As surely as the maple leaves turn red and a chill wind begins to blow, almost 3 million Canadians head to Florida each year.
And as surely as people get sick no matter where they are, thousands of those snowbirds flock to an unusual walk-in clinic in St. Petersburg.
The staff speaks English but “nous parlons Francais” as well. Pictures in the waiting room depict Queen's Park in Toronto and skaters on Ottawa's frozen Rideau Canal. Some of the magazines are from Montreal.
This is Can-Care Clinic, and from now until spring up to 70 percent of its patients will be from Canada.
"I've always liked Canadians," says Dr. William Handelman, the clinic's owner. "They're so appreciative because (in Canada) they can't get the kind of care that we provide without waiting for months."
In the Great American Health Care Debate, those could be fighting words to advocates of a Canadian-style universal health care system. Aren't Canadians supposed to be better off because they don't have to pay for doctor and hospital visits? Don't studies show Canadians are healthier and live longer than Americans even though the United States spends far more per person on medical care?
That's what the advocates argue. But a contrarian view emerges at a clinic like Can-Care, which treats both Americans and Canadians and sees firsthand the results of two very different health care systems.
Until 2003, this was just another walk-in clinic, part of a struggling franchise chain. Handelman, a Kentucky native who has traveled extensively in Canada, decided he could do better working for himself — especially by being "your hometown doc away from home" for the thousands of Canadians who winter in the Tampa Bay area.
One advantage of treating Canadians is that most have travelers insurance to cover any urgent care they might need while out of the country.
Another plus: Canadians aren't as litigious as Americans.
"Canadians don't sue," Handelman says. "It's not in their national consciousness."
Snowbirds usually begin arriving in November, though many came earlier this year "because their summer weather was terrible and the Canadian dollar is strong," says Handelman's wife, Myung Joo, a nurse practitioner.
On a recent day, the clinic saw 46 patients — 29 of them from north of the border.
In general, the Canadian patients are slimmer than Americans, in line with statistics showing that Canada has a lower obesity rate. The Canadians also tend to take fewer prescription drugs.
But that doesn't necessarily mean they're healthier.
"A lot of times, certain things are not treated, but the patient is not too concerned about it," says Dr. Jenny Chamblain, a French-speaking Montreal native who joined the staff this year. "I'll see patients with blood pressure in the 160s over 100, which is considered hypertension, but they're not on any medication."
The clinic treats people who've faced two of the biggest problems with the Canadian system — a shortage of doctors in some areas and long waits for MRIs and other nonemergency tests.
One woman hadn't had a Pap smear in years even though the tests are key in detecting cervical cancer. "She said she couldn't find a doctor," Myung Joo Handelman recalls.
Another patient was suffering from diarrhea, but surprised the staff by asking for an X-ray of her left knee. The reason: She was planning to have surgery for torn cartilage in Canada but realized she could get the X-rays done much faster in the United States.
And yet another patient, this one with melanoma, the deadliest form of skin cancer, had gotten a biopsy in Canada in July, but had yet to be treated by the time he arrived in Florida four months later. Can-Care referred him to a St. Petersburg surgeon.
Travelers insurance, which can cost up to $3,000, depending on age and length of visit, does not cover pre-existing conditions, but does reimburse for simple lab tests, X-rays, EKGs and two office visits.
Preauthorization is required for further testing and hospitalization; insurers sometimes decide they can save money by paying for a patient to fly back to Canada, where they can be treated at government expense.
But many snowbirds gladly pay for noncovered services.
Recently, 79-year-old John Mercer of Grand Falls, Newfoundland, took advantage of one of the clinic's specials — a $149 heart and stroke screening. To get the same screening back home could entail a lengthy wait for both tests and results.
"It has become a problem in Canada," said his wife, Joan, 80. "We're from a small town and to see a specialist you have to go five hours to St. John's. He had an MRI the other day, which we paid out of pocket, too."
Like the Mercers, some Canadians discover the clinic as they drive along 38th Avenue N and spot the sign with the big red Canadian maple leaf. The Handelmans also draw patients by frequenting a local French-Canadian club, where they hand out free magnets, calendars and cup holders, and by running ads on a popular radio show, Canada Calling.
Each year, the clinic hosts an open house exclusively for its Canadian patients; last year's party drew 450.
Though the Handelmans and their staff find much to dislike about Canada's universal health care, they acknowledge one big drawback to the U.S. system — huge amounts of paperwork.
At one point the clinic had a front-office employee hired partly for her fluency in French. But because she was from Canada, with its single payer system, she had no experience dealing with myriad insurance companies and complicated billing procedures.
"We tried to teach her," Myung Joo Handelman says, "but she didn't have a clue."
Susan Taylor Martin can be reached at firstname.lastname@example.org.