Realignment of Doctor's Income 2

[MacHealthS]

So there is serious talk that these specialties will be hit the hardest by the realignment of income: 

Ophthalmology
Radiology
Cardiology
Gastroenterology

Does anyone have any insight into what the reduction of income will be like in these specialties?

[bearded frog]

I mean, its not so simple that you can give numbers and percentage. The idea is that, other than radiology, these specialties are doing procedures that have become dramatically faster/easier/cheaper to perform over the years, and compensation hasn't changed. Talking in generalities but an optho procedure that used to take 6 hours is now 30 minutes for example, so say they got paid a fairly compensated $X for that procedure, now they can do 4 in the same amount of time, safer, etc. Obviously its not linear and for any procedure its harder doing two 30 minute ones than one 60 minute one in general, but that's the theory on why these specialties are making relatively larger amounts to their colleagues. The idea of realignment, at least in Ontario i think, (billing rates are provincial) is to change the compensation for these procedures to be more appropriate for their actual fair compensation.

[MacHealthS]

Thank you for your clarification. Do you have any insight into when this realignment will happen or if it will happen at all?

Right now these specialties are god-like (e.g. opthalmology has an amazing lifestyle and a $1mill+ salary) and many people want to pursue these specialties for that reason. I think if the salaries of these 4 are aligned to be comparable to other specialist/generalist salaries, it could be a deal-breaker for many students. 

 

[Lactic Folly]

It is important to note that the numbers are *not* salaries... they are fee-for-service, so the volume of work must be very high to reach those numbers, and do not represent the average according to the ophtho's I've spoken to. I think that the competitiveness also has to do with the limited number of spots for ophthalmology. At the end of the day, my sense is that students will continue to gravitate towards the fields that suit their interests and fit their personal situations, and those who are drawn to a field for extrinsic reasons will eventually get filtered out by the realities and demands of training and work.

[MacHealthS]

The Star's database is actually great for this: 97 of the 479 ophthalmologists (1/5) billed over $1 mill; top 10 ophthalmologists billed a range from $2.26 mill to $5.36 mill; and the #1 guy (Narendra Armogan) billed more than $42 million over the past seven years, with an average of over $6 million annually.  

This is a big middle finger to all other specialties 

[JohnGrisham]

Don't forget pooled billing - sometimes a number is high because multiple providers are billing under 1 number. 

[member_225]

isn't overhead for ophthalmologists relatively high compared to other specialties as well? something like 50%...

[-JAG-]

[deleted]

[MacHealthS]

Thank you for your detailed response -JAG-

There would be no problem if these specialists would be making this much money in private practice

However, as all of this money comes from the common pot, billing disproportionately larger amounts than other specialists/generalists is essentially taking a big fat dump on them

"We are better than every other specialty" mentality...

---

In the US, specialists don't have such an insane spread in compensation. Ophthalmologists receive on average a $366K, Radiologists $419K, Cardiologists $430K and Gastroenterologists $417K. All specialties matter, and the time of some specialists is not valued disproportionately greater than the time of others

[rogerroger]

The writing has been on the wall for 10-20+ years. 
 

You have multiple provincial governments running crazy deficits for years and years. 
 

You have roughly 40 cents of every tax dollar going to healthcare. 
 

You have medical innovation impacting specialities and what they do asymmetrically and in the case of Canada, independent of market forces. 
 

Changes here were never really a question of if just when. 

Edited February 23, 2020 by rogerroger

[Medapp2017]

On 2/16/2020 at 2:40 PM, Lactic Folly said:

do not represent the average according to the ophtho's I've spoken to

Just wondering, what are the numbers you have heard for an average ophtho? 

[Medapp2017]

On 2/16/2020 at 3:47 PM, member_225 said:

isn't overhead for ophthalmologists relatively high compared to other specialties as well? something like 50%...

I also wonder if this overhead is persistent throughout ophtho's career, or just when they start

[MDinCanada]

21 minutes ago, Medapp2017 said:

I also wonder if this overhead is persistent throughout ophtho's career, or just when they start

Why would it decrease?

I think a huge part of the overhead comes from having to hire a bunch of specialized assistants. And the equipment tends to improve at a face pace.

[Medapp2017]

5 minutes ago, MDinCanada said:

And the equipment tends to improve at a face pace.

I was thinking for example once you buy an equipment such as slit lamp you can use it for many many years...

[Medapp2017]

On 2/23/2020 at 8:57 AM, rogerroger said:

Changes here were never really a question of if just when. 

https://cmajnews.com/2019/10/08/are-fees-for-cataract-surgery-still-too-high/

"The negotiated fees paid to ophthalmologists for cataract surgery hover around $400 across the country, but they have been falling. Rocha says the fee in Manitoba has decreased by about 10% over the past 20 years, while fees in Ontario have fallen by 25%. Cuts like these will hurt recruitment and retention of doctors, he says.

Sweetman says that although technology costs have risen, productivity appears to have increased faster, so even the reduced fees are probably still too high. And he doubts the costs are too high for surgeons to bear. “I suspect that if the costs were too high relative to their pay, they would give numbers to back that up.”

I looked into ophthalmology fees, and was surprised that they were only able to cut cataract surgery fees by 10%/25% in the past many years, while the length of the surgery decreased from what, 6 hours (?) to 6-10 min. The above article was written in 2019, is it likely that there will there will be more dramatic cuts in the next 20-30 years? 

[Snowmen]

On 4/7/2020 at 7:17 PM, Medapp2017 said:

https://cmajnews.com/2019/10/08/are-fees-for-cataract-surgery-still-too-high/

"The negotiated fees paid to ophthalmologists for cataract surgery hover around $400 across the country, but they have been falling. Rocha says the fee in Manitoba has decreased by about 10% over the past 20 years, while fees in Ontario have fallen by 25%. Cuts like these will hurt recruitment and retention of doctors, he says."

Yup. Every year CaRMS shows us that recruiting people in ophto is a real struggle.

[Medapp2017]

59 minutes ago, Snowmen said:

Yup. Every year CaRMS shows us that recruiting people in ophto is a real struggle.

That's my point! I'm thinking it's reasonable that there should be more dramatic cuts 

[indefatigable]

On 4/7/2020 at 7:17 PM, Medapp2017 said:

https://cmajnews.com/2019/10/08/are-fees-for-cataract-surgery-still-too-high/

"The negotiated fees paid to ophthalmologists for cataract surgery hover around $400 across the country, but they have been falling. Rocha says the fee in Manitoba has decreased by about 10% over the past 20 years, while fees in Ontario have fallen by 25%. Cuts like these will hurt recruitment and retention of doctors, he says.

Sweetman says that although technology costs have risen, productivity appears to have increased faster, so even the reduced fees are probably still too high. And he doubts the costs are too high for surgeons to bear. “I suspect that if the costs were too high relative to their pay, they would give numbers to back that up.”

Cataract surgery isn't even the most lucrative aspect of ophthalmology now - it's intravitreal (retinal) injections.  

[QueenStan]

26 minutes ago, insidious said:

Cataract surgery isn't even the most lucrative aspect of ophthalmology now - it's retinal injections.  

shhhh don't distract them from the scapegoat

[Galaxsci]

In Ontario over the last couple years, the government had specifically targeted a number of procedures in ophtho, cardio, rads, etc for which fees should be significantly decreased, but an independent mediator rejected the proposals. So it seems unlikely that (at least in Ontario), the fees will be cut in the future. 

[Thorax]

It is important to note that just because you get into ophthalmology however, doesn't mean that you can find a job doing this kind of lucrative work easily. The ophthalmologists who are making high incomes are likely to try to monopolize their turf, shutting out competition and new entrants are likely limited, so the competition doesn't stop. Most of the doctors billing this much got to where they are by sheer luck and a bit of opportunism. Compensation for each specialty waxes and wanes over time with changes in technology, most of the doctors who probably are billing this much chose ophthalmology back when it wasn't as lucrative and there are many doctors who chose specialties that were more lucrative only to see the salary decrease by the time they became staff. 

If your goal was to make a 1 million plus income, the truth is medicine is absolutely not the way to go about it and you really shouldn't choose your specialty based on income. It can be a small factor, but it should not be a moderate or large factor. 

[Snowmen]

13 hours ago, Thorax said:

It is important to note that just because you get into ophthalmology however, doesn't mean that you can find a job doing this kind of lucrative work easily. The ophthalmologists who are making high incomes are likely to try to monopolize their turf, shutting out competition and new entrants are likely limited, so the competition doesn't stop. Most of the doctors billing this much got to where they are by sheer luck and a bit of opportunism. Compensation for each specialty waxes and wanes over time with changes in technology, most of the doctors who probably are billing this much chose ophthalmology back when it wasn't as lucrative and there are many doctors who chose specialties that were more lucrative only to see the salary decrease by the time they became staff. 

If your goal was to make a 1 million plus income, the truth is medicine is absolutely not the way to go about it and you really shouldn't choose your specialty based on income. It can be a small factor, but it should not be a moderate or large factor. 

That's just another reason to the cut the fee for these ridiculously overpaid procedures.

[MDinCanada]

How are ophthos doing right now with the current measures to decrease non-urgent procedures?

[bearded frog]

Just now, MDinCanada said:

How are ophthos doing right now with the current measures to decrease non-urgent procedures?

All I know that it's suddenly way easier to get inpatient consults to certain specialties lol

[MDinCanada]

13 hours ago, Thorax said:

If your goal was to make a 1 million plus income, the truth is medicine is absolutely not the way to go about it and you really shouldn't choose your specialty based on income. It can be a small factor, but it should not be a moderate or large factor. 

Also, if your goal is to make >1million income, you need to spend more time reading about finances and taxes! Who even needs more than 500k? I think most people are looking at high incomes because they want to have financial freedom, there are much easier ways to achieve financial freedom... People who are financially literate know that it's not how much you make, but how many assets you have.