Top 100 physician-identified OHIP billings released

[targaryen]

https://www.thestar.com/news/gta/2019/06/27/theyre-ontarios-top-billing-doctors-but-for-years-their-identities-have-been-kept-secret-until-now.html

The Star has begun to release their investigation on the highest paid physicians in Ontario. Thoughts?

[#YOLO]

bout to see all these med students posting about their passion for optho and how it aint about the money real quick

[ploughboy]

Pass the popcorn, please.

[011235813]

On 6/27/2019 at 11:27 AM, #YOLO said:

bout to see all these med students posting about their passion for optho and how it aint about the money real quick

lol

[apple94]

I actually know the top biller in Ontario through a friend - not that well though. He is a hardworking dude who basically has his own private hospital. Sure the money he makes looks ridiculous, but the number of patients he services (and the quality I bet) reflects the billings. So he is working within the legal framework why malign him and other top billers and the whole practice of medicine as a rip-off? Is it for more transparency? Give me a break. This is going to lead to more misinformation. People will think all doctors make millions, people will not appreciate why they make millions or how, and people will certainly form biases of different doctors based on their billings (higher billers might be considered more prestigious and better  for example). 

Millions of dollars in billings sounds ridiculous....until you realize this person setup a private practice to make more OR space and meet the needs of patients in Ontario. I definitely advocate for some balancing in the billing codes to preempt the collapse of an unsustainable healthcare system, but this is something experts and the right people need to consider in an isolated non-political manner. When you let the public decide important shit....well just look at what has happened around the world... Trump...Brexit...Ford lol.

[anonymouspls]

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.

 

edit: i made this comment when I was a stupid premed, lmao. 

[freewheeler]

1 hour ago, 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.

Lots of medical students feel this way.

Until they go through clerkship..

That being said, it does give you pause when you consider that a low six figure salary for a physician is often balked at relative to the fairly common mid-to high six figure salaries that many command, with a comparatively select few commanding greater. Contrasted with the general population however, that same low six figure salary in isolation looks pretty good.

However, remuneration does not exist in a bubble, but rather as you referred to, there is the concern of a "brain drain" with further cuts to physician remuneration, not to mention the fairly universally held notion that physicians should be paid commensurate with their training, reflective of their expertise, the often extreme if not at least very undesirable working conditions, be able to pay off their significant educational debt, and much more, after having deferred earning an income as well as many life events in the process of their training.

Absolutely, it is not an easy conversation to have.

Personally at this point in my training, I am just looking forward to having greater autonomy and not having to be places or do things that I have no interest in. 

Comparatively speaking, remuneration is just a bonus that will help me spend my time and seek experiences that are in greater alignment with my interests.

That said, I greatly appreciate it for that.

[1D7]

7 hours ago, 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.

lol healthcare systems are buckling all over the world, including ones that don't pay their doctors well. Physicians are a relatively minor cost in the whole system and are often the ones sustaining it (despite all the bullshit political drama that happens behind the scenes).

[apple94]

We have to balance income inequality among doctors with encouraging innovations in return for higher salaries. I don't like the politicization of this issue by The Star as it will lead to an unbalance and an unfair attack on the profession of medicine as a whole. Furthermore Ford is spending around $1 billion dollars so we can buy beer from Loblaws... ostensibly beer is worth more than healthcare to the people of Ontario. 

[freewheeler]

3 hours ago, nsrdude said:

We have to balance income inequality among doctors with encouraging innovations in return for higher salaries. I don't like the politicization of this issue by The Star as it will lead to an unbalance and an unfair attack on the profession of medicine as a whole. Furthermore Ford is spending around $1 billion dollars so we can buy beer from Loblaws... ostensibly beer is worth more than healthcare to the people of Ontario. 

Well I mean, Ford is literally appealing to the lowest common denominator of society with all of his moves, haha.

[moonlitocean]

On 6/29/2019 at 12:18 PM, nsrdude said:

We have to balance income inequality among doctors with encouraging innovations in return for higher salaries. I don't like the politicization of this issue by The Star as it will lead to an unbalance and an unfair attack on the profession of medicine as a whole. Furthermore Ford is spending around $1 billion dollars so we can buy beer from Loblaws... ostensibly beer is worth more than healthcare to the people of Ontario. 

What a hypocrite 

[apple94]

5 hours ago, moonlitocean said:

What a hypocrite 

Politics is unfortunately at its crux all about pointing fingers at someone else. And I don't like doing that, especially when it comes to our important system of healthcare. But if I had to do it (and you may be right that it may be hypocritical), I would point my fingers at the absurd government spending in other areas outside healthcare (ie. Ford's love for convenient beer) and even within healthcare (i.e. hospital construction contracts). 

[Coldery]

On 6/29/2019 at 7:57 AM, 1D7 said:

lol healthcare systems are buckling all over the world, including ones that don't pay their doctors well. Physicians are a relatively minor cost in the whole system and are often the ones sustaining it (despite all the bullshit political drama that happens behind the scenes).

It does seem like physician salaries account for a pretty sizable portion of total healthcare spending in Ontario/nationwide though. It apparently accounts for about 10% of total provincial spending in Ontario (as a proportion of all spending made by the provincial government). If you do the math, it works out similarly all across Canada too. Something will have to give way eventually and the unusually high billing specialties should be the first one's to sustain it. Treatments have evolved but the billing codes haven't.

 

This is also coming from someone whose close relative(s) benefit from this pretty significantly.

[GrouchoMarx]

Can't sympathize with the attention any of these docs are getting when half of pathologists are on the sunshine list, which I think is partly racially motivated as pathology is overrepresented by melanin infused fmgs

[ArchEnemy]

20 minutes ago, Coldery said:

It does seem like physician salaries account for a pretty sizable portion of total healthcare spending in Ontario/nationwide though. It apparently accounts for about 10% of total provincial spending in Ontario (as a proportion of all spending made by the provincial government). If you do the math, it works out similarly all across Canada too. Something will have to give way eventually and the unusually high billing specialties should be the first one's to sustain it. Treatments have evolved but the billing codes haven't.

  

This is also coming from someone whose close relative(s) benefit from this pretty significantly.

Physician billings account for ~8% of the total provincial budget, which is approximately the same amount it spends on paying off INTEREST on debt. Considering most of the healthcare SERVICES are offered by physicians, is this still considered a high number? 

Physicians are often vilified for their "high" billings. However, the truth is that physician billings have been cut (in relative terms) since 2017. For those who criticize physician billings publicly, I see no mention about the issue of rapidly rising costs of drugs, and even fewer attempt to tackle this. It is unfortunate that physicians make easy targets while pharmaceutical companies avoid this due to the facade of "R&D" costs.

[ArchEnemy]

30 minutes ago, GrouchoMarx said:

Can't sympathize with the attention any of these docs are getting when half of pathologists are on the sunshine list, which I think is partly racially motivated as pathology is overrepresented by melanin infused fmgs

I think you should redirect your anger towards your predecessors who have sold out pathology, not at these hard working FMGs who have sacrificed so much just to provide a better life for their families. 

[GrouchoMarx]

1 hour ago, ArchEnemy said:

I think you should redirect your anger towards your predecessors who have sold out pathology, not at these hard working FMGs who have sacrificed so much just to provide a better life for their families. 

I think you have misunderstood my point. I am not admonishing the FMGs for trying to improve their lives. I'm directing my ire at the OMA and MOH for turning a blind eye towards the severely mismanaged and disadvantageous professional situation in pathology in Ontario, and I think part of this is the result of deep seated institutional racism.

[Coldery]

On 7/1/2019 at 10:19 AM, ArchEnemy said:

Physician billings account for ~8% of the total provincial budget, which is approximately the same amount it spends on paying off INTEREST on debt. Considering most of the healthcare SERVICES are offered by physicians, is this still considered a high number? 

Physicians are often vilified for their "high" billings. However, the truth is that physician billings have been cut (in relative terms) since 2017. For those who criticize physician billings publicly, I see no mention about the issue of rapidly rising costs of drugs, and even fewer attempt to tackle this. It is unfortunate that physicians make easy targets while pharmaceutical companies avoid this due to the facade of "R&D" costs.

I never contended physician billing as a whole. I was only referring to the unequal billing of different physician specialties.

The average Albertan ophthalmologist bills $1,250,000/year ($800k/year average across Canada) in a relatively "lifestyle", PGY-5 specialty.

If something is done to equalize unusually high billing specialties (by cutting billings down to a more reasonable level), more money could be diverted into programs that direly need it, namely FM (cite nationwide FP shortage). If you run the numbers, curbing just the optho $/year to average specialty $/year (after accounting for higher overhead costs) while reallocating all of the extra funds to FM, you'd be giving family docs a $5.7k/year raise nationwide.

Quote

 

1249 opthalmologists with $800k/year -> $600k/year = $250 mil freed

$250 mil / 43500 FP = $5.7k/year raise for every single FM doc

 

(Source 1, Source 2)

Quite substantial considering that it is only one, albeit very high paying, specialty. 

With CaRMS booking FM vacancies year by year, making FM more desirable in any way possible will likely be a good step in the right direction. Whether things are done so simply is another question (lobbying and other politics).

[NLengr]

I'd be leery to publicly support actively cutting back anyone's billings. Not because I don't think optho is overpaid. I'd be more concerned that once you agree that it is legitimate to cut back "overpaid" specialties, the government will start to declare other specialties "overpaid" one or two at a time and cut reimbursement for those specialties too. They wouldnt have a reason to stop until everyone, including FM, takes a nice big pay cut. 

You'd be a fool as a physician to trust the government. 

[JohnGrisham]

1 hour ago, NLengr said:

I'd be leery to publicly support actively cutting back anyone's billings. Not because I don't think optho is overpaid. I'd be more concerned that once you agree that it is legitimate to cut back "overpaid" specialties, the government will start to declare other specialties "overpaid" one or two at a time and cut reimbursement for those specialties too. They wouldnt have a reason to stop until everyone, including FM, takes a nice big pay cut. 

You'd be a fool as a physician to trust the government. 

Exactly.

[011235813]

1 hour ago, NLengr said:

You'd be a fool as a physician to trust the government. 

I'd erase the words "as a physician" and leave the rest as a general rule for life, but that's just me. 

[NLengr]

3 hours ago, John Galt MD said:

I'd erase the words "as a physician" and leave the rest as a general rule for life, but that's just me. 

Not a bad point. 

[NLengr]

4 hours ago, JohnGrisham said:

Exactly.

Divide and conquer is the government's strategy when dealing with docs. Unfortunately, we too often play into their hands.

[apple94]

10 hours ago, NLengr said:

I'd be leery to publicly support actively cutting back anyone's billings. Not because I don't think optho is overpaid. I'd be more concerned that once you agree that it is legitimate to cut back "overpaid" specialties, the government will start to declare other specialties "overpaid" one or two at a time and cut reimbursement for those specialties too. They wouldnt have a reason to stop until everyone, including FM, takes a nice big pay cut. 

You'd be a fool as a physician to trust the government. 

This is exactly what I meant earlier about the politicization of the issue. I think there is a general consensus that opthos and other specialties could use some readjustment in the billing codes. However we don't want to give the government leverage in using healthcare professionals as scapegoats for their lack of fiscal responsibility. Which is why we need to be so careful about public perception - we need to be careful how we talk around this issue and how much power we give journalists with their "opinion" pieces for "transparency purposes". The problem with interview prepping for med schools is it makes you an idealist often at the cost of being pragmatic. And i think that mentality spills over into forums topics like these sometimes.

[targaryen]

I think in order to prevent the government from imposing harsh remuneration changes on all specialties, physicians should be fair to each other and tackle income inequality themselves. Unfortunately, this proactive approach doesn't seem close to happening... Especially with the inception of the OSA.