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Lactic Folly

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  1. Reread Wachaa's last post carefully. I don't think it's saying that disparity isn't an issue (eta: many codes do not account for case complexity, leading to significant variance between practice settings in the same field, so it's not that straightforward to define their value). But perhaps advocating for increased supports, where needed, might be more helpful to the majority of medical practices. As this thread has gone off-topic, I will circle back and say that one advantage of family medicine is the ability to conduct discussions like the thread below in a vastly different tone:
  2. Since cataracts are a publicly funded medical procedure, if a claim is being made that someone is doing increased numbers of a procedure solely for profit, it would be helpful to elaborate on what other medically necessary care has been displaced as a result, or whether some patients actually do not require the procedure. Given that most surgeries occur in publicly funded institutions, most of the decisions regarding number of procedures/day will be made at the administrative level. The wait times in each region of Ontario are constantly being tracked. With over 117k cataract surgeries per year in the province, each hospital needs to keep up. Hospitals are being scored on patient length of stay, in fractions of hours, and compared to their peers. Cataracts are funded as a Quality-Based Procedure, which means that instead of coming from the global hospital budget, these cases are paid separately according to patient volumes, and the cost per patient needs to come under a certain amount. Therefore, hospitals are putting significant emphasis on Lean processes and efficiency, and prioritizing standardization above individual physician preference. It's always more efficient to do multiple cases of the same procedure at once, instead of changing the room setup and having everyone shift gears, including allied health who are paid by the hospital. High-volume centres are also promoted as a way to improve outcomes, and for this reason, Cancer Care Ontario has recommended that patients not have Whipple resections done at lower volume centres, even if their surgeons would like to keep up doing a few per year. In this case, the result might align with physician incomes, but in general a lack of involvement in administrative decisions is a major complaint that I hear from physicians. Maybe it's different where you are and physicians have more agency in directing hospital operations to suit their own agendas, I don't know. But the fee code is really a separate issue to the number of procedures performed per day. I'm not going to change anyone's opinions but just wanted to offer more thoughts for others reading. These perceptions are certainly pervasive, and as said, many members of the public do feel all doctors are overpaid. In the future, you might get called for an urgent hospital case while in clinic. Your hectic day providing necessary coverage for the service may be interpreted by some of your patients as a choice to overextend yourself (for more $) at their expense. The extra time and effort you put into training the future generation of doctors at your clinic might be seen by some patients as sending a less qualified person in order to save time for the staff physician and help increase patient throughput/billings. These are opinions I've heard and read... no one is immune.
  3. Thank you for clarifying that extrinsic and intrinsic motivators can coexist. I don't disagree that pay obviously influences behaviour, but when I responded to Arztin's comment, I was thinking of my friend in ophtho who, as a student, expressed his awe about the gratitude from patients after their surgeries. Now with a young family, he continues to provide volunteer services and teach in the developing world (before this year, anyway). I'm sure he enjoys his income too, but wouldn't presume to state that pay is his only motivation. It's a bit of a harsh judgment to make about the character of a stranger (unless you agree with my undergrad science prof who openly stated all doctors are in it for money, since even a junior resident does much better than a postdoc for what he sees as less intellectual and mostly mechanistic work... and I can't really dispute that). You know, I do get it. The hidden curriculum is extremely strong. As a student, I absorbed all these attitudes and even parroted them myself. At that stage, the talk wasn't so much about money (probably because to students, any staff physician income is a great improvement). However, certain fields were known as "lifestyle" fields. So, if someone entered one of these fields, it must be because they are primarily motivated by lifestyle, and don't have the same work ethic as others... right? Then, a family member had a brief health scare. We received excellent care, and I realized how ignorant my assumptions were, as they were only based on others' comments and no firsthand knowledge. I still remember the resident's grimace as I thanked him for "coming in early on the weekend" when he had already been working in the hospital for some time prior to coming to clinic. I was ashamed for the microaggressions I had previously unthinkingly expressed in conversations about other people I was barely acquainted with, based on their "lifestyle" specialty. Nowadays, I am trying to be a more conscious person. I don't disagree that the fee schedules need a lot of work. I will however not make statements about the personal motivations of someone solely based on their career choice, or how their field has evolved over decades. There are good and bad apples in every field of medicine, which I can attest to from personal experience. People who will go the extra mile for patients, and others who shuffle them out the door in literally less than one minute while building their cosmetic practice. So, when I see a hip/knee arthroplasty surgeon, who only does hip and knee surgeries, over and over again, I think... well that's their job and area of expertise, and patients need the surgeries... that's all.
  4. There is absolutely zero implication of that in my post. I am very surprised to see such a response and have no idea why you would say that. Did you see my post in the other thread here?
  5. How about restoring people's sight and significantly improving their quality of life with a single procedure? Is that such a far fetched possibility?
  6. You mean for credit or audit? Why would tuition be included in the MD program? Why not take one of the numerous online free courses now before classes start?
  7. I'm not sure that such a distinction can actually be made. But I do envision dedicated family physicians working to facilitate positive lifestyle changes, help their patients obtain necessary resources and supports (especially those who are underprivileged), detect early signs of disease, and coordinate multiple aspects of a patient's care, and that these are important aspects of medical care and prevention that help patients navigate the often fragmented healthcare system and reduce the burden of disease.
  8. Traditional family medicine is more about the patient than the disease. Check out the writings of family doctors who share their patients' stories, and how they have built relationships with entire families and cared for them over a lifetime.
  9. Some provincial medical associations have a limited "insurance only" membership option to allow members who reside out of province to continue their insurance policies. I'd ask about that.
  10. Depends on the context. Sometimes insecure people might perceive someone else as bragging about their experiences if they hadn't been asked to share - I wonder if that is what OP is hesitant about.
  11. Not clear whether you think the references provided were themselves weak/lukewarm and this contributed to your rejection, or whether you have gotten a sign that the referees seem weary about continuing to help (for example, delayed responses to requests compared to previous).
  12. There is a re-entry program funded by the Ministry of Health in Ontario. Not familiar with the process in the other provinces.
  13. This is a good suggestion. There are tons of bloggers and authors out there whose writings will provide much more insight into a medical career than your typical hospital volunteer placement.
  14. I think the importance of looking into specialty selection early on has been well covered here. As the medical training process tends to condition people to jump through successive hoops, I'd also give some thought to the longer term scenario - your values in work and life, and how that would translate into the type of career you would like to have and where (for example, if you have any special interests you might like to pursue, or if a particular location is important to you - so you can lay the groundwork and incorporate that into your decision making).
  15. It's important to take care of one's health as best as possible. But time and energy can be a limitation, especially for things like hobbies. I found that having high intrinsic motivation, sense of meaning in one's work, and a supportive team environment made for a positive residency experience overall.
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