cle, then I am sure that other physicians would be very grateful to him. Educating the public is, unfortunately, not the answer. It was not until seat belt legislation was enacted that the rates of death due to motor vehicle accidents began to decrease. Obviously Dr. Shanon and I disagree with Dr. Senecal's comments about air gun regulations. Senecal's point regarding the use of air guns as a way for children to imitate an adult who shoots powdered weapons raises the question of whether such emulation is desirable. Every one of Senecal's suggestions for solving the problem of air gun injuries features the word "should" prominently. However, most people do not change their behaviour unless "should" is replaced by "shall." For example, the provinces with the highest rates of childhood immunization are those in which such immunization is legally required before school entry. Since it takes a velocity of only 40 m/s for a pellet to penetrate the eye we continue to recommend that at the bare minimum the legislation covering powder firearms be applied to air guns; our first choice, notwithstanding Senecal's plea, would be for air guns to be banned. William Feldman, MD Department of Pediatrics Children's Hospital of Eastern Ontario Ottawa, Ont.
years ago, and I have been very happy practising here. I have freedom that Canadian physicians will likely never experience. For example, if I should get fed up with federal bureaucracy I can simply drop out of the Medicare program completely and still do very well with private insurance. I have found that physicians are much more respected in the United States. It is rare to read an article critical of physicians in the major newspapers here, but the continuous stream of doctor-bashing in Toronto's Globe and Mail was a strong motivation for me to leave Canada in the first place. I would also like to correct one misperception propagated by Copeman. Indeed, malpractice insurance is more expensive in the United States, but I am not the one who pays for the insurance my patients do. It is a cost that is simply passed through to the health care consumer. Moreover, I haven't been sued since moving here. Medical malpractice suits are largely an urban phenomenon. The educational system in Wisconsin is, I believe, second to none. Also, I have not experienced the violence and racial strife that Copeman speaks of. I have never known of or seen anyone carrying a loaded revolver. I admit that the situation is different in the inner core of large US
cities. Quite frankly I can't tell the difference between living here and Reference where I lived in my youth, except that the flags here have stars and 1. Funk and Wagnalls Standard Desk Dic- stripes on them. A more importionary, Har-Row, New York, 1984 tant difference for me, in addition to the greater freedom and power over my own practice, is that my income is double and my taxes are Thinking about half of what they would have been moving south? in Canada. The cost of living is much more reasonable, and, most I n response to Dr. William J. important, there is no goods and Copeman's letter (Can Med services tax. Assoc J 1991; 144: 843-844) I Canadian doctors wishing to moved to rural Wisconsin 10 move to Wisconsin should feel 202
CAN MED ASSOC J 1991; 145 (3)
free to contact me. There are plenty of opportunities. Peter W. Timmermans, MD 14 Beaver Dam St. Waupun, WI 53963
Not a day goes by when I don't hear or read about colleagues relocating to the United States. The reasons for moving are many, but everyone involved firmly believes that life will be better across the border. But is it really? Despite Canada's still undefined identity I have found during my fellowship in Cleveland that there are profound differences between Canada and the United States. The most significant is that Canada is a more civilized society: one that rejects capital punishment, supports the needy with social programs, allows nurses to take maternity leave without demotion or loss of job and has physicians who ask their patients what the problem is rather than what insurance they have. Examples of the decaying US social structure can be found every day - and not only in the newspaper but at work and at home. Driving downtown one encounters abandoned warehouses, walls covered with graffiti and many homeless people wandering aimlessly. Article 2 of the Bill of Rights states that the right to keep and bear arms shall not be infringed. Armed guards patrolling the hospital entrances greet the staff coming into work. The operating room's add-on list often includes cases of gunshot or knife wounds, child abuse, suicide attempts etc. Going on a late night stroll or jog now gives me a feeling of insecurity that makes such activities unpleasurable. In addition to helping my 6-year-old son with his homework I find myself obliged to educate him about drugs in school. There are many positive aspects to living in the United States. Professional opportunities abound, and the financial rewards LE
lcr AOUT 1991
years ago, and I have been very happy practising here. I have freedom that Canadian physicians will likely never experience. For example, if I should get fed up with federal bureaucracy I can simply drop out of the Medicare program completely and still do very well with private insurance. I have found that physicians are much more respected in the United States. It is rare to read an article critical of physicians in the major newspapers here, but the continuous stream of doctor-bashing in Toronto's Globe and Mail was a strong motivation for me to leave Canada in the first place. I would also like to correct one misperception propagated by Copeman. Indeed, malpractice insurance is more expensive in the United States, but I am not the one who pays for the insurance my patients do. It is a cost that is simply passed through to the health care consumer. Moreover, I haven't been sued since moving here. Medical malpractice suits are largely an urban phenomenon. The educational system in Wisconsin is, I believe, second to none. Also, I have not experienced the violence and racial strife that Copeman speaks of. I have never known of or seen anyone carrying a loaded revolver. I admit that the situation is different in the inner core of large US
cities. Quite frankly I can't tell the difference between living here and Reference where I lived in my youth, except that the flags here have stars and 1. Funk and Wagnalls Standard Desk Dic- stripes on them. A more importionary, Har-Row, New York, 1984 tant difference for me, in addition to the greater freedom and power over my own practice, is that my income is double and my taxes are Thinking about half of what they would have been moving south? in Canada. The cost of living is much more reasonable, and, most I n response to Dr. William J. important, there is no goods and Copeman's letter (Can Med services tax. Assoc J 1991; 144: 843-844) I Canadian doctors wishing to moved to rural Wisconsin 10 move to Wisconsin should feel 202
CAN MED ASSOC J 1991; 145 (3)
free to contact me. There are plenty of opportunities. Peter W. Timmermans, MD 14 Beaver Dam St. Waupun, WI 53963
Not a day goes by when I don't hear or read about colleagues relocating to the United States. The reasons for moving are many, but everyone involved firmly believes that life will be better across the border. But is it really? Despite Canada's still undefined identity I have found during my fellowship in Cleveland that there are profound differences between Canada and the United States. The most significant is that Canada is a more civilized society: one that rejects capital punishment, supports the needy with social programs, allows nurses to take maternity leave without demotion or loss of job and has physicians who ask their patients what the problem is rather than what insurance they have. Examples of the decaying US social structure can be found every day - and not only in the newspaper but at work and at home. Driving downtown one encounters abandoned warehouses, walls covered with graffiti and many homeless people wandering aimlessly. Article 2 of the Bill of Rights states that the right to keep and bear arms shall not be infringed. Armed guards patrolling the hospital entrances greet the staff coming into work. The operating room's add-on list often includes cases of gunshot or knife wounds, child abuse, suicide attempts etc. Going on a late night stroll or jog now gives me a feeling of insecurity that makes such activities unpleasurable. In addition to helping my 6-year-old son with his homework I find myself obliged to educate him about drugs in school. There are many positive aspects to living in the United States. Professional opportunities abound, and the financial rewards LE
lcr AOUT 1991
