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Realignment of Doctor's Income

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On 10/31/2018 at 8:00 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.

How do you determine the "difficulty"?

I've intubated people, put in central lines, treated STEMIs, reduced fractues and have listened to people cry how Brenda at work is giving them a hard time week after week.

I find the last issue the most difficult one any day of the week. I still infrequently have to do the former but would do that over the last 10 times out of 10.

And it's not reflected in the pay, whatsoever

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1 hour ago, rmorelan said:

I am not saying they are the solution - although they say they aren't over paid at all, all the other fields are under paid ha. There is a lot of the language with this that is pretty warped. All doctors relatively speaking have been making less and less for some time, and almost on every front. You can say that the government cannot afford that - might be true, probably IS true - but they would counter that isn't good enough just to say that and move away - you don't see similar cuts in any other job related to public service. See how the police, teachers, fire fighters or nurses just as off the cuff examples would handle a similar decade of pay reductions, and another 10 years of further reductions?  It would be bloody war to say the least. To date doctors have been positively civil in comparison. That is beginning to change - after literally being squeezed in all directions (greater training costs, greater training time, lower fee schedule, worse tax situation, job market restrictions....)

 

Yes, but what is often forgotten in the discussion is that physician salaries jumped something like 60% in the 2000s. Doctors are still really well paid and in Canada probably one of the best paid professions. The rest of the public service fights hard for their pay because their pay is much lower than doctor pay. Not that i'm going to be against a pay raise, but ultimately, when push comes to shove, it isn't fair that certain specialties are billing well above their counterparts for similar work. 

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20 minutes ago, Edict said:

Yes, but what is often forgotten in the discussion is that physician salaries jumped something like 60% in the 2000s. Doctors are still really well paid and in Canada probably one of the best paid professions. The rest of the public service fights hard for their pay because their pay is much lower than doctor pay. Not that i'm going to be against a pay raise, but ultimately, when push comes to shove, it isn't fair that certain specialties are billing well above their counterparts for similar work. 

I'd rather have doctor salaries growing over the next decade and add more residency spots for students than put up 100K "Ontario Open for Business" signs and other ludicrous government spending on all levels. Also, I voted for the PCs and as much as I still support some of their policies, I think its worth bringing up these issues that our doctors need to be allies rather than creating frustration amongst doctors. You guys already have so much on your plate, this shouldn't be a concern. If only there were more people in the public standing up for MDs...

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1 hour ago, bloh said:

How do you determine the "difficulty"?

I've intubated people, put in central lines, treated STEMIs, reduced fractues and have listened to people cry how Brenda at work is giving them a hard time week after week.

I find the last issue the most difficult one any day of the week. I still infrequently have to do the former but would do that over the last 10 times out of 10.

And it's not reflected in the pay, whatsoever

This x100. The difficulty of ophtho is very overated, the vast majority of ophtho patients outpatient, and procedures are not difficult at all in comparison to what  other procedural specialties have to deal with.   

 

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54 minutes ago, Edict said:

Yes, but what is often forgotten in the discussion is that physician salaries jumped something like 60% in the 2000s. Doctors are still really well paid and in Canada probably one of the best paid professions. The rest of the public service fights hard for their pay because their pay is much lower than doctor pay. Not that i'm going to be against a pay raise, but ultimately, when push comes to shove, it isn't fair that certain specialties are billing well above their counterparts for similar work. 

I think I have to check the exact numbers - I think family doctors income did jump that much but not everyone was in the same ballpark (doctor shortage and all that) - but again I would have to actually look it up. For family doctors was because their income was actually relatively speaking very low (same problem the US has right now).Some other fields definitely did jump as well - radiology included with the full scale PACS system coming online. 

Ha even if you are right as you know memories are short - what happened in the early 2000s isn't really motivating the politics right now even if it should be. Something nearly 20 years ago in an often 30 year career and all that. 

You can argue relative pay levels for sure - but I don't think they are just fighting because their pay is lower. They are fighting because that is exactly what a union is supposed to be doing for its members. No one regardless of level wants to lose money year over year. Even the terms of what is "fair" don't often apply even if they should 

and to be clear - I am not saying I don't think there should be more equalization - I have been saying that for years. I am just describing the current landscape as I see it - and I am a bit worried about the impact of all of this internal strife. Medicine has some really annoying habits when things get tough - usually really sticking it to newer members to start with, exactly at the time when they are most vulnerable ha. Burnout is already at extremely high levels, and things are general messy. 

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2 hours ago, VivaColombia said:

I'd rather have doctor salaries growing over the next decade and add more residency spots for students than put up 100K "Ontario Open for Business" signs and other ludicrous government spending on all levels. Also, I voted for the PCs and as much as I still support some of their policies, I think its worth bringing up these issues that our doctors need to be allies rather than creating frustration amongst doctors. You guys already have so much on your plate, this shouldn't be a concern. If only there were more people in the public standing up for MDs...

Of course you do, but thats because we are all doctors/aspiring doctors. It's like asking CEOs if they deserve a pay raise. CEOs will argue they work very hard for what they do as well. I'm just thinking from a general public's perspective, you are going to have a very hard time convincing the public to support pay raises for doctors who are billing 300-700k.

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5 hours ago, bloh said:

How do you determine the "difficulty"?

I've intubated people, put in central lines, treated STEMIs, reduced fractues and have listened to people cry how Brenda at work is giving them a hard time week after week.

I find the last issue the most difficult one any day of the week. I still infrequently have to do the former but would do that over the last 10 times out of 10.

And it's not reflected in the pay, whatsoever

I find the last case you listed to be the most difficult, and to be the least relatively paid in term of FFS.

I think that physicians are well paid in North America. But to hear the Ontario government wants to cut down on physicians' pay when there is a disproportionate inflation, more strict taxation rules for self-employed professionals (thanks Trudeau), no benefits at all whatsoever for physicians (sick leave, maternity leave, personal emergencies, no pension plan). Of course, the public won't side with the physicians, as physicians don't have a positive image on social media (often seen as greedy money-grabbers compared to other health professions). But if anyone has gone through the whole medical school and residency experience, I really think that it is a tough road and we often sacrifice our personal well-being for that of the patients (the number of times I was oliguric or hypoglycemic in calls or in busy services), it should be reflected in our salary as well. 

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23 hours ago, rmorelan said:

Ha even if you are right as you know memories are short - what happened in the early 2000s isn't really motivating the politics right now even if it should be. Something nearly 20 years ago in an often 30 year career and all that.

Actually, I think there are people at the MOH with very long memories.  And I don't think the MOH got what they wanted from their prior approach.  So now they're changing tactics.

Just a sense I get from watching from the outside.

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22 hours ago, LittleDaisy said:

I find the last case you listed to be the most difficult, and to be the least relatively paid in term of FFS.

I think that physicians are well paid in North America. But to hear the Ontario government wants to cut down on physicians' pay when there is a disproportionate inflation, more strict taxation rules for self-employed professionals (thanks Trudeau), no benefits at all whatsoever for physicians (sick leave, maternity leave, personal emergencies, no pension plan). Of course, the public won't side with the physicians, as physicians don't have a positive image on social media (often seen as greedy money-grabbers compared to other health professions). But if anyone has gone through the whole medical school and residency experience, I really think that it is a tough road and we often sacrifice our personal well-being for that of the patients (the number of times I was oliguric or hypoglycemic in calls or in busy services), it should be reflected in our salary as well. 

I agree, but ironically the specialists who are hypoglycemic on call are not usually the ones who are making the big bucks right now. A lot of the specialists who are making a lot of money are beneficiaries of technology and the government hasn't caught up. Ultimately, this is what needs to be addressed. Should nephrologists who happen to run a dialysis unit, vascular surgeons who do EVAR, cardiologists who read echos, radiologists, and ophthalmologists who do cataracts make significantly more than even their own same specialty peers who don't? Many of these cuts are actually long overdue, in fact, people have been expecting these cuts for years. 

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3 hours ago, Edict said:

I agree, but ironically the specialists who are hypoglycemic on call are not usually the ones who are making the big bucks right now. A lot of the specialists who are making a lot of money are beneficiaries of technology and the government hasn't caught up. Ultimately, this is what needs to be addressed. Should nephrologists who happen to run a dialysis unit, vascular surgeons who do EVAR, cardiologists who read echos, radiologists, and ophthalmologists who do cataracts make significantly more than even their own same specialty peers who don't? Many of these cuts are actually long overdue, in fact, people have been expecting these cuts for years. 

Having actually billed for dialysis, I can't really argue with this. I have a hard time understanding why a chronic run based on dry weight is compensated the same as, say, a stress test or more than double a routine inpatient visit. Sure, dialysis patients can run into trouble, but so do inpatients. Either way, there are a lot of inequities that aren't justified by much of anything at all (especially when they give rise to the cartel-like behaviour of a lot of nephro groups). 

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16 minutes ago, A-Stark said:

Having actually billed for dialysis, I can't really argue with this. I have a hard time understanding why a chronic run based on dry weight is compensated the same as, say, a stress test or more than double a routine inpatient visit. Sure, dialysis patients can run into trouble, but so do inpatients. Either way, there are a lot of inequities that aren't justified by much of anything at all (especially when they give rise to the cartel-like behaviour of a lot of nephro groups). 

The cartel-like behaviour is spot on. Seeing new nephro's trying to "get in" is just sad.

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7 hours ago, Let'sGo1990 said:

Pretty sad how the government finally made us crack and begin cannibalizing one another. 

I agree. A united front is what is needed but it seems like that has crumbled. Sadly, this won't stop with just a few specialists. Everyone will be cut in the end. 

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9 hours ago, A-Stark said:

Having actually billed for dialysis, I can't really argue with this. I have a hard time understanding why a chronic run based on dry weight is compensated the same as, say, a stress test or more than double a routine inpatient visit. Sure, dialysis patients can run into trouble, but so do inpatients. Either way, there are a lot of inequities that aren't justified by much of anything at all (especially when they give rise to the cartel-like behaviour of a lot of nephro groups). 

 

9 hours ago, JohnGrisham said:

The cartel-like behaviour is spot on. Seeing new nephro's trying to "get in" is just sad.

Same thing exists for cataract surgery in ophtho...pretty ruthless actually.

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On 11/6/2018 at 5:55 AM, NLengr said:

I agree. A united front is what is needed but it seems like that has crumbled. Sadly, this won't stop with just a few specialists. Everyone will be cut in the end. 

It's really too bad. Divide and conquer is the oldest trick in the book and to see a group as educated as physicians are fall into it is laughable. 

But yes, everyone will be cut. We don't know exactly how far the government will go with this, and once they're done with the highest billing specialties, they will certainly find a new target. So while there is some element of schadenfreude (for some people) in seeing some of these specialties be cut, it is short sighted and foolish to not support one another. 

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8 minutes ago, Let'sGo1990 said:

It's really too bad. Divide and conquer is the oldest trick in the book and to see a group as educated as physicians are fall into it is laughable. 

But yes, everyone will be cut. We don't know exactly how far the government will go with this, and once they're done with the highest billing specialties, they will certainly find a new target. So while there is some element of schadenfreude (for some people) in seeing some of these specialties be cut, it is short sighted and foolish to not support one another. 

Can we really say there has been support of one another prior? Some groups of doctors have complained about other groups of doctors for at least the last decade, if not more.  There wasnt necessarily the same downward pressure to cause more public bashing, but definitely has existed within the medical community itself.

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Even after the OMA backed-down on the last minute on relativity, the OSA did indeed get its mandate approved by higher-billing specialties: medical (cardio, gastro, nephro), surg (cardiac, ophth) & diagnostics (radiology, nuclear & neurorads).  No mention of vascular surgery.

It's a lot of legislative work to repeal existing frameworks, etc. for a relatively small group of physicians, even though they'll claim to be there for all specialists.  Not to mention whether this will mean losing the binding arbitration that was already negotiated and thus angering other physicians.    

Also, I'm wondering if the Ford government would really increase payments to this highly-paid group while claiming to be broke.  Dr. Jacobs, the leader, seems to be a big Ford supporter so maybe there's a sympathetic ear in government.  It will be interesting to hear the rational that the Ford government uses.  

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2 hours ago, tere said:

Even after the OMA backed-down on the last minute on relativity, the OSA did indeed get its mandate approved by higher-billing specialties: medical (cardio, gastro, nephro), surg (cardiac, ophth) & diagnostics (radiology, nuclear & neurorads).  No mention of vascular surgery.

It's a lot of legislative work to repeal existing frameworks, etc. for a relatively small group of physicians, even though they'll claim to be there for all specialists.  Not to mention whether this will mean losing the binding arbitration that was already negotiated and thus angering other physicians.    

Also, I'm wondering if the Ford government would really increase payments to this highly-paid group while claiming to be broke.  Dr. Jacobs, the leader, seems to be a big Ford supporter so maybe there's a sympathetic ear in government.  It will be interesting to hear the rational that the Ford government uses.  

Ha, yeah this is all very messy. 

It is a relatively small number for sure - although of course the OSA is hoping to expand now that they have a foothold in the door as it were, and that option is always going to be hanging in the wind out there going forward. The OMA didn't even all some sections to vote and for obvious reasons not exactly allowing easy access to members. 

I don't think people in the OSA are expecting dramatically increased payouts etc, but they are I would say collectively furious about the OMA's additional relatively pay cuts on top of what is likely other pay cuts as well (I mean a 30% pay cut of top of whatever the government was throwing at them gets people's attention). 

I think the most important part of all this is we have a second scathing rebuke of the OMA in two short years. I cannot imagine a more powerful wake up call for them than a chunk of their membership leaving. Dare I say the somewhat lazy or at least unproductive approach to things clearly isn't going to stand anymore. We are in full blown rebellion, and not only will we be competing with the government but each association will be competing between each other as well. Also the OMA blinked in a sense - by dropping relativity or at least differing it arbitration they look they didn't really believe in their position and look desperate. 

 

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9 hours ago, rmorelan said:

Ha, yeah this is all very messy. 

It is a relatively small number for sure - although of course the OSA is hoping to expand now that they have a foothold in the door as it were, and that option is always going to be hanging in the wind out there going forward. The OMA didn't even all some sections to vote and for obvious reasons not exactly allowing easy access to members. 

I don't think people in the OSA are expecting dramatically increased payouts etc, but they are I would say collectively furious about the OMA's additional relatively pay cuts on top of what is likely other pay cuts as well (I mean a 30% pay cut of top of whatever the government was throwing at them gets people's attention). 

I think the most important part of all this is we have a second scathing rebuke of the OMA in two short years. I cannot imagine a more powerful wake up call for them than a chunk of their membership leaving. Dare I say the somewhat lazy or at least unproductive approach to things clearly isn't going to stand anymore. We are in full blown rebellion, and not only will we be competing with the government but each association will be competing between each other as well. Also the OMA blinked in a sense - by dropping relativity or at least differing it arbitration they look they didn't really believe in their position and look desperate. 

I agree that physicians of all stripes are unhappy with the OMA.  Still, although I had the same initial reaction to the back-tracking on relativity, in the end I think it was a responsible move to try to move things forward - no question it angered many in the OMA for different reasons.  To me the future status of the binding arbitration is the big question at this point.  

The residual anger regarding relativity drove the vote for the sections that voted yes, but a number of sections voted No: anesth. derm, EM, ENT, plastics, occupational and vascular.  Maybe one or two could do a revote, but I don't think the OSA will ever have broad mandate of the QC association (which includes paediatricians, psychiatrists which the OSA doesn't really seem to be advocating for).

 Maybe this government would be more open to accommodating this group, because of the particular politics (the results were posted on the leader Dr. Jacobs Twitter feed which also has a lot of pro-Ford/anti-Liberal posts, rather than the OSA sites), but it does mean really sticking the Ford government's neck out for a small group of physicians - new legislation,  vs other physicians, and more spending when claiming to be broke.

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3 minutes ago, tere said:

I agree that physicians of all stripes are unhappy with the OMA.  Still, although I had the same initial reaction to the back-tracking on relativity, in the end I think it was a responsible move to try to move things forward - no question it angered many in the OMA for different reasons.  To me the future status of the binding arbitration is the big question at this point.  

The residual anger regarding relativity drove the vote for the sections that voted yes, but a number of sections voted No: anesth. derm, EM, ENT, plastics, PM&R and vascular.  Maybe one or two could do a revote, but I don't think the OSA will ever have broad mandate of the QC association (which includes paediatricians, psychiatrists which the OSA doesn't really seem to be advocating for).

 Maybe this government would be more open to accommodating this group, because of the particular politics (the results were posted on the leader Dr. Jacobs Twitter feed which also has a lot of pro-Ford/anti-Liberal posts, rather than the OSA sites), but it does mean really sticking the Ford government's neck out for a small group of physicians - new legislation,  vs other physicians, and public spending.  

Yeah binding arbitration ultimately is the only real defense to the single provider system we are dealing with. We should have gotten all of that codified an extremely long time ago. 

In the long run I will say I don't know what the OSA will do - that is the interesting thing and problem with politics - it is volatile. In 3 months a relatively thrown together organization has shattered part of the OMA.  Who knows what they will be able to do moving forward - particularly if they do manage to get a good deal moving forward. Not saying that is good or bad actually - only that it is hard to dismiss any possibility in the current climate. The OMA never even really responded to the creation of the OSA viewing it as little more than a joke. Over and over again lately in politics that is exactly the sort of arrogance that to the downfall of many established people/groups. Interesting as well many of the groups you are correct in saying voted no - that still was a relatively close vote for them (ha except for emerg).   

The OMA didn't even reverse relatively - the simply put it down the line as a decision point basically expecting it to happen regardless. I found that move interesting - something that required a collective vote to do was changed at least conceptually without a vote of the members at large. That organization is more than a little confusing at times. 

Ha, and Dr. Jacobs is clearly of the conservative mindset - and he is far from alone in that. The majority of doctors do vote conservative in seems by the polls - which was initially a bit surprising to me. I am recycling my point but I don't think people are expecting the OSA to get some great deal but rather to be in an organization that doesn't ever disadvantage part of its membership even to benefit another group. This wasn't a vote for pro Jacobs politics but against the OMA's long standing inability to what its members were hoping for. 

 

 

 

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At this point I'm glad I have my USMLEs and my US board exams done. But that is NOT to say that the US is a safeguard when they will be going through massive health care cuts and changes over the coming years as well. 

The one saving grace is that as health care costs are rising due to an aging baby boomer population, so does the demand for more physicians, and thus need to pay us to prevent another brain drain. The OMA and other groups need to educate the public about the risk of another brain drain so that we have their support in coming provincial elections where topics like physician reimbursement should be at the top of the agenda.

For what it's worth, I think I'm well compensated at present, and all I'm asking for is to be given pay increases that match the inflation rate or CPI. 

Edited by leviathan

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