Across the border: How this Canadian DO is growing the osteopathic profession

This month, we travel north of the border to Canada to speak with Dennis Fiddler, DO, former president of the Canadian Osteopathic Association (COA).

While osteopathic physicians’ numbers are not large in Canada—there are roughly 40 U.S.-trained DOs in all of Canada—Dr. Fiddler comes from quite the DO lineage. He is proud to follow in the osteopathic footsteps of his father, uncle and cousin.

As a proponent of the osteopathic medical profession, Dr. Fiddler is a point of contact for premeds interested in osteopathic medicine and DOs returning to Canada to practice. His story is intertwined in the modern growth of Canadian osteopathic practice.

Dr. Fiddler started his training in sunny South Florida at Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM), soaking in not just the sunshine, but also the osteopathic principles of medicine. From there, he completed clinicals in the region and saw firsthand the major differences between the American and Canadian medical systems.

After observing health care for four years in the States, he ultimately decided to return to Canada to complete residency and practice medicine. In this edited Q&A, Dr. Fiddler discusses his journeys on both sides of the border as well as what it is like being an emergency physician in Canada.

What did your path to osteopathic medicine look like?

My father and uncle were both U.S.-trained DOs practicing in Canada. They were the first two fully licensed osteopathic physicians in the province of Ontario, were integral in establishing osteopathic practice in Canada and were very involved in the COA. I was lucky enough to know their path to osteopathic medicine.

In addition to the family draw, I wanted to make a difference and not just “help” people. When you can make a difference in somebody’s life, that resonates deeper than just helping someone. That’s what led me to osteopathic medicine, as it is all-encompassing.

NSU-KPCOM was one of three osteopathic schools at the time that was accepting pre-med students after 90 credit hours of undergrad without a degree. So, I applied after 90 credit hours in my undergrad years and I got accepted. There was also a sense of adventure of traveling across the entire U.S., and you can’t beat the weather down there in south Florida either.

Being exposed to both the U.S. and Canadian health care systems, can you describe the main differences between them?

I personally really wanted to come back to Canada to work. I knew what it was like in Canada to actually have universal medical coverage. In the U.S., I saw some advanced pathology of diseases that we do not generally see up here. I assume this is mainly due to health care affordability and accessibility.

In the U.S., sometimes patients have to put off certain treatments or medications due to cost. In Canada, with our provincial health plans, the health care visits and medical procedures are covered, so our patients or their private insurance do not end up footing the bill. There’s of course a flip side to it.

Because every Canadian is covered in Canada, it can take you longer to get elective procedures you want done, such as a knee replacement, hip replacement, et cetera. In the U.S., if you want a hip done tomorrow, you pay a surgeon and get it done. However, in emergency medicine, all procedures or tests that we deem are necessary get done at no cost to the patient.

In Canada, if I am going to treat somebody, I know that it will be covered, and it will not be a financial burden to them. If I want to perform a procedure or imaging modality to help them, I do not have to worry about an insurance company denying it without prior authorization.

You are an ER-trained doctor, what made you go into this field?

My dad and uncle were not only DOs but also emergency medicine physicians. I even work at the rural emergency department that they helped maintain for more than 20 years. You can say it’s kind of genetically made, but I think it honestly works well for my brain. My brain tends to work on many problems at once and emergency medicine complements it because it’s a chaotic environment too.

Also, I like helping people at their time of crisis. This is when I feel I can be of the biggest benefit to their health care.

Can you share with the readers a patient story or interaction that resonated with you and steered you to where you are now?

I can give you two stories as to what made me want to come back to Canada to work. I was a med student in Florida and I had a patient who was on the pediatric service. This kid came in with acute respiratory distress syndrome from measles. They were in the PICU because their lung function had decreased so much, and it was shocking to me that we were going over vent settings on pediatric patients. The treatment of measles is supportive and there’s not much we could do at that time.

I kept thinking in my head, ‘What are you talking about? This is a preventable disease. How is this happening?’ Unfortunately, the parents did not have the resources to get the kid to his doctor and ultimately couldn’t get the vaccine. I kept thinking that this is a preventable disease, and this could have been avoided. With universal health coverage, this type of scenario is less likely in Canada.  

However, at this time, some parents do not want vaccination for their children. Maybe I will see more of this in the future. But I had a tough time seeing a kid on a ventilator with a preventable disease.

The second story was when I was doing internal medicine clerkships. While rounding, we were going to see a patient with a cough, hemoptysis, fevers and night sweats. A couple people in her apartment building had TB. I went to talk to the patient with my N95 mask in the negative pressure room.

After speaking with her, we came out to the attendings and told them the gold standard test was the beta interferon gold to rule out TB. However, there is a brought differential that still needed to be excluded with some bloodwork and imaging. The attending said, ‘Well, yeah, that might work, but her insurance won’t cover that, so we are going to have to give her Isoniazid for the next nine months.’

I thought to myself, ‘We are not even going to prove that she has TB and we are going to give her a medication that could screw up her liver for the next nine months, because that’s what the insurance company is forcing our hand to do.’

What advice would you give to students looking to shadow DOs and mentors in Canada?

It’s easier to shadow DOs in the U.S., due to their increased numbers in comparison with Canada. In Ontario, there are no rules against shadowing, but the issue is finding a DO to shadow. Even though most of the DOs are in Ontario, it can still be difficult. Each province has their own version of patient privacy laws.

Another good resource for premed students is the Canadian Osteopathic Medical Student Association (COMSA). This organization is run by current Canadian osteopathic medical students in the U.S. Also, the COA can forward you to DOs in Canada who are letting students shadow them. DOs in the U.S. who wish to return to Canada to practice should contact us at the COA. We would be happy to show them the path.

Related reading:

From Philly to Florida: How this DO’s path led to him serving underserved patients

Public health: How this DO is improving access to care for patients in the Mississippi Delta region