Jennifer King

This article seeks to understand Canada’s failure to implement Jordan’s Principle, a child-first policy ensuring First Nations have access to the same level and quality of services available to other children. Policy-making in Canada rests firmly within a neoliberal political framework that extends market-based thinking to all aspects of social life. Neoliberal thought interlocks with stories of Other to inform notions of deservingness as well as one’s potential as a valuable citizen with something to contribute. Social policy decisions, including the decision to implement a particular policy or not, offer a means through which to disseminate neoliberal values and norms. As self-determining peoples with distinct rights, lands, and governance structures, First Nations transgress the image of the “good” neoliberal citizen in a variety of ways. Neoliberalism holds that punitive measures are sometimes needed to encourage citizens to adopt particular norms, and this allows policy makers to rationalize and justify policies that discriminate against First Nations children. Stereotypes about Indigenous peoples are also used to manipulate public sentiment in favour of government policy. Canada’s failure to implement Jordan’s Principle can be understood as part of a broader strategy to encourage First Nations to rescind their distinct rights and assimilate as good neoliberal citizens.

Objective: To examine variation in the practice patterns of individual general surgeons and how they differ between rural and urban areas of North Carolina. Summary of Background Data: Traditional physician supply analyses often rely on “head counts” and do not take into account how physicians’ practice patterns differ. Practice characteristics including the volume and the breadth of services that a physician provides may be especially important in understanding the supply and distribution of specialists, such as general surgeons. Methods: Cross-sectional study using physician licensure data linked with administrative records on all inpatient hospital discharges and all surgeries performed at freestanding ambulatory surgery centers in North Carolina in 2004. Results: Total procedure volumes varied widely (interquartile range: 356–700). The average general surgeon in a rural county performed 54 different procedures at least once during the year, compared to 59 in counties with small urban areas and 62 in metropolitan counties. The 10 procedures that a general surgeon performed most frequently accounted for 72% of that surgeon's total annual procedures in rural counties, 67% in counties with small urban areas, and 66% in metropolitan counties. These rural metropolitan differences were smaller after controlling for secondary specialty and other surgeon characteristics. Conclusions: There was significant variation in the volume and scope of procedures that North Carolina general surgeons performed in the year. Many general surgeons in metropolitan areas performed an array of procedures that was broader than those in rural areas.