Realignment of Doctor's Income

[rmorelan]

Thought this might lead to some discussion on the forum - I have been saying for ages on the forum that the landscape of doctor's income will change at some point and the high paying fields - of course my specialty of radiology is of course one - will be reduced. While today the OMA has acted on that outside in fact of the government directly - and will be reducing the fees of various fields to increase the income of others internally. 

I am still learning the details but if I am understanding this:

The groups immediately impacted will include:

Opthalmology
Radiology
Cardiology
Gastroenterology

The groups next on the block if there are no fee increases of 1.5% or higher include:

Radiation Oncology 
Anesthesiology
Clinical Immunology 
Nephrology
Lab Medicine
Vascular Surgery
ENT
Endocrine
Nuclear Medicine 
Urology
General surgery
Rheumatology

The groups who will see their fees remain flat for the next decade based on the plan, if no new money is injected include:

Dermatology
Pediatrics
Medical Oncology
Orthopedic Surgery
ER
Neurology

which is most of the fields outside of family medicine and psychology (which are relatively lower paying). This move will I am sure have an impact on some people's specialty choices, and since some of the discussions on the forum revolve around income I thought I will mention all this - the idea long term is basically it is that roughly speaking an hours work will be worth similar values. It will also have big impacts I am sure on the hiring landscape - any one in a field being cut won't be looking to add any new warm bodies to the mix any time soon. Traditionally that means it will be hard to find work. I assume as well it will have a ripple effect on other provinces as well. 

[LittleDaisy]

26 minutes ago, rmorelan said:

Thought this might lead to some discussion on the forum - I have been saying for ages on the forum that the landscape of doctor's income will change at some point and the high paying fields - of course my specialty of radiology is of course one - will be reduced. While today the OMA has acted on that outside in fact of the government directly - and will be reducing the fees of various fields to increase the income of others internally. 

I am still learning the details but if I am understanding this:

The groups immediately impacted will include:

Opthalmology
Radiology
Cardiology
Gastroenterology

The groups next on the block if there are no fee increases of 1.5% or higher include:

Radiation Oncology 
Anesthesiology
Clinical Immunology 
Nephrology
Lab Medicine
Vascular Surgery
ENT
Endocrine
Nuclear Medicine 
Urology
General surgery
Rheumatology

The groups who will see their fees remain flat for the next decade based on the plan, if no new money is injected include:

Dermatology
Pediatrics
Medical Oncology
Orthopedic Surgery
ER
Neurology

which is most of the fields outside of family medicine and psychology (which are relatively lower paying). This move will I am sure have an impact on some people's specialty choices, and since some of the discussions on the forum revolve around income I thought I will mention all this - the idea long term is basically it is that roughly speaking an hours work will be worth similar values. It will also have big impacts I am sure on the hiring landscape - any one in a field being cut won't be looking to add any new warm bodies to the mix any time soon. Traditionally that means it will be hard to find work. I assume as well it will have a ripple effect on other provinces as well. 

I don't understand why the government would target pediatrics, the general pediatricians's gross annual income are less than GPs, perhaps due to their long consults and less in-patients. 

[rmorelan]

Just now, LittleDaisy said:

I don't understand why the government would target pediatrics, the general pediatricians's gross annual income are less than GPs, perhaps due to their long consults and less in-patients. 

I think that is more if there is no money coming in - and it is specifically for the fee schedule. That probably doesn't affect some of the other ways they can get paid etc. 

You can make the similar arguments for almost anything on that section - neurology has relative low pay for internal, ortho is a job market hell right now, med oncology is really a ton of work for the pay, and ER has major issues at least in some areas. 

We have finally reached the point where the costs are increasing beyond sustainable levels in health care and have no where to go overall I think. There are already groups now forming to break away from the OMA and try to form separate groups to represent themselves. 

[JohnGrisham]

4 minutes ago, rmorelan said:

I think that is more if there is no money coming in - and it is specifically for the fee schedule. That probably doesn't affect some of the other ways they can get paid etc. 

You can make the similar arguments for almost anything on that section - neurology has relative low pay for internal, ortho is a job market hell right now, med oncology is really a ton of work for the pay, and ER has major issues at least in some areas. 

We have finally reached the point where the costs are increasing beyond sustainable levels in health care and have no where to go overall I think. There are already groups now forming to break away from the OMA and try to form separate groups to represent themselves. 

The groups trying to separate are a terrible idea. Look at Quebec where Specialists and GPs already have seperate groups, its a nightmare and many times lobby against each other.

The gov't wants in-fighting, to distract from the real problem of tight funding. They want specialists and generalists to bicker and fight amongst each other, to be divisive and not have a unified front. It makes their job much easier to turn it around on us. 

I think many specialists deserve their differential pay, but also think that generalists tend to be short changed as well. I  hope the specialists trying to break off from the OMA take a step back and pause.   Yes the OMA is a nightmare, and is out of touch, no doubt - but there must be a way to recover it and make it relevant again?  

[rmorelan]

1 minute ago, JohnGrisham said:

The groups trying to separate are a terrible idea. Look at Quebec where Specialists and GPs already have seperate groups, its a nightmare and many times lobby against each other.

The gov't wants in-fighting, to distract from the real problem of tight funding. They want specialists and generalists to bicker and fight amongst each other, to be divisive and not have a unified front. It makes their job much easier to turn it around on us. 

I think many specialists deserve their differential pay, but also think that generalists tend to be short changed as well. I  hope the specialists trying to break off from the OMA take a step back and pause.   Yes the OMA is a nightmare, and is out of touch, no doubt - but there must be a way to recover it and make it relevant again?  

Not disagreeing but when your own union is voting to reduce your income - when its main function is to do the exact opposite - then you are obviously going to set up a fight. There already is exactly that in fighting. Add to the fact that you are paying mandatory fees to said union which they are using to create plans that reduce your income after years and years of everything else they have messed up with,  then for many it is looking like a "cannot be any worse than this" situation. Plus in Ontario at least some of these splinter groups (cardiology in particular) have successfully argued their case outside of the OMA directly to the government - and feel that they are worth what they earn based on what they do, and what other cardiologists earn elsewhere and they shouldn't have to subsidize other fields of medicine effectively. Ha to paraphrase some of the arguments. 

 

 

[JohnGrisham]

12 minutes ago, rmorelan said:

Not disagreeing but when your own union is voting to reduce your income - when its main function is to do the exact opposite - then you are obviously going to set up a fight. There already is exactly that in fighting. Add to the fact that you are paying mandatory fees to said union which they are using to create plans that reduce your income after years and years of everything else they have messed up with,  then for many it is looking like a "cannot be any worse than this" situation. Plus in Ontario at least some of these splinter groups (cardiology in particular) have successfully argued their case outside of the OMA directly to the government - and feel that they are worth what they earn based on what they do, and what other cardiologists earn elsewhere and they shouldn't have to subsidize other fields of medicine effectively. Ha to paraphrase some of the arguments. 

 

 

Agreed, the OMA has really lost its way.  There is and always has been in-fighting. Just seems like its going to get worse.

Those cardiologists that were able to effectively lobby for themselves, that means the rest of the fields effectively have less lobbying power no? The piece of the pie is shrunk and the remaining funds are then to be split otherwise.   

The common refrain is that "we should lobby for more healthcare funding, so we can fund all healthcare providers" - i think many people underestimate how much of our annual governmental budget is already going to healthcare. It's reaching critical mass. Not to mention the strength of other allied health unions. Everyone is looking out for their own piece of the pie- logically for sure, and now within the ranks of doctors as well(though this has been going on long before the current political climate). 

As for "an hour with specialist X should be equal to an hour with specialist Y" i patently disagree. An hour with a subspecialist may actually be worth less than an hour with a paediatrician in certain contexts. Sometimes an hour of a GPs time is mostly just squandered refills and "reassessments". Much easier said then done, but i hope someone smarter than I figures out a better metric system than FFS, and time-based models.   Probably wont happen in our lifetime unfortunately?   I think everyone in medicine knows about the tips and tricks of optimization of fees and billings,. and everyone has been in a clinic in most specialties where you're think "did we really just bill 300$ for this consult that took 5 minutes of thought?".  I dont think this is inherently bad, as some have said - the systems job is to get health care providers to work harder, faster and for less. So one has to counterbalance to protect oneself from being taken advantage of. Its a big song and dance in medicine.  All healthcare systems are extremely innefficient, and no amount of MPHs, MBAs, MHAs running around on salaries and pensions will fix that other than exacerbating and wasting even more precious limited funding.

No real argument or thesis statement here, just rambling.   It's going to be interesting times in Canada, in 20 years who knows how much closer to other systems like the UK, Australia etc we will be in terms of compensation models, work requirements, call coverages etc. 




 

[NeuroD]

What on earth are pediatrics and neurology doing here? They both earn 10-15% less than family and their salaries have grown 1/5-1/3 as much as family over the last 20 years.

[indefatigable]

4 hours ago, JohnGrisham said:

Agreed, the OMA has really lost its way.  There is and always has been in-fighting. Just seems like its going to get worse.

Those cardiologists that were able to effectively lobby for themselves, that means the rest of the fields effectively have less lobbying power no? The piece of the pie is shrunk and the remaining funds are then to be split otherwise.   

The common refrain is that "we should lobby for more healthcare funding, so we can fund all healthcare providers" - i think many people underestimate how much of our annual governmental budget is already going to healthcare. It's reaching critical mass. Not to mention the strength of other allied health unions. Everyone is looking out for their own piece of the pie- logically for sure, and now within the ranks of doctors as well(though this has been going on long before the current political climate). 

As for "an hour with specialist X should be equal to an hour with specialist Y" i patently disagree. An hour with a subspecialist may actually be worth less than an hour with a paediatrician in certain contexts. Sometimes an hour of a GPs time is mostly just squandered refills and "reassessments". Much easier said then done, but i hope someone smarter than I figures out a better metric system than FFS, and time-based models.   Probably wont happen in our lifetime unfortunately?   I think everyone in medicine knows about the tips and tricks of optimization of fees and billings,. and everyone has been in a clinic in most specialties where you're think "did we really just bill 300$ for this consult that took 5 minutes of thought?".  I dont think this is inherently bad, as some have said - the systems job is to get health care providers to work harder, faster and for less. So one has to counterbalance to protect oneself from being taken advantage of. Its a big song and dance in medicine.  All healthcare systems are extremely innefficient, and no amount of MPHs, MBAs, MHAs running around on salaries and pensions will fix that other than exacerbating and wasting even more precious limited funding.

No real argument or thesis statement here, just rambling.   It's going to be interesting times in Canada, in 20 years who knows how much closer to other systems like the UK, Australia etc we will be in terms of compensation models, work requirements, call coverages etc. 

 

This rambling kind of gets to the crux of the problem - how should time be valued?  The cardiologists are making a "relativity" argument themselves by comparing their earnings to others outside the province (but does that eventually mean being forced into US model of payments.. which undervalues primary care?).  How should productivity be incentivized - and can it even really be incentivized in a specialty like psychiatry?  What about training time and cost - how or should this be figured into the renumeration?  Should pay be based on the associated cost of the intervention (- this might favour cardiology, etc ..)?  How to take into account the potential benefit for a patient?   

To go back to QC for a moment, the specialists as a whole earn more than ON specialists.  But it's the lower paying specialties, like psychiatry and paediatrics that are really bringing the numbers higher - less so specialties at the higher end like cardiology and radiology.  Specialists are now a public target and the new government wants to cut fees across the board.  So in a sense in QC the specialists have gotten the larger share of the pie, but not so greatly  the specialists at the higher end as it may appear.  And this might not be the kind of outcome that the radiologist Dr. Jacobs, whose seems to be leading the OMA breakup wants to end up with.  

Higher earning specialists often mention higher overheard and equipment costs - but little detailed data is available for systematic comparison.  I think this would be a good step to enhance the dialogue.

To put another example out of left field is jet fighter pilots - highly subsidized training with very expensive equipment, but relative low earnings so many of them leave for commercial flying.  So public cost does't always equate with higher pay..  

[#YOLO]

Ford Nation eh

[rmorelan]

3 minutes ago, #YOLO said:

Ford Nation eh

Ha, conservative, liberal or NDP - all of them have the same constraints to deal with. There is only so much money and the long term higher than inflation cost of health care is now reached the point we are in now. That is a problem no one has managed to deal with. 

This redistribution doesn't solve that problem either - and I guess it isn't even directly being done by the government but rather the OMA. Plus I should point out that a lot of these plans assume on going less than inflation increases for doctors for the next 10 years or so. Inflation is not at 1.5% for instance. 

[freewheeler]

Perhaps negotiations would proceed more amicably after a joint..

[GrouchoMarx]

the oma is worthless.

they basically threw pathology under the bus 30 years ago and we havent recovered since.

theyre trying the same with radiology and ophtho but at least those two fields are putting up a huge fight against it. props to them.

[distressedpremed]

Robbing Peter to pay Paul. Jeez. 

[NLengr]

The OMA is the worst interest group I have ever seen. The only logical conclusion is that the executive must be getting bribes from the government. 

[NLengr]

13 hours ago, tere said:

 

To put another example out of left field is jet fighter pilots - highly subsidized training with very expensive equipment, but relative low earnings so many of them leave for commercial flying.  So public cost does't always equate with higher pay..  

I've never seen a breakdown of numbers, and I know pilot loses to commercial operations are a big deal for the RCAF but I wonder if most of those losses are multi engine pilots (Hercs, Polaris, CP-140 etc) and helicopters vs fighter pilots. 

I mean, non fighter pilots would have a more similar civilian flying job. It's easy to imagine how mind numbing flying an Air Canada 737 would be after years of flying a CF-18. 

In the States it would be less of an issue to leave fighters because the Air National Guard gives you an opportunity to fly commercial and continue to fly fighters part time.

[rmorelan]

1 hour ago, NLengr said:

The OMA is the worst interest group I have ever seen. The only logical conclusion is that the executive must be getting bribes from the government. 

I think it is more politics - in the OMA radiology, cardiology and so on is a really small group. They almost 50% family medicine so guess where the focus goes. 

[rmorelan]

6 hours ago, distressedpremed said:

Robbing Peter to pay Paul. Jeez. 

like many of these things it is slow motion affects - which is another way of saying it won't impact older radiologists as an example. If my math is right, and it may not be because all this isn't out there yet really, radiology over the next 10 years will effectively have a 30% reduction in fees - and this is after all the other reductions going back 10 years now. Radiology wasn't on ROAD anymore do to the shear work volume. Now it isn't going to be on there for income as well basically ha. I suppose we really will see the impact probably soon on CARMS as well - I don't think it is a surprise that many people went into radiology because it had higher income - by the time someone in CARMS gets out 6 years from now that won't be the case or shortly won't be at least. 

[#YOLO]

[LittleDaisy]

4 hours ago, rmorelan said:

I think it is more politics - in the OMA radiology, cardiology and so on is a really small group. They almost 50% family medicine so guess where the focus goes. 

They are cutting down revenues for FHO & FHT GPs as well. I received a few emails from OMA on Friday. I hope that it won't go through, it will further decrease the interest in Family Medicine when we know there is a high need. 

[JohnGrisham]

1 minute ago, LittleDaisy said:

They are cutting down revenues for FHO & FHT GPs as well. I received a few emails from OMA on Friday. I hope that it won't go through, it will further decrease the interest in Family Medicine when we know there is a high need. 

I think all parties know that "interest in FM' is pretty irrelevant. With spots as tight as they are, its not like the majority of medical students have elsewhere to go. They could cut FM reimbursments in half tomorrow and there wouldnt be much of a change in FM matching overall, spots will still get filled.

[LittleDaisy]

7 minutes ago, JohnGrisham said:

I think all parties know that "interest in FM' is pretty irrelevant. With spots as tight as they are, its not like the majority of medical students have elsewhere to go. They could cut FM reimbursments in half tomorrow and there wouldnt be much of a change in FM matching overall, spots will still get filled.

What's ironic is the Ontario government is reducing the new grads entering FHO & FHTs, while cutting down the revenue of FHT by reducing the enrollment fee for new patient, getting rid of preventative bonuses, make some out-of-basket codes in-basket (18 month well-baby check, influenza) which defeat the purpose of comprehensive & complex and preventative objective of FHO. 

[insomnias]

2 hours ago, JohnGrisham said:

I think all parties know that "interest in FM' is pretty irrelevant. With spots as tight as they are, its not like the majority of medical students have elsewhere to go. They could cut FM reimbursments in half tomorrow and there wouldnt be much of a change in FM matching overall, spots will still get filled.

Sure, but how many spots are filled isn't really as important; we're interested in how many full-time family doctors we get / how many patients ultimately get their own family doc. CCFPs can go to other provinces -- or countries. There's the US, of course, but also NZ, Australia, UK, Ireland, some middle eastern countries,... Besides, one isn't limited to practising as a full-time family doctor after finishing residency. You can instead choose to go into management and/or consulting, or you could just work long enough to pay off your debt, net $70k each year, and travel/volunteer with MSF for the rest of the year or something. If the reimbursement is the straw that breaks the camel's back, there are always options. This ends up being a pretty big negative for a province that's just poured money into funding that student's undergrad, medical school, and residency and continues to have issues with physician distribution.

What would worry me more than the reduced reimbursement is if a provincial government stipulates that all CMGs have to do a "ROS" to pay back the cost of training like some countries (e.g. Norway, Singapore) do

[brady23]

I hope there are more positive changes in the remuneration for Family Doctors with these negotiations.

The government has placed too many restrictions on where new grads can practice for the newer funding models which is unfortunate.

 

[JohnGrisham]

33 minutes ago, insomnias said:

Sure, but how many spots are filled isn't really as important; we're interested in how many full-time family doctors we get / how many patients ultimately get their own family doc. CCFPs can go to other provinces -- or countries. There's the US, of course, but also NZ, Australia, UK, Ireland, some middle eastern countries,... Besides, one isn't limited to practising as a full-time family doctor after finishing residency. You can instead choose to go into management and/or consulting, or you could just work long enough to pay off your debt, net $70k each year, and travel/volunteer with MSF for the rest of the year or something. If the reimbursement is the straw that breaks the camel's back, there are always options. This ends up being a pretty big negative for a province that's just poured money into funding that student's undergrad, medical school, and residency and continues to have issues with physician distribution.

What would worry me more than the reduced reimbursement is if a provincial government stipulates that all CMGs have to do a "ROS" to pay back the cost of training like some countries (e.g. Norway, Singapore) do

Definitely - dont disagree at all.  Generally Canada is better compensated than most of the countries listed(except the middle eastern ones, but those come with their own bag of worms), so we have a bit of a ways to drop yet in terms of compensation. 

My example was a bit extreme of course, but i think a slow decline in compensation across the board is something to expect.  

[shematoma]

29 minutes ago, JohnGrisham said:

Definitely - dont disagree at all.  Generally Canada is better compensated than most of the countries listed(except the middle eastern ones, but those come with their own bag of worms), so we have a bit of a ways to drop yet in terms of compensation. 

My example was a bit extreme of course, but i think a slow decline in compensation across the board is something to expect.  

If I had to speculate, one reason compensation in Canada won't drop much is the potential for doctors to relocate to the US. Most doctors wouldn't be willing to do this (politics, family, having to take USMLE, etc. and FM need a 3rd year of residency), but all it takes is a small number before the healthcare system starts feeling the pinch.