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blah1234

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  1. I find the liability issue interesting. I think there should be a way to build in the anticipated cost of litigation into the business model and then adjust your product premium accordingly. You can probably even set out terms of liquidated damages in your contract when you sign with hospitals. I think if the current model has physicians or hospitals covering malpractice insurance a larger company should be able to figure out a cost-effective way to insure themselves. I think if there is an AI product that can perform at an acceptable level then the business case should be relatively easy in comparison to the R&D.
  2. Full Disclosure: I am in a field that bills middle of the pack and I'm not defending high/low billers but rather I want to explore the principles behind how we should approach reimbursement I agree that reimbursements should be tied to health outcomes. I also agree that a neurosurgeon is good at what he is trained in and not so good with other tasks. However, I disagree that if a physician works 1.5x as much as their peers they automatically deserve more money than all their peers just because of more hours. However, I do agree that practically we should compensate physicians who are working significantly harder than the norm as there are flaws in the fee schedule. If we look at traditional health economics the 3 basic types of reimbursement for physicians are fee-for-service (FFS), capitation, and salary. The FFS system which the majority of us operate in is great for compensating physicians who work hard but at the cost of measuring patient throughput rather than outcomes. There is also the concern of whether codes between specialties are fair which I will get to later on. I think that FFS by itself, while not perfect, helps reward physicians who are working "harder" than their peers in the same field. I am assuming in this example that most are practicing the standard of care and are seeing consults as fast as safely possible for an optimal outcome. With regards to fees between specialties, I am approaching this issue from the position of the payer (which in this case would be the government). If I am going to spend $1 of healthcare funding I would want to spend it on the intervention that returns the most value. In this case, I hope that every $1 of reactionary or preventative intervention brings the most amount of savings that I would otherwise incur from not treating a patient (while also accounting for the time value of money). There's no perfect metric out there but if you want to use QALY, DALY or whatever hybrid methodology you can quickly see that not all services are valued equally. Some part of this may be the difficulty in tying outcomes to specific actions like preventative medicine as I mentioned in my previous post. Through this, I don't believe from a resource perspective we should be looking at equality or equity from the viewpoint of a physician's take-home income, but rather if a resource input into physician 1 will deliver more output than physician 2. Now, this is oversimplifying things as we should also use fees to prevent the deincentivisation of certain fields and to ensure that students still studying them. I believe this framework stemming from researchers like Dr. Olsen show that there is the theoretical case that a specific physician working 30 hours a week could be delivering more economic value to society than a physician working 80 hours a week and thus be compensated more. Practically speaking I don't think the reality is quite that extreme but we should still be cognizant how our services should not be equally valued which could explain many of the disparities in the fee schedule. I do think that currently we prioritize measurable interventions like procedures over things like counselling which leads to the current distribution of specialties on the billing spectrum. I use acuity as a dimension (although not the only dimension) because the value of treating high acuity cases can mean the difference between life and death for a patient which has a huge impact in many health outcomes metrics. It is acuity in combination with other factors that generate the worth of a physician to society and thus their compensation in this single-payer system. I think as physicians we are obviously concerned with how much take home income we are making instead of straight gross billings, however, I don't think we should be the primary stakeholder or consideration when deciding how to allocate healthcare dollars. Likely we'll have to start blending payment models rather than rely purely on FFS to reimburse physicians. Happy to hear your thoughts on the matter.
  3. Oh boy here we go again with another relativity debate haha . I personally think reimbursement should be tied to health outcomes and the amount of economic value generated rather than just purely measuring hours. However, it is very difficult to attribute outcomes to certain preventative tasks for example. How do you prove that smoking cessation helped prevent a case of cancer from developing if it never develops? This would save the healthcare system a ton but it is very difficult to measure. On the other hand it's pretty easy to measure taking out an appendix before it ruptures as an intervention that generates value. It may be that pediatric radiologists, through their reads, generate 1.5x the positive health outcomes that a normal endocrinologist would generate. I think that kind of analysis is going to be riddled with biases and poor data inputs. Income relativity is always a tough subject as I think people want to do what's best for themselves. Though I will say that I have a hard time rationalizing how some fields with the longest hours and the highest acuity (i.e. neurosurgery) are not at the top of the compensation scale in the current system.
  4. I agree that the medical specialties don't exist in isolation. However, the way I was taught at least framed all the core rotations in context of how that knowledge is useful for a "general physician". Knowing the red flags of common presentations and knowing what field handles what emergencies. The training I received in medical school was not to prep me to be a future psychiatrist or pathologist but instead how to being a functional general doctor. I agree that the broad exposure helps students determine what kind of doctor they want to be but I don't think the curriculum should be structured as one large job fair. We should be producing capable professionals like other professional schools that are capable of independent practice with the option to specialize if needed. Unlike our peers in dentistry, law, etc we are not accomplishing that task because of the split of the CCFP and the Royal College. Perhaps one year isn't enough to be a capable family physician (a position I agree with). However, I would find it hard to believe that a one-year internship would not give you the skills needed to do administrative work, or walk-in clinics, or other low-acuity community work that physicians in the US and other Commonwealth countries seem to do fine with just an internship year. At the end of R-1 I knew that I had a lot to learn and I wasn't perfect but I was also capable of doing a lot of things. Right now we have a system where if someone is unhappy with their program and decides to leave as an R4 in whatever they do not have the ability to do anything in medicine which I think is ridiculous.
  5. I know from my friends that some cities/regions have many openings. I was surprised as I had also heard things were bad during my training.
  6. A somber outlook but one that I agree with. I feel academics downplay job market challenges for a variety of reasons from innocent misrepresentations due to ignorance to what I suspect is the selfish need to fill a call schedule. I'm not sure how we will stop academic centers from demanding residents for purely service reasons. I don't particularly feel confident about the leadership in the field. I feel the best people all end up leaving academia and thus the people who rise to the top are not the ones who are going to enact positive change.
  7. That's smart. I'm surprised more fields (or the government) haven't done that to prevent Canadians from leaving and to reduce the bargaining power of new grads.
  8. Neurosurg is the other field I have heard has similar cross board issues. From what I understand it is a curriculum difference?
  9. Is because of a difference in curriculum or training length or some other factor? I wasn't aware ENT had this problem.
  10. If I recall correctly from my PGME committees they have special spots reserved for them as part of an agreement between their government and ours. This is due to the fact they do not have the training capacity in their home country and thus rely on other countries to accommodate them in return for significant funding. This funding helps support a lot of things like textbook grants for domestic residents. They are bound by a contract to return back and practice, but I think it is relatively simple to break that contract and practice in Canada as they are going to be accredited by the royal college and have provincial licences. Feel free to correct any parts that are incorrect. It has been a while since I dealt with this and it was never my focus or interest.
  11. I'm not aware of any research to support that statement. I assume it was just built on the notion that medical knowledge has dramatically expanded in the past couple of decades. From what I understand the general licence in the US and Australia is not as flexible as full FM but I mean that's still better than nothing. Assuming your study is accurate I guess the counter argument the CCFP could put forth is wanting graduates to be skilled within the first few years of practice rather than become competent through "trial by fire" with suboptimal outcomes for patients. Regardless, I still favour the return of the general licensure. I think it would alleviate a lot of problems with the current system as I don't think it really achieved the goals of the CCFP of getting more respect.
  12. I'm not sure if delaying had any material benefit given that public perception would've had little impact during the ADR process. This data would've been available to the relevant parties. I feel all this has done is create the notion that we are against transparency in an attempt to obfuscate our billings. I feel like that is a more damaging narrative to the public. Perhaps I'm just too pragmatic as I don't believe in wasting resources to fight losing battles. I feel none of our accreditation/licencing/representative bodies have any degree of budgetary discipline which results in the constant increases in membership fees.
  13. No idea why we fought this so hard in Ontario. It's the norm in other provinces.
  14. I still think there should be a "default" type of doctor. I know that the CCFP doesn't want to be seen as second class citizens but what is the point of the generalist training in medical school if it doesn't necessarily lead to anything. I understand the argument that one internship year isn't enough to learn everything but at least give people the ability to work as associates or something. Last time I checked there was still stigma towards FM despite the change to make FM its own specialty so perhaps we should move on and give back flexbility to the students so they don't have figure out what kind of doctor they want to be on day 1.
  15. I'm curious as well. How do they get the students spots? I assume they are providing the funding but how do schools find training capacity? Does the school get pressured to just accept these students?
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