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Top 100 physician-identified OHIP billings released

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Since there's a pay wall...

Top 10 from the most recent year:

1. Ophthalmologist

2. Neurosurgeon w/pain clinic

3. Family doctor w/pain clinic

4. Ophthalmologist

5. Radiologist w/fertility imaging centre

6. Internist w/dialysis centre

7. Family doctor w/pain clinic

8. Anesthesiologist w/pain clinic

9. Radiologist

10. Ophthalmologist

The Top 100 list over the last several years consists of roughly 30% from ophthalmology, 20% from radiology, 20% from internal med+cardiology, and 20% family medicine. The remainder are unlisted. Note that this list contains data from 2011 and the traditionally high earning specialties have taken some hits since then. It's possible that moving forward the distribution will favour family medicine and IM+subspecialties.

Also, none of these numbers take into account overhead or private earnings.

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"For patients, the question remains: Are we getting good value? When a general practitioner bills $400,000 for looking after 1,300 patients while a nurse practitioner looks after 800 patients for $120,000 and gets better satisfaction on average, serious questions must be raised."

source: https://www.thestar.com/opinion/star-columnists/2019/07/03/what-next-for-ontarios-top-billing-doctors.html

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23 hours ago, nsrdude said:

"For patients, the question remains: Are we getting good value? When a general practitioner bills $400,000 for looking after 1,300 patients while a nurse practitioner looks after 800 patients for $120,000 and gets better satisfaction on average, serious questions must be raised."

source: https://www.thestar.com/opinion/star-columnists/2019/07/03/what-next-for-ontarios-top-billing-doctors.html

Ahhh the star......if it was up to them, there would be no physicians in the country and health outcomes would be perfect as a result. They sell papers by doctor bashing. 

No citation on that data, so as far as we know, someone made it up. And those patients the NP is seeing are low acuity, uncomplicated patients. People are gonna be happy when you give them a birth control refill or treat an uncomplicated UTI. They are gonna be less happy when they are a poorly controlled T2DM and you are telling them they have to lose weight and exercise, while at the same timing starting insulin and piling extra BP meds on them to try and prevent an MI. On top of that, there are good studies out of the US that shows patient satisfaction (at least during hospitalization) is inversely related to outcomes. Satisfaction is a terrible metric to use to judge performance. It has nothing to do with actual outcomes that matter (survival, glucose control, time till recurrence etc).

 

The Star is anti-doctor. Everyone knows it. Unfortunately, the OMA has done a crap job with public relations in Ontario and now they are paying the price. 

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8 minutes ago, NLengr said:

Ahhh the star......if it was up to them, there would be no physicians in the country and health outcomes would be perfect as a result. The sell papers by doctor bashing. 

No citation on that data, so as far as we know, someone made it up. And those patients the NP is seeing are low acuity, uncomplicated patients. People are gonna be happy when you give them a birth control refill or treat an uncomplicated UTI. They are gonna be less happy when they are a poorly controlled T2DM and you are telling them they have to lose weight and exercise, while at the same timing starting insulin and piling extra BP meds on them to try and prevent an MI. On top of that, there are good studies out of the US that shows patient satisfaction (at least during hospitalization) is inversely related to outcomes. Satisfaction is a terrible metric to use to judge performance. It have nothing to do with actual outcomes that matter (survival, glucose control, time till recurrence etc).

 

The Star is anti-doctor. Everyone knows it. Unfortunately, the OMA has done a ceap job with public relations in Ontario and now they are paying the price. 

I agree that the OMA doesn't do a great job with it's ads or campaigns. However, I wonder if it's because at the core we are a very privileged group of professionals (at least we are perceived as such) and that there is no real way to be aggressive in promoting our self interests. I think they have cycled through a bunch of media firms and I find it extremely hard to believe that they are all ineffectual when they do have successes under their belt with other orgs. I personally think that there just isn't a good way to advocate for our self interest without it backfiring. 

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8 hours ago, blah1234 said:

I agree that the OMA doesn't do a great job with it's ads or campaigns. However, I wonder if it's because at the core we are a very privileged group of professionals (at least we are perceived as such) and that there is no real way to be aggressive in promoting our self interests. I think they have cycled through a bunch of media firms and I find it extremely hard to believe that they are all ineffectual when they do have successes under their belt with other orgs. I personally think that there just isn't a good way to advocate for our self interest without it backfiring. 

Good point. At least in my home province, there is a large swath of the general public that tends to be hostile to anyone successful or who makes a good living. Not just docs either; lawyers, engineers, engineering techs and tradesman who are well compensated, professors, business people, dentists.....jealousy is strong around here. 

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28 minutes ago, NLengr said:

Good point. At least in my home province, there is a large swath of the general public that tends to be hostile to anyone successful or who makes a good living. Not just docs either; lawyers, engineers, engineering techs and tradesman who are well compensated, professors, business people, dentists.....jealousy is strong around here. 

It's an Atlantic thing

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It would be one thing to simply focus on the privilege that professionals enjoy, but it seems that often detractors additionally seek to minimize the hard work, care and contribution to others' welfare, in order to support their narrative. It is this part that I think is most regrettable, rather than the discussion of privilege itself.

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On 7/8/2019 at 10:19 PM, NLengr said:

Ahhh the star......if it was up to them, there would be no physicians in the country and health outcomes would be perfect as a result. They sell papers by doctor bashing. 

No citation on that data, so as far as we know, someone made it up. And those patients the NP is seeing are low acuity, uncomplicated patients. People are gonna be happy when you give them a birth control refill or treat an uncomplicated UTI. They are gonna be less happy when they are a poorly controlled T2DM and you are telling them they have to lose weight and exercise, while at the same timing starting insulin and piling extra BP meds on them to try and prevent an MI. On top of that, there are good studies out of the US that shows patient satisfaction (at least during hospitalization) is inversely related to outcomes. Satisfaction is a terrible metric to use to judge performance. It has nothing to do with actual outcomes that matter (survival, glucose control, time till recurrence etc).

 

The Star is anti-doctor. Everyone knows it. Unfortunately, the OMA has done a crap job with public relations in Ontario and now they are paying the price. 

I am not sure if NP has 800 patients under their care.

For instance, they are paid as a governmental employee, with extended benefits and pension. They do not pay 30% overhead. For a GP who has 800 patients rostered to them, who has to pay 30% overhead and expensive CPSO and CMPA fees, who has no benefits nor pension; they are paid relatively the same after overhead and insurance plans!

They mostly work under a supervision of MDs in FHO/FHTs (please correct me if I am wrong) ; In FHO/FHTs, they mostly  provide walk in episodic care, see urgent patients the same day as their main providers were away or unable to fit them in. The UTIs and Rx refills that Nlengr mentioned are real life situations, and that's whom NPs usually end up seeing. The patients who are complex and who have multiple concerns will opt to see a MD or a resident physician in academic setting.  They see uncomplicated patient  with 1-2 concerns maximum q 30 minutes. Those patients are not rostered to them. For anything more complicated, i.e: the T2DM patient requiring insulin, as Nlengr mentioned, they will immediately refer to a GP for consultation, which in itself complicates the process. They work from 9 am - 3 pm, I doubt that they can handle 800 patients independently ?

Or the NPs have an unique niche, and work in neurosurgery, acute trauma surgery, IM subspecialties under supervision of staff physicians in academic centre---> they are equivalent as a resident physician IMO and needs supervision while they have much better working conditions with twice the pay, please correct me if I am wrong. 

I don't know why the government and the general public thinks that after 1-2 year of Master in Nursing makes you as equivalent and a good primary care provider as a family doctor who: undergoes 4 years of undergraduate studies 2) 4 years of medical school where you learn all the basic sciences and every organ system 3) 2 years of residency ? 

I am pretty disappointed that CFPC  allows NPs to have the same level of responsibilities as a GP, it is a punch in your back saying that all your studies & clinical rotations are as equivalent as a nurse who does 1-2 year of master and who can now practice independently. It is kind of saying to the public, we can find nurses who work for cheaper, and those family doctors are greedy and they are too privileged, and they deserve a pay cut as hinted nicely by the Star. 

I don't know why the government does not think things through over long term, they might see that it costs less money to train a NP for 1-2 years, but they don't think about the quality of care, our aging population who has multiple medical issues,  the complexity of cases and the medical knowledge's differences between a NP and MD. 

It seems that the public always likes the NPs more, because the nurses are nicer and they are paid less, and perceived as less privileged as GPs. But not one single writer in the Star ever writes a story about a GP who provides OHIP-less care to their patients, who does paperworks to advocate for more services for their patients for free, and who sacrifices their early & late 20s to meet the rigorous demands of medical school & residency? 

It seems like the public and the press is anti doctors and are fond of doctors-bashing. They don't care about the care we provide and how hard we work, or how hard we have worked to get here, they disregard or ignore the length of our training and our difficult working conditions. All they see is just damn doctors who just want to get paid good money. 

Sorry for my long rant,, would appreciate if others jump in !

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2 minutes ago, LittleDaisy said:

...I don't know why the government does not think things through over long term....

Because no politician thinks past the next election. All that matters is getting re-elected and securing that sweet sweet pension. Just keep telling the public what they want to hear (even if it's wrong or not in anyone's best interest) so they re-elect you and you can draw that sweet pension. 

Seriously. That's all that matters.

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14 hours ago, LittleDaisy said:

I am not sure if NP has 800 patients under their care.

For instance, they are paid as a governmental employee, with extended benefits and pension. They do not pay 30% overhead. For a GP who has 800 patients rostered to them, who has to pay 30% overhead and expensive CPSO and CMPA fees, who has no benefits nor pension; they are paid relatively the same after overhead and insurance plans!

They mostly work under a supervision of MDs in FHO/FHTs (please correct me if I am wrong) ; In FHO/FHTs, they mostly  provide walk in episodic care, see urgent patients the same day as their main providers were away or unable to fit them in. The UTIs and Rx refills that Nlengr mentioned are real life situations, and that's whom NPs usually end up seeing. The patients who are complex and who have multiple concerns will opt to see a MD or a resident physician in academic setting.  They see uncomplicated patient  with 1-2 concerns maximum q 30 minutes. Those patients are not rostered to them. For anything more complicated, i.e: the T2DM patient requiring insulin, as Nlengr mentioned, they will immediately refer to a GP for consultation, which in itself complicates the process. They work from 9 am - 3 pm, I doubt that they can handle 800 patients independently ?

Or the NPs have an unique niche, and work in neurosurgery, acute trauma surgery, IM subspecialties under supervision of staff physicians in academic centre---> they are equivalent as a resident physician IMO and needs supervision while they have much better working conditions with twice the pay, please correct me if I am wrong. 

I don't know why the government and the general public thinks that after 1-2 year of Master in Nursing makes you as equivalent and a good primary care provider as a family doctor who: undergoes 4 years of undergraduate studies 2) 4 years of medical school where you learn all the basic sciences and every organ system 3) 2 years of residency ? 

I am pretty disappointed that CFPC  allows NPs to have the same level of responsibilities as a GP, it is a punch in your back saying that all your studies & clinical rotations are as equivalent as a nurse who does 1-2 year of master and who can now practice independently. It is kind of saying to the public, we can find nurses who work for cheaper, and those family doctors are greedy and they are too privileged, and they deserve a pay cut as hinted nicely by the Star. 

I don't know why the government does not think things through over long term, they might see that it costs less money to train a NP for 1-2 years, but they don't think about the quality of care, our aging population who has multiple medical issues,  the complexity of cases and the medical knowledge's differences between a NP and MD. 

It seems that the public always likes the NPs more, because the nurses are nicer and they are paid less, and perceived as less privileged as GPs. But not one single writer in the Star ever writes a story about a GP who provides OHIP-less care to their patients, who does paperworks to advocate for more services for their patients for free, and who sacrifices their early & late 20s to meet the rigorous demands of medical school & residency? 

It seems like the public and the press is anti doctors and are fond of doctors-bashing. They don't care about the care we provide and how hard we work, or how hard we have worked to get here, they disregard or ignore the length of our training and our difficult working conditions. All they see is just damn doctors who just want to get paid good money. 

Sorry for my long rant,, would appreciate if others jump in !

I agree with your point on differentiating the roles of NP and GPs, but let's not minimize the education and experience of NPs. NPs will have a 4 year BSCN, 2 years of full time practice as a RN and 2  years of graduate schooling resulting in a masters in nursing and a NP graduate diploma. That's a minimum of 8 years to become a NP in Canada, arguably more time spent in healthcare than a new grad GP If you want to just compare time. Only recently, NPs have received a much needed pay bump. I don't think GPs are getting overpaid, but rather NPs are underpaid as healthcare providers. 

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1 hour ago, orthoooo said:

I agree with your point on differentiating the roles of NP and GPs, but let's not minimize the education and experience of NPs. NPs will have a 4 year BSCN, 2 years of full time practice as a RN and 2  years of graduate schooling resulting in a masters in nursing and a NP graduate diploma. That's a minimum of 8 years to become a NP in Canada, arguably more time spent in healthcare than a new grad GP If you want to just compare time. Only recently, NPs have received a much needed pay bump. I don't think GPs are getting overpaid, but rather NPs are underpaid as healthcare providers. 

You need to compare the quality of those 8 years and what is actually being taught. 

Nursing school isn't anything close to med school. It's shorter (each year at my former university only ran Sept to April), far easier and much of the material covered is not medicine (lots of nursing, community wellness etc., very little on differential diagnosis and management). Plus the clinicals that nurses get are nursing clinicals. They aren't anything like clerkship in length, intensity or scope.

As for NP school, from what I have seen with the nurses I know who are doing it, it's not that rigorous or encompassing. Nothing I would ever consider close to a family residency (again far less intensity, volume and scope).

Finally, they have 2 year or more of NURSING experience but that isn't medicine. It's completely different than medicine. It's a valuable skillset and god knows I respect the skills of the nurses I work with, but I would never say what they are doing could be construed as providing experience in the practice of medicine (and I know my nurses would agree).

NPs have a roll to play in the system. But they shouldn't be considered as alternative family docs because they are not, which is often how the government portrays them to the public.

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3 minutes ago, NLengr said:

You need to compare the quality of those 8 years and what is actually being taught. 

Nursing school isn't anything close to med school. It's shorter (each year at my former university only ran Sept to April), far easier and much of the material covered is not medicine (lots of nursing, community wellness etc., very little on differential diagnosis and management). Plus the clinicals that nurses get are nursing clinicals. They aren't anything like clerkship in length, intensity or scope.

As for NP school, from what I have seen with the nurses I know who are doing it, it's not that rigorous or encompassing. Nothing I would ever consider close to a family residency (again far less intensity, volume and scope).

Finally, they have 2 year or more of NURSING experience but that isn't medicine. It's completely different than medicine. It's a valuable skillset and god knows I respect the skills of the nurses I work with, but I would never say what they are doing could be construed as providing experience in the practice of medicine (and I know my nurses would agree).

NPs have a roll to play in the system. But they shouldn't be considered as alternative family docs because they are not. 

Yes, I agree that NPs should not replace family docs and they are providing care from a nursing model rather than a medical model. I agree with everything you have mentioned lol. I was taking issue with the devaluing of NP's education and experience as just a "1-2 year of Master in Nursing".

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i cant really feel a lot of sympathy for the top billers. pathologists have been on the sunshine list for years with their average physician salaries. its not even an option for them not to be  on that list. nobody stood up for them then. nobodys standing up for them now. but lo and behold we are whining about top billers data being sacrosanct.

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2 hours ago, orthoooo said:

Yes, I agree that NPs should not replace family docs and they are providing care from a nursing model rather than a medical model. I agree with everything you have mentioned lol. I was taking issue with the devaluing of NP's education and experience as just a "1-2 year of Master in Nursing".

What I really meant was that 4 years of bachelor degree in nursing school is not the same  in terms of material taught, intensity and scope of practice as 4 years of medical school.

2 years of working experience as a nurse where you rarely make any major clinical decisions, and where you page the resident or staff physician instantly when you are worried, is not the same as rotating through 2 years of clerkship. Their educational background consists most of providing direct clinical care, rather than diagnosing and making clinical decisions. They don't learn the depth of patho physiology or basic science as a medical student.

The NP students that I work with, they start at 9 am and finish at 4 pm and they work directly with a NP in a FHT/FHO,  with 1 hour of nice lunch break; is not the same as a Family Medicine resident who rotates through all the heavy off-service rotations: general surgery, deliver babies overnight, doing NICU calls, doing CTU calls, doing overnight ER shifts, rural family medicine rotation; while continuing to provide longitudinal family medicine care to their patients.

It's ironic that CFPC was thinking of extending Family Medicine residency into a 3 year program to make future family physicians more competent and well-rounded, where as the provincial governments portray NPs with their nursing background as "competent" as GPs and cost less and are "less privileged". 

What I am worried about is that the more our profession allows the middle level caregivers to gain more autonomy to a point where NPs functions at the same level as a GP in Ontario (please correct me as the Ontario government has recently opened their scope of practice with practically no activity restrictions), the more we will be facing future consequences where the public has less respect for GPs, and where the government begins to train NPs as they "cost less"  instead of investing money in Family Medicine residency for our unmatched CMGs. Where do we draw the line? The more we allow other middle level care providers to gain autonomy, the more we are at risk of losing our professional scope of practice. 

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2 hours ago, moonlitocean said:

Let’s have the NPs run a hospital and see how much people like that.

 

If we don’t stop mid level encroachment, we will soon end up like the US. 

Can you elaborate on the last part? Is it the fact that MDs have lost their scope of practice with NPs, PAs having more autonomy?

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5 minutes ago, VivaColombia said:

Can you elaborate on the last part? Is it the fact that MDs have lost their scope of practice with NPs, PAs having more autonomy?

Yes. Being a family physician in Canada is superior to being one in the US, for a lot of reasons but increasing encroachment and loss of autonomy are some of them.

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On 7/29/2019 at 12:02 PM, LittleDaisy said:

What I am worried about is that the more our profession allows the middle level caregivers to gain more autonomy to a point where NPs functions at the same level as a GP in Ontario (please correct me as the Ontario government has recently opened their scope of practice with practically no activity restrictions), the more we will be facing future consequences where the public has less respect for GPs, and where the government begins to train NPs as they "cost less"  instead of investing money in Family Medicine residency for our unmatched CMGs. Where do we draw the line? The more we allow other middle level care providers to gain autonomy, the more we are at risk of losing our professional scope of practice. 

Scope encroachment will only progress further and further. To my knowledge, PAs currently are not regulated/legislatively recognized in Canada - but I think this will end in a matter of a few years. I have had the privilege with working with a few NPs to date - some are very knowledgeable and collaborative while some are borderline misrepresenting themselves. I think what Quebec has currently is what I would be comfortable with: NPs can dx 6 common chronic conditions (like hypertension, asthma, diabetes, etc.) and direct management. The fact that NPs can prescribe controlled medication in Ontario boggles my mind a little bit. If government is only seeing NPs as being the cheaper alternative to FPs, you might as well fold the family medicine discipline and just have NPs do primary care and just directly all MD grads to do a RC specialty lol 

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3 hours ago, thesupreme said:

Scope encroachment will only progress further and further. To my knowledge, PAs currently are not regulated/legislatively recognized in Canada - but I think this will end in a matter of a few years. I have had the privilege with working with a few NPs to date - some are very knowledgeable and collaborative while some are borderline misrepresenting themselves. I think what Quebec has currently is what I would be comfortable with: NPs can dx 6 common chronic conditions (like hypertension, asthma, diabetes, etc.) and direct management. The fact that NPs can prescribe controlled medication in Ontario boggles my mind a little bit. If government is only seeing NPs as being the cheaper alternative to FPs, you might as well fold the family medicine discipline and just have NPs do primary care and just directly all MD grads to do a RC specialty lol 

I've heard that PAs are regulated in Manitoba and Alberta, with Nova Scotia introducing a pilot program to have them expand their role in the medical field. I'm not sure if that means PAs will have more autonomy in the rest of the provinces like in the US? Signs are pointing to MDs facing more autonomy loss from PAs and NPs soon...and that doesn't sound appealing for patient care.

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4 hours ago, thesupreme said:

Scope encroachment will only progress further and further. To my knowledge, PAs currently are not regulated/legislatively recognized in Canada - but I think this will end in a matter of a few years. I have had the privilege with working with a few NPs to date - some are very knowledgeable and collaborative while some are borderline misrepresenting themselves. I think what Quebec has currently is what I would be comfortable with: NPs can dx 6 common chronic conditions (like hypertension, asthma, diabetes, etc.) and direct management. The fact that NPs can prescribe controlled medication in Ontario boggles my mind a little bit. If government is only seeing NPs as being the cheaper alternative to FPs, you might as well fold the family medicine discipline and just have NPs do primary care and just directly all MD grads to do a RC specialty lol 

I am more comfortable with the Quebec system as well. I hope that we really can put the end to the increasing scope of practice, and where some NPs have begun to roster patients to themselves as primary care providers in GTA, which is surprising.

The Ontario government originally opened NPs for the lack of primary care in Northern Ontario, yet a few years later, many of them are practising in GTA, either in academic hospitals or in FHO/FHTs, or some even run their own "family medicine" clinics. I am without words, that CFPC and OMA lets this happen, thinking that NPs are as equivalent as GPs. 

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11 hours ago, LittleDaisy said:

I am more comfortable with the Quebec system as well. I hope that we really can put the end to the increasing scope of practice, and where some NPs have begun to roster patients to themselves as primary care providers in GTA, which is surprising.

The Ontario government originally opened NPs for the lack of primary care in Northern Ontario, yet a few years later, many of them are practising in GTA, either in academic hospitals or in FHO/FHTs, or some even run their own "family medicine" clinics. I am without words, that CFPC and OMA lets this happen, thinking that NPs are as equivalent as GPs. 

... the embattled OMA ...

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On 6/29/2019 at 2:16 AM, ysera said:

It's kind of hard to talk objectively about this issue on a board filled with premeds and medical students. I definitely don't think this system is sustainable, if we're going to continue to offer healthcare to everyone (which we should) then something needs to give. 

I can't think of any other industrialized nation in the world that pays it's doctors the rates at which we do in North America. I think that's an area that should be looked into more going forward by policy makers, though it's going to be tough when we have to compete with the US system to retain our physicians. It's hard to imagine that there is ever a situation which justifies a physician billing the government for millions of dollars. There are world class physicians in Europe working just as hard while making a fraction of that. I don't know what the answers are but I definitely know things can't go on like this.

 

Our number one priority should be maintaining the integrity of the system, not maintaining physician salaries.

lololol. 

Those guys earned every penny. If you want to talk about "giving" then first look at slashing the admin and non-frontline staff salaries first. It's beyond shameful that you're making a post like  this. 

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On 7/9/2019 at 6:41 AM, NLengr said:

Good point. At least in my home province, there is a large swath of the general public that tends to be hostile to anyone successful or who makes a good living. Not just docs either; lawyers, engineers, engineering techs and tradesman who are well compensated, professors, business people, dentists.....jealousy is strong around here. 

It's all jealousy. Nothing more. We even have em in this thread, who most certainly are not actually in medicine.

 

On 7/29/2019 at 8:31 AM, orthoooo said:

I agree with your point on differentiating the roles of NP and GPs, but let's not minimize the education and experience of NPs. NPs will have a 4 year BSCN, 2 years of full time practice as a RN and 2  years of graduate schooling resulting in a masters in nursing and a NP graduate diploma. That's a minimum of 8 years to become a NP in Canada, arguably more time spent in healthcare than a new grad GP If you want to just compare time. Only recently, NPs have received a much needed pay bump. I don't think GPs are getting overpaid, but rather NPs are underpaid as healthcare providers. 

 

On 7/29/2019 at 9:38 AM, orthoooo said:

Yes, I agree that NPs should not replace family docs and they are providing care from a nursing model rather than a medical model. I agree with everything you have mentioned lol. I was taking issue with the devaluing of NP's education and experience as just a "1-2 year of Master in Nursing".

What?? That's exactly what it is! They do a tiny fraction of the training that a doctor does. Your 4th year med student is more competent than a NP. 

On 7/8/2019 at 9:53 AM, nsrdude said:

"For patients, the question remains: Are we getting good value? When a general practitioner bills $400,000 for looking after 1,300 patients while a nurse practitioner looks after 800 patients for $120,000 and gets better satisfaction on average, serious questions must be raised."

source: https://www.thestar.com/opinion/star-columnists/2019/07/03/what-next-for-ontarios-top-billing-doctors.html

When you do 0 complex medicine and just refill meds; it's easy to get "satisfaction" ratings.

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