Ah yes, we get those.
Nobody in Canada get these checks that I know of, either by FP or derm. Nobody sees derms for the things they do here. Our kids’ pcp immediately referred them to derm for mild acne. In Canada, FPs prescribe accutane.
I was lucky enough to architect the corporate insurance plan we are on. It’s a HDHP PPO for which we pay $1/month:)