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rmorelan

Realignment of Doctor's Income

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3 hours ago, JohnGrisham said:

At least anecdotally, i think med students of this generations and residents are less inclined to take USMLEs and jump through hoops to go to the US. Its objectively a lot harder nowadays to just get up and move to the US. Not unmanageable, but definitely logistically harder than before.  

In roughly 2 months of med school, I've heard the words "take the USMLEs" from residents/staff at least thrice, including today. We're definitely aware of our options and thinking about what might be necessary to do it. Considering the number of specialties that now require fellowships to get jobs, many of which end up being done in the US, I think the number of CMGs taking the USMLEs will only increase

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1 hour ago, ArchEnemy said:

I have never considered moving to the US during my medical school training. However, it's talks about cuts and the nasty politics displayed by the (previous) government that have convinced me to take the USMLEs while I still have some residual knowledge about FOOSH or menstrual cycles. I would imagine that this will be the biggest hurdle for most practising physicians though.

I would rather work in an environment where by skills and knowledge are valued.

you don't even need the USMLEs for all states. Several just require you to pass the US boards, and use the LMCE in its place. Getting it is still a good idea mind you but that did take me by surprise ha. relevant as until Canada gets a big AI lab I probably have to continue to do at least some work here just to do my research.  

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1 hour ago, insomnias said:

In roughly 2 months of med school, I've heard the words "take the USMLEs" from residents/staff at least thrice, including today. We're definitely aware of our options and thinking about what might be necessary to do it. Considering the number of specialties that now require fellowships to get jobs, many of which end up being done in the US, I think the number of CMGs taking the USMLEs will only increase

Sure, and it was the same when i was earlier on, but the vast majority dont end up taking it. Very few, even at a school that is more "academically focused". 

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1 hour ago, rmorelan said:

you don't even need the USMLEs for all states. Several just require you to pass the US boards, and use the LMCE in its place. Getting it is still a good idea mind you but that did take me by surprise ha. relevant as until Canada gets a big AI lab I probably have to continue to do at least some work here just to do my research.  

Feel free to correct me if I am mistaken. I am under the impression that most Canadian physicians do not have much difficulties obtaining the "license to practice". Rather, they experience difficulty in obtaining a valid "Visa" that allows them to stay and practice in the USA. The H1B Visa, as I understand it, requires USMLE. So the goal of the USMLEs is to obtain an H1B visa, rather than securing a license? 

I am sure that there are exceptional cases whereby USMLE can be bypassed, but this is the minority rather than majority. 

Ha I would imagine that US would probably be one of the first countries to implement AI into direct patient care. Canada will lag behind by miles.

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20 minutes ago, JohnGrisham said:

Sure, and it was the same when i was earlier on, but the vast majority dont end up taking it. Very few, even at a school that is more "academically focused". 

Yeah from what I have seen, most of my classmates did not start writing the USMLEs until post-CaRMS (Step 2 CK alongside MCCQE Part I) or during Residency. 

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6 hours ago, ArchEnemy said:

Feel free to correct me if I am mistaken. I am under the impression that most Canadian physicians do not have much difficulties obtaining the "license to practice". Rather, they experience difficulty in obtaining a valid "Visa" that allows them to stay and practice in the USA. The H1B Visa, as I understand it, requires USMLE. So the goal of the USMLEs is to obtain an H1B visa, rather than securing a license? 

I am sure that there are exceptional cases whereby USMLE can be bypassed, but this is the minority rather than majority. 

Ha I would imagine that US would probably be one of the first countries to implement AI into direct patient care. Canada will lag behind by miles.

you can go directly to a green card if you want and by pass those visas. I don't want to say that in general that is easy per say - it is another pile of government paperwork and takes time. Still as you can imagine there are a lot of tick boxes that doctors can hit to make the situation faster - including that with a doctor shortage in the US people will support you, you are ready to work and licensed to do so in a professional field, speak english extremely well/educated and so on. 

One  of the residents above in my old program did that and is now working at mass gen.  

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8 hours ago, rmorelan said:

you can go directly to a green card if you want and by pass those visas. I don't want to say that in general that is easy per say - it is another pile of government paperwork and takes time. Still as you can imagine there are a lot of tick boxes that doctors can hit to make the situation faster - including that with a doctor shortage in the US people will support you, you are ready to work and licensed to do so in a professional field, speak english extremely well/educated and so on. 

One  of the residents above in my old program did that and is now working at mass gen.  

This always makes me wonder, what if you're going into private practice? What if I was willing to set up my own neurology clinic? Could I challenge the boards, get a worker's Visa, and open shop?

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3 hours ago, PhD2MD said:

This always makes me wonder, what if you're going into private practice? What if I was willing to set up my own neurology clinic? Could I challenge the boards, get a worker's Visa, and open shop?

doing a private practice in the US isnt as logisically simple as Canada. You'd need mega insurance coverage, hiring billing staff to deal with the 100s of different insurance plans, etc etc.  It's not like in Canada where you just need a office room, a competent MOA who will do all the logistics and billing.  

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30 minutes ago, JohnGrisham said:

doing a private practice in the US isnt as logisically simple as Canada. You'd need mega insurance coverage, hiring billing staff to deal with the 100s of different insurance plans, etc etc.  It's not like in Canada where you just need a office room, a competent MOA who will do all the logistics and billing.  

hmm...ok for the sake of this example, let's say you setup a cash-only clinic, or you're joining a small existing clinic.

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It’s interesting to see the announcement of the Ontario Specialists Association’s board of directors which is “representing a broad range of specialties”. Two radiologists, a gastroenterologist, a cardiologist, a nephrologist, an eye surgeon, a vascular surgeon and an emerg doc. Is this a group that looks like they are going to defend the status quo?

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1 hour ago, BigM said:

It’s interesting to see the announcement of the Ontario Specialists Association’s board of directors which is “representing a broad range of specialties”. Two radiologists, a gastroenterologist, a cardiologist, a nephrologist, an eye surgeon, a vascular surgeon and an emerg doc. Is this a group that looks like they are going to defend the status quo?

Not sure I understand. Their goal is to protect the smaller specialist groups from having their incomes cut to support family docs. It’s a good mix. 

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2 hours ago, BigM said:

It’s interesting to see the announcement of the Ontario Specialists Association’s board of directors which is “representing a broad range of specialties”. Two radiologists, a gastroenterologist, a cardiologist, a nephrologist, an eye surgeon, a vascular surgeon and an emerg doc. Is this a group that looks like they are going to defend the status quo?

I think there are 3 radiologists actually -- the Chair (David Jacobs) is also a radiologist. 

From searching CPSO, I believe Michael Murray is actually certified in family medicine but also practising Emergency Medicine. I'm not sure if Emergency Physicians would be in favour of this individual representing them?

What about representation from Psychiatrists, Pediatricians, Plastic Surgeons, Pathologists, Neurologists, Orthopedic Surgeons, Dermatologists, Plastic Surgeons and Urologists (list goes on...)?

Seems like the same group of 4-5 highly paid specialties (who are targets of impending cuts) trying to camouflage themselves under the guise of "specialties" to remove themselves from the limelight.

Edited by ArchEnemy

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15 minutes ago, Aconitase said:

Not sure I understand. Their goal is to protect the smaller specialist groups from having their incomes cut to support family docs. It’s a good mix. 

You find that the current representatives on the "Ontario Specialists Association" are a good mix and representative of the different subspecialties? 

Edited by ArchEnemy

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6 hours ago, ArchEnemy said:

What about representation from Psychiatrists, Pediatricians, Plastic Surgeons, Pathologists, Neurologists, Orthopedic Surgeons, Dermatologists, Plastic Surgeons and Urologists (list goes on...)?

Seems like the same group of 4-5 highly paid specialties (who are targets of impending cuts) trying to camouflage themselves under the guise of "specialties" to remove themselves from the limelight.

That's exactly the point, I think.  They're trying to get an official mandate, regardless of whether there are any other specialties involved,  which not only helps their short-term negotiation prospects, but also sets them up as being in charge should any official recognition follow.  If I were a non-represented specialist, I'd object to the name - since it implies the organization has broad support (rather than association of cardiologists, ophthalmologist, radiologists...).  It's a clever move though - supposing whatever deal is made is split among whatever this new organization is and the OMA, then they'll do a nice job of avoiding (or minimizing) any cuts for themselves.     

Best case for them - official recognition with broad "specialist" mandate and separate negotiations/arbitration with the government.  Worst case  - OMA remains only official negotiating body and they're some kind of dependent subgroup.  They might end up with some kind of intermediate participatory role at the negotiating table, but  I would suppose that would make things much more complicated.

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4 hours ago, ArchEnemy said:

You find that the current representatives on the "Ontario Specialists Association" are a good mix and representative of the different subspecialties? 

Of the highly paid ones yes

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Obviously in medicine not everything should be paid the same. In general, a cardiologist or an ophthalmologist should be paid more overall than a general pediatrician (saying as a pediatrics resident), reflect the amount of training and skill required to do the job.

The question is, how much more? I think a realignment is needed. Yes, pay the primary care physicians who are the backbone of our health care system and work very hard more to reflect what they do. Ophthalmology and some of the other highest paid specialties have fee structures that have not changed as the actual practice of medicine has changed. For instance, being paid X amount for a certain procedure that used to take hours and very specialized skills that with new technology now takes 30 minutes should have the fee for that service changed accordingly. And so on for other specialties. I think that every doctor who values patient care and an equitable system would agree with this.

I do not envy whoever decides how much a service in medicine is worth. I realize that nobody wants things taken away, but in a public system equity is important.

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On 10/30/2018 at 7:41 AM, BigM said:

It’s interesting to see the announcement of the Ontario Specialists Association’s board of directors which is “representing a broad range of specialties”. Two radiologists, a gastroenterologist, a cardiologist, a nephrologist, an eye surgeon, a vascular surgeon and an emerg doc. Is this a group that looks like they are going to defend the status quo?

Literally looks like the overpaid specialties crew hahaha

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2 minutes ago, Edict said:

Literally looks like the overpaid specialties crew hahaha

ha well that isn't surprising as lets just say they would be the people at present most motivated to do something. 

Raises some big issues though - lets assume this sort of constant cutting will continue - after all by the time all this is done it will be 20 years of it. You have an organization - the OMA - that hasn't been able to deal with that situation to the satisfaction of I would say the majority of the membership. Hence the OMA rebellion a couple of years ago, and hence this sort of stuff now. All this before the "real" cuts have taken place etc. Things are only going to get nastier. The OMA is under attack from the inside and those attacks have increased for some pretty clear reasons. You cannot continue to piss off your membership year after year and expect that to end well. 

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On 10/31/2018 at 10:00 PM, bearded frog said:

Obviously in medicine not everything should be paid the same. In general, a cardiologist or an ophthalmologist should be paid more overall than a general pediatrician (saying as a pediatrics resident), reflect the amount of training and skill required to do the job.

The question is, how much more? I think a realignment is needed. Yes, pay the primary care physicians who are the backbone of our health care system and work very hard more to reflect what they do. Ophthalmology and some of the other highest paid specialties have fee structures that have not changed as the actual practice of medicine has changed. For instance, being paid X amount for a certain procedure that used to take hours and very specialized skills that with new technology now takes 30 minutes should have the fee for that service changed accordingly. And so on for other specialties. I think that every doctor who values patient care and an equitable system would agree with this.

I do not envy whoever decides how much a service in medicine is worth. I realize that nobody wants things taken away, but in a public system equity is important.

The issue is these specialties that are the target for cuts are consensus overpaid. Many of these specialties being targeted make easily 40% more than other specialists that work similar hours. Much of this is because procedures that once took longer now take shorter periods of time. For example, EVARs are a cash cow for vascular surgeons, because as technology has improved, EVARs take half the time they used to and the billings code hasn't kept up. If the OSA fails to get support from all the specialties, which they likely won't given their agenda, i don't think they will have much power at the negotiating table. 

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