By BERNIE BELLAN Elsewhere on this website we have a piece by Dr. Elisa Flaybush who, although she received her medical training at the University of Manitoba medical school, went to the US for specialized training in gastroenterology – and chose to remain in the US. You can read Elisa’s commentary on our Canadian medical system at “Manitoba trained Jewish physician now living in US laments state of medical care in Canada.”

That piece elicited quite a few views. Unfortunately, we do not allow comments on our website. (We get inundated with spam comments and it’s too time consuming to wade through them to find legitimate comments.) Interestingly though, we received a very thoughtful email sent to us through our “Contact Us” link from another former Winnipegger, Dr. Martin Koyle – who also chose to go elsewhere for specialized training – in his case, in urologoy, following his graduation from the U of M medical school. In Dr. Koyle’s case, however, after spending most of his career in the US, he did return to Canada – to teach and work first in Montreal and latterly in Toronto.

(We might also note that Dr. Koyle has been the recipient of many awards throughout his career, most recently having been selected as one of the American Urological Assocation’s 2026 Distinguished Award Winners.)

Following is Dr. Koyle’s piece, written in response to Dr. Flaybush’s piece:

Bernie: I enjoyed your dialogue with Elisa, whom I do not know. I must admit that my training and education in Manitoba more than prepared me for subsequent specialist training and spending the majority of my career in the USA, but returned to spend the last 10 years of my full-time career as Professor of Surgery at the University of Toronto Temerity Faculty of Medicine and Women’s Auxiliary Endowed Chair in Urology and Regenerative Medicine at SickKids. Like Elisa, I was not mentioned in Eva (Wiseman)’s book because, like Elisa, I never returned to Winnipeg to practice, but have returned multiple times to operate and serve as visiting professor.
Much of my 40-year career and success was because of the education and mentorship I received from Eva’s husband, Nathan, also Dr. Alan Decter, Dr. Luis Oppenheimer, and Dr. Harvey Chochinov, all Jewish. Certainly, many of my non-Jewish educators had major impacts on my development as well and I feel fortunate to have been lucky. Before I accepted a postgraduate residency training position at Harvard I had long discussions with Nathan and Alan, and looked at all alternatives. One of them said that the 3 most overrated things in the world were “homecoming, sex and Harvard Medical School!” After a few months back I replied to that comment, agreeing with the latter insight, but fervently disagreeing with comments regarding homecoming and sex! However, the Harvard reputation and networking opportunities paid dividends that I likely would not have garnered had I stayed in Manitoba to train and then eventually sought to seek other opportunities.

I too believe that the Canadian healthcare system is broken despite best intentions. Reality is reality. From the time of William Osler until my starting practice in 1984, medical knowledge was doubling in a linear fashion roughly every 7 years. Over the past few decades, with all the innovations and disruptions, biomedical knowledge now grows exponentially, every 2.5 months! Moreover, the number of medical specialties and subspecialties has gone from 40 to 150 over the past 4 decades. Moreover, in my parent specialty of urology, within 5 years of my subspecializing in pediatric urology, I had become a dinosaur, as urology over that short period had changed so dramatically. Routine x-rays were replaced by ultrasound, then CT scans, and then MRI was added. Hands on surgery became largely replaced by laparoscopy and now robotic surgery. New drugs, new guidelines, new metrics, litigation, peer pressure, the electronic medical record, and much more have increased the complexity even more… and the costs to boot! Since the system is based on taxpayer dollars, it is always playing catch up.
Elisa and I are proceduralists that cost the system money and much of what we do is therefore elective. In Canada, in order to see a specialist like her or me, you most often need a referral from a primary care provider, usually using an archaic methodology of FAXing a referral form and hoping a response ultimately reaches the patient. In the USA, if we don’t address a call or referral immediately and appropriately, whether in private practice like Elisa, or in an academic environment like me, we are quite likely to lose that referral base and even that entire practice. So, customer service in our competitive model is essential.
In my practice, I am salaried and see insured and indigent patients, who are all treated equally. In semi-retirement, we are constantly attempting to improve access in the hospital where I work. During my 10 years in Toronto – and I assume it’s similar in Manitoba, my practice felt like an impersonal, never-ending conveyer belt, with very little relationship with the referring provider or, sadly, the patient. The physician also was the one who bore the brunt of patient complaints for any delay or cancellation, despite having no control of the system in which I worked.
Elisa, being in private practice, likely has more control over flow than I do. I use allied health providers, nurse practitioners and physicians as a team to improve flow. They are underutilized in Canada and too much reliance is placed on the gatekeeper, the family doctor. Canada tries to play nice in the sandbox, so to speak, by thinking that all inhabitants of a given province or territory have equal access and equal care. However, many patients in Canada need supplemental insurance – which can be costly if not offered by an employer.

So healthcare is challenging. We are living longer, with more chronic conditions that can now be treated better and hence, prolong life. In the US as much as 25% of healthcare dollars are spent on prolonging the inevitable. In Canada there is far more emphasis on palliative care and hospice, far reducing end of life costs. There is much waste in both systems – with a lot of over management (mismanagement?). In the US it is as challenging as the Canadian system, but for different reasons. There is a profit motive in an open market system, whether that be the insurance company, the hospitals themselves, or the provider. Whether the government provides the dollars through taxes (Canada) or all those pieces that don’t necessarily fit perfectly in the American system, the bottom line needs to finish in the black.

So healthcare is broken, and while fair and equitable is a laudable human-focused goal, it is challenging to achieve in a never-ending playing field. Similarly, an open market system – as Elisa has suggested, works in many instances, but in order to provide for all, it is reliant on government (tax) dollars as well. With the changes in administration in the US, where there is fear that the Social Security and Medicare (federal care dollars for those over age 65 and those with significant conditions like kidney failure) pots are not being replenished as the population ages, and state support has diminished for Medicaid (support for low income), the system also faces mounting challenges as well.

Martin A. Koyle MD, MSc, MMgmt, MBA(cert.), FAAP, FACS, FRCSC, FRCS (Eng.), FRSM
Professor Emeritus, University of Toronto, Temerity Faculty of Medicine & Institute of Health Policy, Management, & Evaluation (IHPME)
Adjunct Professor, University of Minnesota School of Medicine
Faculty, IMHL & GCHM programs, McGill University, Desautels Faculty of Management
Email: marttch@me.com; marty.koyle@gmail.com.
Twitter:@MakMarttch

By MYRON LOVE About a year ago, Winnipegger Mark Kagan reached out to the Jewish community through the pages of the Jewish Post (and jewishpostandnews.ca) in his efforts to find a liver donor. At the time, his liver and his health were rapidly failing and he was quickly running out of time.
Back then, the former Best Western Hotels manager – who is in his mid-60s – reported that there is no cure for his condition (a non-alcohol related rare liver disease called Nodular Regenerative Hyperplasia).
“My only hope for survival is a liver transplant,” he said.  
The good news is that he was able to get a liver transplant this past April in Toronto and his recovery went well.  Within a short time, he was able to eat normally and resume exercising.  He spent three weeks post-op in the hospital in Toronto and another two weeks at the Health Sciences Centre before being cleared to go home again. 
The bad news was that once his liver failed, in turn, it caused his kidneys to fail.   “My doctors originally hoped that my kidney function would return on its own once the liver was transplanted,” he notes.
That didn’t happen.  Now Kagan has to have dialysis three times a week while trying to find a kidney donor.
On Tuesday, December 9, Kagan’s quest for a kidney donor will be the focus of a program at the Rady JCC hosted by Renewal Canada, a Toronto based organization that works within the Jewish community to find kidney donors and facilitate transplants. The event – that begins at 7:30 pm – is described as a Kidney Donation Awareness and Swab Drive with the hope that a donor can be found for Kagan. Speakers will include Rabbis Carnie and Kliel Rose – both discussing the mitzvah of organ donation, Penny Kravetsky representing Renewal Canada, and past donor Esther Dick, as well as Kagan.
Kagan adds a special thank you to Rebbitzen Bracha Altein for her role in directing his mother to Renewal Canada. 
 
Comments that Kagan made last year in the Post article still ring true: 
“Your support means everything to me and my family,” Kagan said. “Even if you cannot donate, sharing my story could connect me with someone who can. Thank you for taking the time to read and consider helping in this crucial time.”
 
Interested readers can register by going online at  https://www.renewalcanada.org/

By BERNIE BELLAN (Nov. 27, 2025) Introduction: We received a comment this morning from a former Winnipegger who had something to say about the state of medical care in Manitoba. Once you read her message you will be able to read an exchange of emails into which we entered that give more information about her:

I’m a physician who graduated from the University of Manitoba medical school (class of 1999). After training, I moved to Arizona to practice as a gastroenterologist. During my training in Winnipeg, I was always told how bad the American health care system was. I am here to tell you that this is incorrect. The poorest American who can’t afford health insurance and qualifies for state funded insurance has better health care than ALL of you.
I work in private practice. Yes, I’m busy. Yes, it takes many weeks to see me. However , if a family physician calls me and asks me to see a patient urgently, I will. If a patient needs a procedure urgently, I will get it done. If a patient needs to speak to me after my office hours or on weekends and holidays, I call them back. I am not the exception to the rule. I am practicing standard of care.
My niece has been in an out of the children’s emergency room (in Winnipeg) for several weeks because of kidney stones. She has been told numerous times by numerous physicians that her case is not “urgent”. Apparently, you can only get care if you become “urgent”. Urgent means that you are really sick and have developed complications. So, my niece has to end up in the ICU with sepsis (infection) and in renal failure for her to have the procedure she needs? What she was given was a prescription for morphine. Great, getting a teenager hooked on opiods as a way to treat kidney stones , that’s the answer? Her urologist told her mother (my sister) that the system is broken. Finally, an honest answer but in no way a solution.
The American health care system is not perfect but it’s significantly better than what you have. I’m appreciative of my excellent training I received in Winnipeg however, I could never work in your broken system as now I know better.
Good luck to you all.
Dr. Elisa Faybush

In response to Dr. Faybush’s comment, we sent her the following email:

Hi Dr. Faybush,
I read your message about the state of health care in Manitoba with great interest.
I wear 2 hats: I’m both an editor at the Jewish Post newspaper, also the publisher of a website called jewishpostandnews.ca
I would consider printing your message, but I’m curious: Is there a particular reason that you sent it to a Jewish publication?
For instance, are you Jewish yourself? It might put things into some sort of context which would explain why the letter was sent to us – or perhaps you sent the same message to other publications.
It would be helpful if you could elaborate on why you sent your message to us.
Regards,
Bernie Bellan

Dr. Faybush responded:
Hi Bernie 
Yes I’m Jewish.  Raised in garden city. My grand parents were Ann and Nathan Koslovsky

I sent the letter to the Winnipeg free press and was contacted for an interview but they wanted to interview my sister as well. Unfortunately my sister didn’t want to be interviewed. 
I read your publication on line regularly to keep up with the Jewish community in Winnipeg. 
My family still lives in Winnipeg and I was home this past summer for my niece’s graduation 
I will always consider Winnipeg my home. 
I’m so  frustrated with the Canadian health care system and wanted the people from Winnipeg to know they deserve better. 
Elisa Faybush 

We wrote back:
Thanks for the speedy reply Elisa. I’ll add something to the end of your message about your roots.
And, for what it’s worth, I agree totally with you about the state of health care in Canada. It’s a sacred cow but this cow should be put out to pasture.

She responded:
100% agree

Feel free to call if you would like 
(number redacted)

We wrote:
Well, if you’d like me to do a profile of you – which we do quite often of doctors who left Manitoba, usually written by Gerry Posner, I’d be glad to do that.
But it would be a full-on profile, not just a lament for the Canadian health care system. By the way, I searched your name in the History of Jewish Physicians in Manitoba, which was authored by Eva Wiseman a few years ago. I didn’t see your name in there, but one of the criteria for inclusion in that book was someone must have practised in Manitoba for at least 5 years after graduating. I assume you left before 5 years had elapsed. Is that right?

Elisa responded:
You are correct. I left after residency to complete my fellowship in gastroenterology in Arizona and never left.  
I went to garden city collegiate graduated in 1991 and then went on to complete my bachelor of science at the u of w. 
I’m not looking for a profile but thank you for the offer. I just need to express my opinion and I appreciate you giving me an outlet to do so. 

We wrote:
When did you graduate from medical school?

Elisa responded:
1999

We wrote:
And did you go to Arizona immediately upon graduating? 

Elisa responded:
After graduating u of m medical school in 1999 I completed my internal medicine residency at the u of m from 1999-2002.  I then left to go to the university of Arizona in Tucson  for my gi fellowship from 2002-2005. I then moved to Phoenix and  started private practice. I just completed 20 yrs in practice this year. 

We wrote:
ok great – I think it’s important to provide a fuller description of your career to lend some further significance to your original comment. By the way, you must have studied under Chuch Bernstein – right?

She responded:
Yes. He is the reason I did my fellowship in the USA. He encouraged me to do so.  He probably thought I would come back to work in Winnipeg like he did!  

We wrote:
He’s a great guy. I bet I know a lot of your schoolmates from med school. It’s too bad the Canadian medical system has alienated so many talented people. I still have lots of friends who were doctors and who still live here, but they’re all so embittered about our system.

Elisa responded:
I never practiced in Winnipeg but I  hear about the problems with it as family members have to navigate through this broken system. 
 If I lived and practiced in Winnipeg I would know the doctors and specialists that I could call to help my family members but I’ve been gone for so long I don’t have any relationships with anyone anymore: