Physician political orientation

[medigeek]

On 7/9/2018 at 9:41 PM, TheSalmonMousse said:

Right, except it isn't exactly a free market in the US if supply (of doctors) is artificially limited by the state, essentially by limiting the number of spots in residency and blocking the opening of new medical schools. So a proper free market should drive physicians' wages down if it weren't for state intervention and lobbying by the AMA. At lest that's the Milton Friedman argument, which I think makes a lot of sense.

A true free market is not within the realm of reality in medicine. You can't have random quack doctors with fake credentials. It'd be insanity. 

On 8/9/2018 at 10:31 AM, Moscovici2020 said:

All med students and doctors I know  lean left with the exception of some elderly physicians (my miserable grandfather for example). Conservative policies when it comes to healthcare are often just bad and don't have much compassion. Medicine is meant to be a humanistic profession. 

So left as in social policies? Or left as in, government should cut physician income and raise our taxes? Which is it? If you know doctors in the latter, I assure you they're in the minority. If med students in the latter (of which there are quite a few), no one cares what uninformed students think. 

[SunAndMoon]

4 hours ago, brady23 said:

Tbh for me, at the end of the day, I have my own beliefs about women's rights, LGBTQ rights, etc. - I'm not too concerned if the party I vote for has the same beliefs.

??????

you realize their "beliefs" impact policymaking, right? That's ok to you, as long as you know you don't hate the gays, the brown neighbors and you have some sense of assurance that lifestyle won't be potentially threatened? 

[brady23]

1 hour ago, SunAndMoon said:

??????

you realize their "beliefs" impact policymaking, right? That's ok to you, as long as you know you don't hate the gays, the brown neighbors and you have some sense of assurance that lifestyle won't be potentially threatened? 

Yup and that's fine with me. There's other avenues of supporting causes like charities, my vote goes where my priorities lie. 

[Moscovici2020]

2 hours ago, medigeek said:

A true free market is not within the realm of reality in medicine. You can't have random quack doctors with fake credentials. It'd be insanity. 

So left as in social policies? Or left as in, government should cut physician income and raise our taxes? Which is it? If you know doctors in the latter, I assure you they're in the minority. If med students in the latter (of which there are quite a few), no one cares what uninformed students think. 

Yeah left as in social policies

[Anon1221]

On 6/9/2018 at 9:46 AM, adhominem said:

Having done several rounds of MMIs in Alberta I would definitely agree that there are questions which favor a left-leaning ideology. It is no secret that most academics are left-leaning, and admissions committees are undeniably going to leaning in that direction as well due to the biases of the individuals creating the questions and discussing what sort of 'problematic' (i.e. right wing) answers could arise. 

would you be able to provide an example?

[SunAndMoon]

3 hours ago, brady23 said:

Yup and that's fine with me. There's other avenues of supporting causes like charities, my vote goes where my priorities lie. 

Yeah you don't actually believe in anything, I just want to make sure you're aware of that and accept that fact.

[brady23]

39 minutes ago, SunAndMoon said:

Yeah you don't actually believe in anything, I just want to make sure you're aware of that and accept that fact.

False but whatever floats your boat! We live in a democracy and everyone is entitled to vote as they see fit :)

[medigeek]

5 hours ago, Moscovici2020 said:

Yeah left as in social policies

That's fine as long as one doesn't fall into the minority crew of those who support cuts to physician income. Wynne gov took pleasure in cutting doctors' income in order to give raises to administrators who do nothing all day and make 6 figures. 

Or those who supported the trudeau/morneau corp tax changes. There was a group of like... 200 doctors? who signed off supporting the evil tax changes. It's always stuff involving like <0.01% of doctors that gets media attention (ex. quebec doctors who rallied against income raises). 

[rmorelan]

16 hours ago, medigeek said:

That's fine as long as one doesn't fall into the minority crew of those who support cuts to physician income. Wynne gov took pleasure in cutting doctors' income in order to give raises to administrators who do nothing all day and make 6 figures. 

Or those who supported the trudeau/morneau corp tax changes. There was a group of like... 200 doctors? who signed off supporting the evil tax changes. It's always stuff involving like <0.01% of doctors that gets media attention (ex. quebec doctors who rallied against income raises). 

or the other 0.01% the other way that are opening up private clinics and going to court to try to keep them

Messy either way. I wouldn't call the changes "evil" more that we agreeing to some of them in liu of fee increases simple stupid. Honestly I blame us more on that one than the government. 

[NLengr]

18 hours ago, medigeek said:

That's fine as long as one doesn't fall into the minority crew of those who support cuts to physician income. Wynne gov took pleasure in cutting doctors' income in order to give raises to administrators who do nothing all day and make 6 figures. 

Or those who supported the trudeau/morneau corp tax changes. There was a group of like... 200 doctors? who signed off supporting the evil tax changes. It's always stuff involving like <0.01% of doctors that gets media attention (ex. quebec doctors who rallied against income raises). 

Hey now, Ontario needed those sub-LHINs. More levels of bureaucracy always helps.

[medigeek]

7 hours ago, rmorelan said:

or the other 0.01% the other way that are opening up private clinics and going to court to try to keep them

Messy either way. I wouldn't call the changes "evil" more that we agreeing to some of them in liu of fee increases simple stupid. Honestly I blame us more on that one than the government. 

Those private surgery clinics are ultimately helping people though. Left wing provincial govs have been damaging healthcare delivery to people because doctors making more $$ to them is evil. 

5 hours ago, NLengr said:

Hey now, Ontario needed those sub-LHINs. More levels of bureaucracy always helps.

You'd be surprised how much better life would be overnight if you vaporized the LHINs. Same goes for so many layers of bureaucracy. 

 

[NeuroD]

4 hours ago, medigeek said:

Those private surgery clinics are ultimately helping people though. Left wing provincial govs have been damaging healthcare delivery to people because doctors making more $$ to them is evil. 

You'd be surprised how much better life would be overnight if you vaporized the LHINs. Same goes for so many layers of bureaucracy. 

 

It's not that governments see doctors who earn more money as evil. It's that most provinces can't afford healthcare anymore, but no government wants to make that clear to its population or offer alternatives (hurts the vote). So they're underfunding healthcare while simultaneously telling the public that all is well, and they can afford it...and if anything is wrong, scape goat the doctors!

As a med student, I was shocked when I was sitting with a neurosurgeon and the chief of surgery (at a UofT hospital) walked in to complain that he had already surpassed his quota of spine surgeries (and this was a very conservative surgeon!). Asking the neurosurgeon what the hell that meant revealed a very broken "man behind the curtain". 

Our governments can't afford healthcare anymore. Instead of doing something about it, service providers at different levels are told directly or in directly to cut services. Meanwhile the public is being told that everything is fine, and doctors are being prepared as scape goats for when the inevitable financial demise of the system happens. There are always a few bad apples, but for the most part, doctors who bill more are doing more work for the public. We don't say that plumbers who fix more pipes shouldn't get paid more than plumbers who fix fewer pipes. But that's the narrative being built around physicians these days.

[rmorelan]

6 hours ago, medigeek said:

Those private surgery clinics are ultimately helping people though. Left wing provincial govs have been damaging healthcare delivery to people because doctors making more $$ to them is evil. 

 

 

hasn't just been the left wing govs ha - there has been a slow progressive decline in health care funding relative to inflation for 30 years even while it has increased as a proportion of the overall budget.  Health care represents almost 50% of the provincial budget in Ontario, and doctors command if I remember just over 10% of the budget out of that. That is a bit more than is spent on post secondary education to put it in perspective.  Health care costs are also rising as a fraction of overall country GDP. 

the problem is that health care cost rise faster than inflation, so in the long term  we have some tough decisions to make. Makes sense - usually things stay the same price or fall over time as we become better at it but that assumes the underlying technology isn't changing. In medicine is constantly changing and getting more effective at the cost of rising expenses. Right wing, left wing, centralist......doesn't matter really, the underlying problem remains - you have X costs, Y revenue and X>Y and X will continue to grow faster than Y. Now there are always things to can do to make things more efficient - and we should with the administration being a common target there. Doesn't change the fact that costs are still rising faster than inflation and thus the tax base that support the entire system - so in an sense slows things down but doesn't change things. 

Ha, I would still argue it isn't "evil" to them - that implies a passion and deep anger about. To them doctors are just a large line item on a budget that has to go down, and a large potential tax revenue source. They have to reduce costs, and we are an easy target because for the most part we really don't fight back - same with the greater than inflation increases in post secondary education going back again 30 years over multi governments in multiple provinces - another easy target.  Some of those private health care clinics are just flat out breaking the law and I don't think their primary goal was to help people - these are very profit driven personalities here. That isn't evil either mind you ha

 

 

[NeuroD]

1 hour ago, rmorelan said:

hasn't just been the left wing govs ha - there has been a slow progressive decline in health care funding relative to inflation for 30 years even while it has increased as a proportion of the overall budget.  Health care represents almost 50% of the provincial budget in Ontario, and doctors command if I remember just over 10% of the budget out of that. That is a bit more than is spent on post secondary education to put it in perspective.  Health care costs are also rising as a fraction of overall country GDP. 

the problem is that health care cost rise faster than inflation, so in the long term  we have some tough decisions to make. Makes sense - usually things stay the same price or fall over time as we become better at it but that assumes the underlying technology isn't changing. In medicine is constantly changing and getting more effective at the cost of rising expenses. Right wing, left wing, centralist......doesn't matter really, the underlying problem remains - you have X costs, Y revenue and X>Y and X will continue to grow faster than Y. Now there are always things to can do to make things more efficient - and we should with the administration being a common target there. Doesn't change the fact that costs are still rising faster than inflation and thus the tax base that support the entire system - so in an sense slows things down but doesn't change things. 

Ha, I would still argue it isn't "evil" to them - that implies a passion and deep anger about. To them doctors are just a large line item on a budget that has to go down, and a large potential tax revenue source. They have to reduce costs, and we are an easy target because for the most part we really don't fight back - same with the greater than inflation increases in post secondary education going back again 30 years over multi governments in multiple provinces - another easy target.  Some of those private health care clinics are just flat out breaking the law and I don't think their primary goal was to help people - these are very profit driven personalities here. That isn't evil either mind you ha

 

 

I always wonder about that "source of tax revenue" bit. Despite deductions and legal tax reductions, doctors pay a sizeable amount back to the government. Of the 11ish billion they pay us, they get at least 3-4 billion back directly. Probably 5-6 billion back total indirectly. Any increases to cover extra services doctors provide essentially comes at a 30-50% discount for the government.

[rmorelan]

51 minutes ago, PhD2MD said:

I always wonder about that "source of tax revenue" bit. Despite deductions and legal tax reductions, doctors pay a sizeable amount back to the government. Of the 11ish billion they pay us, they get at least 3-4 billion back directly. Probably 5-6 billion back total indirectly. Any increases to cover extra services doctors provide essentially comes at a 30-50% discount for the government.

that's true - although that all doesn't go back to the province, and it is also true for a huge number of other people ha. 

[NeuroD]

29 minutes ago, rmorelan said:

that's true - although that all doesn't go back to the province, and it is also true for a huge number of other people ha. 

But compared to public employees we send a larger proportion, so essentially they get the largest discount on physicians.

True though, much of it goes federal.

[TheSalmonMousse]

On 7/9/2018 at 9:41 PM, TheSalmonMousse said:

Right, except it isn't exactly a free market in the US if supply (of doctors) is artificially limited by the state, essentially by limiting the number of spots in residency and blocking the opening of new medical schools. So a proper free market should drive physicians' wages down if it weren't for state intervention and lobbying by the AMA. At lest that's the Milton Friedman argument, which I think makes a lot of sense.

 

On 8/11/2018 at 5:34 PM, medigeek said:

A true free market is not within the realm of reality in medicine. You can't have random quack doctors with fake credentials. It'd be insanity.

I agree, complete deregulation makes no sense and almost no one is arguing for that I think. The important issue is excessive intervention by the AMA who, under the pretext of maintaining quality training, have been unduly limiting the amount of new doctors being trained (there's a Forbes on this topic: https://www.forbes.com/2009/08/25/american-medical-association-opinions-columnists-shikha-dalmia.html#7620a13a42f2).

There's an often made argument that Canadian earnings are justified in that they loosely follow US earnings, which are presumed to be market-based. The point I'm making is that the whole argument falls apart when you consider that the American market is far from free since supply is essentially controlled by the AMA. So it seems to me you'd need to invoke other reasons than the market to justify physicians' earnings.

[medigeek]

10 hours ago, rmorelan said:

hasn't just been the left wing govs ha - there has been a slow progressive decline in health care funding relative to inflation for 30 years even while it has increased as a proportion of the overall budget.  Health care represents almost 50% of the provincial budget in Ontario, and doctors command if I remember just over 10% of the budget out of that. That is a bit more than is spent on post secondary education to put it in perspective.  Health care costs are also rising as a fraction of overall country GDP. 

the problem is that health care cost rise faster than inflation, so in the long term  we have some tough decisions to make. Makes sense - usually things stay the same price or fall over time as we become better at it but that assumes the underlying technology isn't changing. In medicine is constantly changing and getting more effective at the cost of rising expenses. Right wing, left wing, centralist......doesn't matter really, the underlying problem remains - you have X costs, Y revenue and X>Y and X will continue to grow faster than Y. Now there are always things to can do to make things more efficient - and we should with the administration being a common target there. Doesn't change the fact that costs are still rising faster than inflation and thus the tax base that support the entire system - so in an sense slows things down but doesn't change things. 

Ha, I would still argue it isn't "evil" to them - that implies a passion and deep anger about. To them doctors are just a large line item on a budget that has to go down, and a large potential tax revenue source. They have to reduce costs, and we are an easy target because for the most part we really don't fight back - same with the greater than inflation increases in post secondary education going back again 30 years over multi governments in multiple provinces - another easy target.  Some of those private health care clinics are just flat out breaking the law and I don't think their primary goal was to help people - these are very profit driven personalities here. That isn't evil either mind you ha

 

 

True, but before even looking at doctors there better be enormous cuts made at the admin level across all sectors. We don't need all these admins because we don't even need the rules they come up off. I mean seriously, how hard is it now to set up an elective for a med student vs years ago? There are layers of useless rules that can be erased followed by hiring less admin.

Save the easy money first and then look at doctors. 

[NLengr]

9 minutes ago, medigeek said:

True, but before even looking at doctors there better be enormous cuts made at the admin level across all sectors. We don't need all these admins because we don't even need the rules they come up off. I mean seriously, how hard is it now to set up an elective for a med student vs years ago? There are layers of useless rules that can be erased followed by hiring less admin.

Save the easy money first and then look at doctors. 

I remember reading an article on the numberof administrators/bureaucrats to front line providers where they compared Ontario a few countries in Europe (can't remember if it was physicians or everyone in general).

I'm too lazy to google the article now but I remember it was insane. Ontario had something like 4 times more admin per frontline staff than Norway and something like 10 times more than Germany. 

[Blasé]

On 8/11/2018 at 11:19 PM, SunAndMoon said:

Yeah you don't actually believe in anything, I just want to make sure you're aware of that and accept that fact.

Just because someone doesn't vote the way you want them doesn't mean they "don't believe in anything." Is it that hard to believe his priorities lie in his personal and family finances than "supporting" causes. There isn't only one way to support social causes. When I vote, my priorities lie in my own finances. I can choose to support social causes as I see fit, rather than leaving it to the government.

[medigeek]

1 minute ago, NLengr said:

I remember reading an article on the numberof administrators/bureaucrats to front line providers where they compared Ontario a few countries in Europe (can't remember if it was physicians or everyone in general).

I'm too lazy to google the article now but I remember it was insane. Ontario had something like 4 times more admin per frontline staff than Norway and something like 10 times more than Germany. 

That's insane!!! And we should have far less than Europe if anything. 

[NLengr]

2 minutes ago, medigeek said:

That's insane!!! And we should have far less than Europe if anything. 

We also make terrible choices for who we hire as administrators. So much of it is political patronage or union crap. Some of it is just poor decision making by people who have no qualifications to be managing a huge organization. 

 

I worked at a hospital where the manager for the OR retired and was replaced. The person who replaced them had never worked in or even been in an OR prior to starting the job. 

[SunAndMoon]

11 minutes ago, Blasé said:

Just because someone doesn't vote the way you want them doesn't mean they "don't believe in anything." Is it that hard to believe his priorities lie in his personal and family finances than "supporting" causes. There isn't only one way to support social causes. When I vote, my priorities lie in my own finances. I can choose to support social causes as I see fit, rather than leaving it to the government.

Is that why I said that they don't believe in anything? Because they don't vote the way I want them to? What I said is that they don't vote according to their own beliefs, which indicates that they don't really care much about those beliefs. I stand by that. Donating a few dollars to ease one's conscience won't really change that.

[Blasé]

44 minutes ago, SunAndMoon said:

Is that why I said that they don't believe in anything? Because they don't vote the way I want them to? What I said is that they don't vote according to their own beliefs, which indicates that they don't really care much about those beliefs. I stand by that. Donating a few dollars to ease one's conscience won't really change that.

Just because they vote in line with their financial priorities doesn't mean that "they don't really care much about those beliefs." Perhaps they believe that these social issues can be addressed in a different way. For all you know, they could be actively involved with organizations that address those social issues, yet not vote for a party that also supports the same issue. My point is that it's not as black and white when voting for a political party. Very rarely do people agree with the entire platform of a party. For many people, voting comes down to prioritizing issues that are more important for them and finding a balance. Hence why you see many people on here that are socially liberal, yet are fiscally conservative.

[NeuroD]

3 hours ago, SunAndMoon said:

Is that why I said that they don't believe in anything? Because they don't vote the way I want them to? What I said is that they don't vote according to their own beliefs, which indicates that they don't really care much about those beliefs. I stand by that. Donating a few dollars to ease one's conscience won't really change that.

You don't agree with EVERYTHING the liberals/NDP propose. I'm sure there's SOMETHING that the conservatives support that you agree with. And yet you vote with the left based on the issues you've prioritized (which I assume is social liberalism).

Similarly, others may agree with some of the leftist platform, but still prioritize their families' well being over that platform...hence "socially liberal but fiscally conservative". The fact is that there's a lot of grey area, and many reasonable people who agree with you on social policy will vote conservative for other reasons, and chose to enact change for social issues in their own way (voting is HARDLY the most effective way to enact change). Politics, like life, is grey. If I remember your other posts correctly, your early in your training. Learning that there's grey and reasonable people on both sides will be an important skill to pick up during your training.