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-JAG-

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  1. Posted this elsewhere but thought I may get more answers here. Are there any clinics in Canada that offer MRI’s covered by Medicare? Can radiologists bill for these services? I couldn’t find anything in any provincial fee schedule on fees for the technical component of MRI’s, only interpretation. The only leads I could uncover were that the Quebec government was negotiating with the Fédération des Médecins Spécialistes du Québec on covering MRI and CT outside hospitals as early as 2016 yet even the 2019 fee schedule clearly states that radiologists cannot bill for these services outside a hospital, which leads me to think that negotiations have broken down. In Ontario, I found this [https://insolvencyinsider.ca/filing/oxford-advanced-imaging/], which clearly states that someone was providing public MRI access outside hospitals, but that the company has gone into insolvency. I can’t find any technical components for MRI’s on the OHIP fee schedule. Does anyone have more information on this? Thanks, -JAG-
  2. Are there any clinics in Canada that offer MRI’s covered by Medicare? Can radiologists bill for these services? I couldn’t find anything in any provincial fee schedule on fees for the technical component of MRI’s, only interpretation. The only leads I could uncover were that the Quebec government was negotiating with the Fédération des Médecins Spécialistes du Québec on covering MRI and CT outside hospitals as early as 2016 yet even the 2019 fee schedule clearly states that radiologists cannot bill for these services outside a hospital, which leads me to think that negotiations have broken down. In Ontario, I found this [https://insolvencyinsider.ca/filing/oxford-advanced-imaging/], which clearly states that someone was providing public MRI access outside hospitals, but that the company has gone into insolvency. I can’t find any technical components for MRI’s on the OHIP fee schedule. Does anyone have more information on this? Thanks, -JAG-
  3. I’ve seen that for spasticity it’s usually ultrasound guided, but often for migraines, it’s more of a shotgun approach. I do think you can bill for ultrasound guidance in Ontario, something like 28$.
  4. I was under the impression that the injection fee was covered. After all, it’s in the fee schedule and there aren’t any special governing rules concerning the code that I’m aware of other than the fact it could only be billed every 12 weeks. The top billing family doctors who specialize in Botox pain treatment are billing OHIP, not the patient. We wouldn’t know what they were making if the patient was paying, or am I not seeing something important?
  5. If you wish to complete a masters or PhD, it’s much smarter to do it after residency during your fellowship. That way you’re sure that it will be applicable to your specialty and area of interest versus if you do it during medical school. The best part however is that you can get paid a pretty generous salary to do it. In some provinces you get a fellow’s income while completing your degree, which can be close to 100k, and have few or even no clinical responsibilities outside of call. You can also be sure wether you event want to pursue a graduate degree or not. Doing a PhD to be more competitive for a certain residency is overkill imo. Just do well on your rotations, be likeable, try to make connections with staff and residents at your home program early (M1/M2 years, people forget how important this is, especially in small fields) and have a few publications.
  6. Xeomin is, to my knowledge, the only approved generic in Canada, but still something like 5$ a unit. Interesting that the patient provides the Botox (I’m assuming through their private insurance? I doubt most Canadians can afford do drop 3-4K a year on this) Must be the only time patients have to provide the material for an insured service. I’ll dig deeper into the OHIP fee schedule and see if anything about this is mentioned there. Thanks for the insight. Edit: looking at the UHN website, there is a special category for “payment” under the procedure, where they say that the physician will discuss it with you... interesting Second edit: Similar wording on a cerebral palsy site. It’s covered under special circumstances by OHIP+, if not by private insurance or “alternate funding”
  7. In some provinces (Alberta and Ontario to be specific), Botox is an insured service when used to treat conditions such as chronic migraines and spasticity. This usually involves 10+ injections, but the procedure is relatively short and, because it isn’t targeted like a nerve block, doesn’t seem to take much skill. (American YouTube guides show nurses doing it in 5-10 minutes) At a glance, the codes seem very high for such a straight forward procedure. In Alberta, including the injections, tray fee and visit, you’re looking at a bit over 150$. This is about the same as you get in Ontario. Googling the names and reviews of the two highest billing family doctors in Ontario show that they both seem to have a significant portion of their practice around this. However, the math just doesn’t check out. A standard round of injections uses around 155 units of Botox. Botox wholesaled at around 6$ a unit minimum form what I’ve seen. It’s therefore no surprise that in the states doctors bill patients’ private insurance thousands of dollars for this procedures. Also, it’s not like you can just go down the street and by off brand botulinum A, so no way to cut costs. What gives? Any additional codes/fees that I’m missing here? Sure some doctors are billing in excess of 3.5 million a year with this but they must be spending way more than that on Botox, no? Or are they giving REALLY low doses and banking on the placebo effect taking over? Are there special provisions for situations like these? For example, in Quebec, when physicians provide prohibitively expensive services, they sometimes sign special agreements with the RAMQ to cover the costs. An example of this was when the ophthalmology department of a large regional hospital was shut down for a few years for renovation. The ophthalmologists got a few million from the RAMQ and were able to bill specially agreed upon codes that were higher than the ones in the provincial fee schedule due to the extreme costs of basically building an eye hospital from the ground up. (This became a huge fraud case later but that’s a story for another time) Is there something similar in Ontario/Alberta? The closest thing I can think of is OHIP reimbursing OB/GYN’s for their extremely expensive (75k+) CMPA dues.
  8. Selon les données pour les admissions en médecine à Sherbrooke en 2019 il y avait 708 collégiens convoqués aux MEM. J’imagine que ça serait à peu près les mêmes personnes convoquées aux entrevues de l’UdeM et de Laval, disons que le nombre total est plutôt de 800 en raison du Casper. Avec environ 400 places en médecine au Québec réservées aux collégiens, ça fait pas un taux d’acceptation de 50%? Comparé au reste du Canada où c’est en bas de 20%, je dirai qu’on a des bonnes chances pourvu que notre CRC est assez élevée, surtout vu que les universités francophones ne regardent pas le CV
  9. The 400k figure from the CMA is for all IM specialties is not entirely representative of Oncology earnings. You can check out the provincial job boards, many oncologists are salaried so that information is directly available. For example, there is a position in Regina currently open on Saskdocs paying 422k, so I would guess it’s probably close to what most oncologists make in the province. In Quebec, where oncology is included with hematology despite them being two separate fields here, the average was 483k in 2018. Most seem to be FFS or rémunération mixte. In Ontario, the OMA said it was 300k in 2012. That seems quite low to me, but I don’t know if it’s changed since.
  10. Yes, they are gross payments. Important to note that overhead isn't very high in Quebec because most specialties work mostly in public hospitals in the province. For example, there is relatively little private office run radiology and geriatrics in QC compared to other provinces. Also helps that the governments pays you more if you work outside a public institution (établissement) which obviously helps with overhead.
  11. I posted the National Assembly's budget earlier today which included average compensation for every specialty, you can see for yourself and compare to the CIHI numbers for other provinces. The basic trend is that all specialists in Quebec basically earn the same thing (500k +/- 10%) bar radiology (850k average) and cardiac surgery (but they work so much so the hourly rates are probably the same) Family medicine does well here too. No FHO but the government basically pays your overhead with the "en cabinet" fees for office visits (+ 30 to 35% for FM visits done in a private office/clinic). Good counselling and workers comp codes as well (you mention STD's or women's health and it's 30$, some CSST forms that take 5 minutes to fill out are 65$ and all that is on top of the flat rate which is around 50$ for a visit in a private office, appointment or not) Basically, if you're a cardiologist, gastroenterologist or nephrologist for example Quebec is not the place to be, but its also the only place you can expect to make close to 500k on average in psych, peds, geriatrics, GIM (well ON and AB do well here too), allergy or EM (numbers for this specialty are hard to come by, but I heard ON and AB do well here too, but QC is still definitely ahead of BC or the maritimes)
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