone was home, so yeah.
Dorothy: So you’re a general practitioner, or a—
L.J.: Family physician.
Dorothy: What is the difference? Is it just our terms and Canadian terms?
L.J.: The old term of a GP, a general practitioner, was someone who just did their one year internship and then went into general practice, whereas for the last, I think, sort of 20 plus years ago, you do your residency in family medicine, um, sort of as a distinct stream. So there’s a, so there’s not really, excuse me. Um, so we don’t really train sort of GPs anymore. It’s all family physicians.
Dorothy: So it’s almost a specialty now.
L.J.: Yes.
Dorothy: [00:03:00] Did you always want to be a doctor?
L.J.: I always wanted to be a doctor. Yes. Since about age six. Yep.
Dorothy: And was there an experience that?
L.J.: Um, not really. I think I just remember always being really like, just fascinated by, by sort of the human body and wanted to learn about it. And, um, I don’t come from a family of doctors. My mom was actually a receptionist in a doctor’s office. Um, so I did go in to the office where she worked when I was a little. And, yeah. That’s what I always wanted to do.
Dorothy: So, when did you finish medical school? How old were you?
L.J.: Uh, so I graduated medical school in, I remember, 2008? Yes, wait, uh, yes, 2008.
Dorothy: Had residency, didn’t seem to do it.
L.J.: That was, and then two years of residency, so finished residency in 2010.
Dorothy: Okay. Yeah. And, was that a, um, [00:04:00] was being a woman, made it any harder? Better? Did you see a difference in the way you were treated?
L.J.: I didn’t notice a huge difference, but family medicine is, is primarily like it’s vast majority of new family doctors and are, are women. So in my residency cohort, we were about, I think, 10 women and two men. Um, I think if you’re in a more, an area that’s still more sort of male dominated, like a lot of surgical specialties. Um, I think a lot of women experience a lot of, um, of gender bias. I don’t recall noticing a huge difference, but it’s, it’s, it’s more just because my specialty is more—
Dorothy: Well, but it also is a little bit more, I think, because women are more accepted, we hope, in a lot of areas.
L.J.: Yeah.
Dorothy: But even 30 years ago, there weren’t a lot [00:05:00] of female doctors, unless they were pediatric or, I guess, I guess family medicine. So, that is a good field for, for women to explore. I know that you did some research during your time as a, going through medical school.
L.J.: So before, uh, so before going to medical school, I did a master’s degree in genetics. Yeah. So actually when I first went in, started medical school, I actually was, was thinking of going into like clinical genetics as my specialty, and then ended up changing my mind.
Dorothy: I know some of your papers really focused on that. They were interesting. You did, and you did some work in cancer.
L.J.: Yeah, with cancer genetics. Yeah.
Dorothy: Yeah. Yeah. Yeah. So So within the systems, you know, being married to a Canadian, I’ve long, uh, heard about the differences in medical care here and medical care there and the philosophy that’s behind it. Uh, [00:06:00] we U. S. folks, because, you know, we’re all Americans, but folks in the U. S. still think that, oh my gosh, that’s terrible. You know, those Canadians are socialists. I mean, they, they have national medicine or national health care. So how do, how do you see the difference coming from the other way?
L.J.: Yeah, so I think, so, Um, yeah, so it’s not, it’s not sort of socialized medicine, um, because I’m not, I’m not a government employee. I don’t, I’m not employed by the government. I’m self employed. So I like, we hire our staff, so I have employees, but it’s a, it’s a single payer system. So when I, I see a patient and I bill for a patient. I bill the provincial government, um, but I’m not, I’m not a government employee. So I think some people don’t realize that difference that most physicians in, in Canada are self employed. Um, and we, we bill the [00:07:00] government’s government pays us, but, but they’re not our employer.
Dorothy: And how many are in your practice?
L.J.: Uh, we’re seven family doctors in my office, yeah.
Dorothy: And all female?
L.J.: Uh, five women and two men.
Dorothy: And your patient is primarily older, younger?
L.J.: Um, older. Uh, so I’m actually, my practice, I’m actually the third physician to have this practice sort of continuously. So it first opened in sort of like the late seventies. Uh, and there was one person there for about 20 years. Someone else took over the practice, um, he had the practice for about, um, another, that was, um, another maybe 15 years and then I took it over. So, a lot of those patients have been with the practice continuously, um, so because of that it is sort of, the practice has kind of aged, so it is an older, sort of an older demographic in, in my practice, um. [00:08:00] Uh, not a ton of like, of babies, mostly more sort of—
Dorothy: But you’re about to have, you have several patients who are about to have babies?
L.J.: I do, for, I have four patients all due in January, which is like the first time that’s ever happened. So, I don’t do the delivery, so I’m not delivering the babies, but I will take care of the babies once they’re, once they’re born, which is fun.
Dorothy: Oh yeah, yeah. Now, You did not start a family until after you had your medical degree and were in practice, right?
L.J.: Yes. Yeah. So after I finished residency. Yeah.
Dorothy: And how easy or hard was that?
L.J.: Um, it was, uh, I guess one of the, the challenges is that because we’re Uh, again, cause we’re not employees because we’re self employed, the time off. So the standard in Canada is one year of maternity leave for people who are, uh, employed.
Um, but because we’re self employed, we don’t, we don’t have access [00:09:00] to those, uh, benefits. Um, so the challenge is more with the time off. We get some funding from our provincial medical association for parental leave. Um, so. You know, most, you know, most women in Canada will have a year at home. Um, so with my two kids, it was, uh, six months, which I think in the U S is considered a lot, but that was like, people were like, Oh no, you have to go back at six months. Oh, that must be so hard. Uh, but thankfully, um, because Chris has access to parental leave. So he was able to take six months off. So, so both our kids were home for, you know, their, their first year before going to daycare.
Dorothy: Yes, that would be very unusual here. Any kind of maternity leave would be unusual. Especially a paid maternity leave of any kind. Yeah. So, uh, but still you had to juggle a lot with kids and school and, having a [00:10:00] practice and—
L.J.: Yeah, so, uh, yeah, I mean just sort of scheduling child care. Thankfully, Chris’s schedule is flexible and my mom helped us out a lot when the kids were younger and still does.
Dorothy: Is child care covered there? Wouldn’t you have to pay for it?
L.J.: No, no, it would. There is now, um, a program for what’s called 10 Dollar daycare, but that didn’t exist before, so no, yeah, I had to pay for it. Yeah, pay for it. Yeah, so that, yeah.
Dorothy: The, uh, One of the interesting things to me, of course, being in breast cancer for so many years, you know, our statistics are just about the same, U. S. and Canada. Uh, and it’s the second, you know, killer of women. It’s, it’s, all the things that we hear about it here, 1 in 8. About 25 percent of your female population will have it. Have you had to treat very many women with breast cancer?
L.J.: Uh, yeah, definitely. I’ve had, yeah, lots, lots of patients of varying [00:11:00] ages. Yeah. Anywhere from actually one of the, uh, when I was first in practice, and I actually remember this very clearly because it was sort of August of 2010 when I was like a month into practice, like one of my first experiences of like breaking bad news was a young woman, I think she was 39 at the time. Um, and she had, um, a triple negative breast cancer and she unfortunately died, but I have a very distinct memory of that being like my first time breaking bad news when I was in practice was, yeah, was a young woman with, with breast cancer and yeah, I mean, I have an older practice, so, um, uh, so, uh, yeah, so, uh, unfortunately fairly common scenario of either, you know, things picked up on screening mammogram or women coming in with a new breast mass, yeah.
Dorothy: But imagine, or think about this, triple negative was a death sentence in 2010, and it’s not anymore.
L.J.: Yeah, yeah.
Dorothy: I mean, that, that is just one of the, um, [00:12:00] good things, and I know it’s, you know, good, relative, but it is encouraging that we have found a way to deal with that when, that’s not that many years ago.
L.J.: Yeah, well, 14. It makes me feel old that that was 14 years ago when it was first in practice.
Dorothy: LJ, please. This is, there is no oh with you. Come on. I just wish people could watch you with your kids, running with them and playing with them. That, that, uh, certainly has kept you young. Uh, but another thing that I’m curious about, are you seeing in Canada, just like here, so many more young people? Uh, being diagnosed with cancer?
L.J.: I mean, I’ve heard that a anecdotally, yeah. Certainly. Um, uh, I am not sure what the statistics are, but it, it’s certainly something I’ve, I’ve heard it, you know, for, and, you know, for like, um, colon cancer, it’s for example. Picking ’em up in younger people, and maybe that’s because we’re screening better, so, or just, you know, more. [00:13:00] You know, kind of doing a better job of investigating them, I don’t know, but, um, but yeah, that’s, I’ve certainly heard that.
Dorothy: But see, we don’t even have the stats yet, really. You know, we’re still looking at that, going, how did this, look at this number, look, you know, in all the different cancers. So, it’s interesting that, uh, and you know, it’ll be 10 years before we really can verify.
Yes, there was a shift here, but, you know, from what I hear and from my colleagues, it definitely has shifted. It’s kind of, uh, It’s more than scary right now, how many young people. And at The Rose, we diagnose a lot of young people. So one of the things that, you know, we continue to repeat and, and message is catching it early makes all the difference. I know that’s probably the same message there. And also the importance of knowing your own breast. So many women find their [00:14:00] cancers. I mean, it is not, mammography is not the only thing to find it.
L.J.: Yeah, because actually another, um, younger woman in my practice that, yeah, she’d had her, she’d had her screening mammogram. Her screening mammogram was normal, but she had a, she had a lump. And I think actually the technician said, well, regardless of what your mammogram shows, you need to go get that lump checked. So she came in and saw me. I was like, yeah, I can definitely feel something. Send her for ultrasound and they could see it on ultrasound and even on her diagnostic mammogram they still couldn’t see it.
Um, but, but yeah, that was, I think that was actually, it was pre COVID. So that was a good five, so she’s almost five years out now. Um, and she did, she did great. So thank God that she came in and got that checked and wasn’t reassured by the, the clear mammogram.
Dorothy: And, and how smart of the technologist to say let’s go get this checked and not, You know, that’s one of the things about having that physician in the loop. Because [00:15:00] if we were to give a report to someone that says, Oh, your mammogram is normal, and she knows there’s a lump in her breast. Well, we didn’t do her any favors. We need that physician to be in the middle of all this to say, Oops. You know, you might have had a normal, but we still need to check this out.
There’s, there’s, uh, especially in our more difficult to diagnose, like lobular or, you know, some of these are just so difficult to see on, on mammogram, but boy, when you do the clinical exam, it’s there, it has to be. So in your, in your practice, do you, do you feel there is any, bias to how fast someone gets in, you know, that’s the other complaint we have. We say, oh, if we had national insurance, health insurance, we’d have to wait forever, like we’re not waiting a long time now, but you’d have to wait forever to get testing or that kind of [00:16:00] stuff. Do you, is that, is that a myth or is that true?
L.J.: Yeah, I mean certainly there, there can be delays like, um, that, that absolutely can happen. I mean, I work in a fairly well resourced area, so, um, I haven’t found it to be. When it comes specifically to, to, um, cancer related investigations, I haven’t found it to be a huge issue. There’s other, sort of, the more, kind of, chronic things like, um, you know, joint replacements, that kind of thing. They’re certainly a big issue with wait times.
Um, um, My experience has been that, you know, if it, if we’re, if I’m worried about a cancer, if we know it’s cancer and investigations are needed, that, that you can get it done in a, in a reasonable timeframe. And, you know, that I’m, I’ve certainly heard that in other, you know, certainly more rural remote areas or, you know, um, uh, you know, we’ll have more challenges with, with access, but [00:17:00] if it, when it, when it needs to happen, it can happen. And sometimes it takes some phone calls, um, and favors, but, um, you know, but when, when I’m worried about something, I can usually, usually get things done in a reasonable timeframe.
Dorothy: And what were you talking about with centralized testing? Uh, was it MRI?
L.J.: Uh, so there’s, well, so for example, like our screening mammography program is a provincial program. So, you know, women get sent their reminders when they’re due. They get sent their, sent their results and I get the results. So, I don’t have to, you know, remember to, you know, recall women for their screening mammogram. It’s all done through the provincial screening mammography program.
Dorothy: And it’s all covered in that?
L.J.: Yep.
Dorothy: But if I needed an MRI, you were, and it’s the same here, you know, you look for the place that can get you in the fastest.
L.J.: Yeah, so there’s a central, um, central booking for MRI for all, and this is all in like the Vancouver area. I don’t think it’s the same in other parts of the province, but, so all, it all goes to one [00:18:00] place and then they sort of, you know, kind of fan everything out so that the wait times are, are even, so you’re not having to guess like, Oh, can I send them to this hospital or this hospital? Like it’s all, it’s all centralized. And obviously they triage it based on, you know, based on urgency. So, yeah.
Dorothy: And there’s no longer a stigma with breast cancer, is there, within most of your population?
L.J.: Um, not that, that I have, have noticed. No, in, in terms of, um, um, you know, coming in for exams or getting screened or anything that there’s any reluctance that I haven’t noticed. No.
Dorothy: We still have many disparities.
L.J.: Yeah.
Dorothy: Um, and I’ve always wondered if the national approach to healthcare would have solved some of that. Mm. Because women that don’t know won’t go. Women that don’t have the funding won’t go. So, you know, we’ve created this double, uh, wall for any woman who’s not, you [00:19:00] know, well off or well resourced and, you know, that kind of thing to, to find those services.
L.J.: Yeah, I will say that, you know, one of the big barriers to, to screening and care in general is access to primary care. That’s probably the biggest limitation in the system at the moment. It’s kind of a belt 20 percent of the population in British Columbia does not have a family physician or, or a primary care provider, like a nurse practitioner.
Um, so if you don’t, if you can’t even access the system at that level, then that’s often the barrier to, you know, getting all your routine screening. Um, and then you’re left going to an urgent care or an emergency when, when you need something. So there, there are, there is a mechanism for people without a primary care provider to get screening, but it’s, it’s certainly a barrier when there’s not someone to say, Oh, hey, I see you don’t, haven’t had a mammogram, you know, make sure you call and book it if you don’t have that reminder, if you’re not even in the system. So that, I [00:20:00] think that’s probably probably the single biggest challenge in the system right now is primary care access.
Dorothy: Are you the care, are you the gatekeeper to everything?
L.J.: Yes.
Dorothy: Yeah. Just like here. Yeah. Yeah. And, and I think that in our situation, rural Texas has a lot more challenge because so many of the family doctors have left the small communities and gone to bigger. So we’re, we’re really seeing an issue with that here. And I think the stats are pretty much the same. You know, how many people do not have a family doctor or general prac or primary care physician? Now, one of the things you, you said during your stay here was we were talking about just trauma. And you said that, you know, you’ve got to know all these things so that when you have a trauma case come in, a gunshot, and you went, wait, wait, you know, I said, what? And you said:
L.J.: We don’t see a gunshot.
Dorothy: Yeah, but you don’t see, I just went, what? You had to actually, medical [00:21:00] students had to come to the, to the U. S. to get that kind of.
L.J.: So for, I mean, this isn’t my area, but from what I understand is that, uh, like, uh, people who are specializing in, um, trauma surgery or sometimes emergency, if they want to have more exposure to those kinds of injuries, we’ll come and do training in the U. S. And, and it, again, it’s not that there’s no gun violence in Canada, there certainly is. It’s just obviously a lot less. So I’ve never, you know, and I, I went to medical school in Toronto, so I trained in downtown Toronto and my, in residency I did, you know, my hospital was in downtown Vancouver and never saw a gunshot wound ever. Not one. So, yeah.
Dorothy: Oh my goodness, that, that is a difference, really, when I, all the other physicians I’ve ever talked to have had that experience that are here, yeah, that is, um. I’m not sure what that says about us, really. So do you plan to have a very long practice?
L.J.: Oh, that’s a good question. You know, it’s cause now I, you know, I’m, yeah, [00:22:00] 14 years into practice. So I, I always thought of myself as sort of, Oh, I’m still early career. And then recently I was like, Oh gosh, I’m mid career. I had to start thinking about, yeah, where, uh, yeah, like, You know, what is sort of the, what is the, what’s my exit, exit strategy? Um, so yeah, I don’t, I don’t know. And well, yeah. All my patients are like, you can never retire. So they’re like, don’t leave us. So we’ll see. It’s still far enough away that I haven’t quite thought about it yet. But.
Dorothy: So you still love what you do.
L.J.: Yeah. I mean, sometimes I say, um, I don’t always love my job, but I love my career. If that makes sense. Like I love family medicine. There’s a lot of, uh. Parts of it that are challenging, like all the administrative stuff, [00:23:00] um, that kind of comes along, uh, with it. But at the end of the day, you know, I, I, I know my patients so well, um, and I love that, that part of it, like the relationship I have with my patients. So that’s certainly what keep them going. Cause a lot of people, uh, I think especially during the pandemic, a lot of people left family practice. Thankfully we did have a bit of a change in our payment model in our province recently to increase pay for family physicians that did bring a lot of people back into family practice.
But yeah, certainly the, in family medicine, it is the, I think, the connection with your patients that kind of keeps you, keeps you going.
Dorothy: You know, it’s the same here with listening to the physicians talk about, Yeah, we have an electronic medical record.
L.J.: Yeah.
Dorothy: I’m sure you do.
L.J.: Yeah.
Dorothy: Sure it’s electronic, but I have to sit here and put all this stuff in.
L.J.: Yeah.
Dorothy: It’s just not worth my time. But you don’t, you don’t have to fight insurance companies, even though there is a private insurance there, right? Private and public?
L.J.: [00:24:00] Uh, no, there’s no private for like any sort of necessary medical care. There’s no like, cause sometimes patients will come, like you’ll have sort of what’s called extended benefits for, um, you know, medications or, you know, things like physiotherapy, massage therapy, but anything that’s done, anything that’s necessary, medical care is.
So, uh, so no, I had to submit my bill to the province and they pay me and I don’t have to argue.
Dorothy: Oh my gosh, that would be so unique, so unique here. I do remember, uh, your father in law, Patrick’s father, saying to me when, uh, we were first together, he said, you know, there’s two differences, or there’s a difference in, in the U. S. care and Canadian care, and he said, here in Canada we have public and private, because some people can buy the extra. There—
L.J.: Yeah, there are some things you can access privately.
Dorothy: And he said, but in the U. S. you have public [00:25:00] and private and none.
L.J.: Yeah.
Dorothy: And I went, Oh, that’s exactly why The Rose exists. Because we do deal with a huge population that has none. I mean, it’s just, for him, that was. Unconscionable. You know, it was like, how could this be happening? I’m a physician. I take care of people and to know there’s people out there that will never have care, you know, it was just beyond his imagination. He was very adamant about that. Well, what else would you like us to know about the differences or the plus and minuses?
L.J.: Yeah. And it’s, and, Yeah, I mean, and, you know, I’m not an expert on, on, on health policy and health economics by any means. So, um, And yeah, I mean, I certainly don’t want to leave the impression that everything is sunshine and roses, because it’s not. There are certainly challenges in the system and, um, you know, [00:26:00] overcrowded emergency rooms and overcrowded hospitals and hallway medicine. And, you know, I don’t do acute care, so I can’t sort of speak to that directly. But, um, but yeah, certainly a lot of my colleagues are very overworked and overwhelmed.
And, you know, as are we in family medicine, I mean, I, I could easily double the size of my practice, um, but then, then there’s going to be less access to me. So I always kind of tell people like, well, you could either, you know, if I take on more patients, then while you’re going to wait six weeks for an appointment to see me.
So it’s always difficult because every day, are you taking new patients? Are you taking new patients? My friend, my neighbor, their doctor retired. Like, can you take them? I’m like, I just like, it can’t, like, I just don’t have, I don’t have the capacity in the, um, In the schedule. So there’s certainly a lot of challenges in the system for sure.
But I do, you know, when I do just. I’d, I’d never have to worry that if I, if I do want, you know, whatever test or, you know, if a patient needs whatever surgery, [00:27:00] the barrier will be, you know, the wait time. And, but they, they will get it , no one’s gonna deny them care based on whether or not their insurance will pay for it, if they can pay for it. So they a bit of—
Dorothy: So you make a plan?
L.J.: Yes.
Dorothy: And it gets executed?
L.J.: Yes. Yes.
Dorothy: I think of all the things that you’ve talked about today, that is the number one difference.
L.J.: Yeah.
Dorothy: And how physicians feel here. They feel like so much of that control and ability to guide their patients is now dictated by something else or someone else.
L.J.: Yeah. System. Certainly there’s, yeah, challenges, but it is, yeah, it is always nice to know that like, if I feel they need it, if their specialist feels they’ll need, they need it, whatever test or, you know, treatment, it’ll, it’ll happen. There might be a delay, but it’ll happen.
Dorothy: Yeah. Right.
L.J.: Yeah.
Dorothy: Well, thank you so much. We’ve enjoyed just knowing these differences. I’m almost afraid to let this one air because doctors everywhere will be going, I want to go to Canada. I don’t want to have to deal with [00:28:00] all this. But, uh, but obviously you found that profession that you want to be in. And it’s, it’s very, uh, it’s rewarding for you.
L.J.: Yes. Yeah, for sure.
Dorothy: Well, thank you again for being with us.
L.J.: Thank you for having me.
Post-Credits: Thank you for joining us today on Let’s Talk About Your Breasts. This podcast is produced by Speke Podcasting and brought to you by The Rose. Visit therose.org to learn more about our organization. Subscribe to our podcast, share episodes with friends, and join the conversation on social media using #LetsTalkAboutYourBreasts. We welcome your feedback and suggestions. Consider supporting The Rose. Your gift can make the difference to a person in need. And remember, self care is not selfish. It’s essential.
