Ages of Med Students

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<threadtitle>Info on women in medicine</threadtitle>

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<username>Emma</username>

<dateline>1017004980</dateline>

<title>Info on women in medicine</title>

<pagetext>Hi,

 

I recently read Women In Medicine by Carol Lopate. It's a great book and discusses literally all aspects of women in medicine. The only downside is that this book was published in 1968 and it's mainly an American perspective.

 

Can anyone suggest anything that's more recent and is a bit more Canadian? Website, publication, books?

 

Thanks.

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<threadtitle>Working more to earn less; doctors say they're losing out</threadtitle>

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<username>Ian Wong</username>

<dateline>1018337040</dateline>

<title>Working more to earn less; doctors say they're losing out</title>

<pagetext>Here's an interesting article published in today's Vancouver Sun. If I'm not mistaken City Square is the little mall directly beside the massive Vancouver General Hospital Complex(apparently the second largest hospital complex aside from some behemoth in Toronto, if my memory serves me correctly.) You'd figure there'd be no shortage of patients in that mall.

 

This is a pretty memorable quotation: "In the old days 20 years ago if I did a hysterectomy, it would buy a nice suit. Ten years ago, it would get me a decent sports jacket. Now it would just get me a classy pair of trousers."

 

Ian

UBC, Med 3

 

www.canada.com/vancouver/news/story.asp?id={2D6388E4-C15E-4E3D-9DA3-E669DA50A50F}

 

<!--EZCODE BOLD START--> Working more to earn less; doctors say they're losing out<!--EZCODE BOLD END-->

 

Jeff Lee

Vancouver Sun

 

Monday, April 08, 2002

 

Dr. Jack Burak sees one of 2,000 patients at his family practice in City Square in Vancouver. Burak, who has been practising for 23 years, now works 80 hours a week and says that if he were to work normal hours his income would be roughly that of a head nurse.

 

Obstetrician Dr. John Turner says he's working longer hours to keep his salary stable.

 

Over the past 28 years as an obstetrician-gynecologist, Dr. John Turner has watched his clientele change. No longer are most of the women who come to see him young, upright and of child-bearing age. They are elderly, their hair has greyed, and time has aged their bodies.

 

Over those same 28 years, Turner has watched his earnings as a specialist doctor in B.C. also wear down.

 

"In the old days 20 years ago if I did a hysterectomy, it would buy a nice suit. Ten years ago, it would get me a decent sports jacket. Now it would just get me a classy pair of trousers."

 

That analogy speaks volumes about the lot doctors in B.C. say they face under a strained medical system that has witnessed massive demands for services without corresponding increases in payments.

 

The average doctor now works longer hours and sees more patients to make a comparable income, doctors said in interviews last week.

 

Last month, on the brink of a withdrawal of services by specialists angered by the Liberals' flip-flop on an arbitrated award, the province and the B.C. Medical Association reached a settlement that would see $392 million more pumped into doctors' wages.

 

Of that, $185 million will be used to top up the fee schedule the Medical Services Commission uses to pay "fee-for-service" doctors. The rest will be split between boosting on-call rates and developing strategic initiatives to stabilize the funding system.

 

That $185 million represents about a compounded (spread over nearly two years) 11.6-per-cent increase over the $1.63 billion spent last year on fee-for-services.

 

But doctors say that only begins to close the gap between what they believe they are worth and what they are actually paid.

 

"We are relatively well-paid, but that has been shrinking over time. But is this just a money issue? No. It is about keeping the system working, and doctors are the kind of people who are in demand everywhere," said BCMA president Heidi Oetter, who crafted the last-minute deal with the province.

 

The argument over what a doctor is really worth in B.C. is to a large degree subject to interpretation.

 

The province has lots of statistics to show that the medical system is better funded than most in Canada, and that doctors share in that wealth.

 

Per-capita, doctors in B.C. are nearly at the top of the scale. Last year, according to the Canadian Institute for Health Information, the per-capita amount spent on physicians here was $537. Only in the Northwest Territories was the amount higher ($585). At the bottom end of the scale was Prince Edward Island, with per-capita spending on doctors of $293. With B.C. near the top, one might think doctors here have little to complain about.

 

Oetter said that may be true, but B.C. is an expensive place to live, and an aging population places more demands on its physicians.

 

But the BCMA has statistics of its own that it says show doctors have fallen far behind in their earning power.

 

When the association went into arbitration with the province last year over fee increases, it tabled an index it says shows doctors now earn more than 18 per cent less than they did 20 years ago, when adjusted for inflation.

 

If a doctor was paid $100 for a procedure in 1982, he would receive nearly $135 for that service now. But inflation has risen by 65 per cent over the same period, meaning that in fact that $135 is really worth only $81 and change, or a decline of 18.66 per cent.

 

Over the same period, the average British Columbian's annual income has also tumbled, but only by 12 per cent, according to Statistics Canada.

 

The practical effect, Oetter said, is that the average family doctor now works 56 hours a week, while the average specialist puts in more than 60 hours a week to maintain their income levels.

 

Dr. Jack Burak, a family physician with 23 years of service, puts in far more hours but still feels like he's falling behind.

 

Burak, a partner in a six-doctor facility at CitySquare in Vancouver, said he now finds himself working 80 hours a week. Rather than spending more time on leisure activities or other pursuits, he routinely stays late at his office. The image of a general practitioner spending time on a golf course is a mirage, he said.

 

"I am not one of those chosen doctors on the golf course on a Wednesday afternoon because I can't afford to. The only way you can survive now is to work longer hours and see more patients," Burak said. "You just feel like you are on the treadmill all the time."

 

As a "full-service family physician," Burak still delivers babies, does house calls and makes hospital visits. He has privileges at three area hospitals.

 

Burak, who is the honourary secretary-treasurer of the BCMA, last year billed the Medical Services Commission just over $250,000.

 

But out of that, more than $104,000 went to office expenses, including his share of a secretarial/office pool of eight full- and part-time employees, all of whom get better pay increases than he does. It also went for the office lease and medical supplies.

 

A large portion of the remainder went to income tax and to pay for Burak's own benefits, such as health and dental insurance. What's left, he said, reinforces his overwhelming belief that doctors are no better paid than other professionals.

 

"If I were to work normal hours, I would have roughly the same income as a head nurse at a large hospital, but the kicker is they get a 25-per-cent benefits package and I have to pay for all that myself," Burak said. "We regularly sit around in the evening and can't understand why we can't really get ahead."

 

The office visit, that starting point for every patient, is not a money-maker for any doctor in this province. When Burak started 23 years ago, he was paid about $13 for the standard 15- to 20-minute office visit. Now he's paid $26.53.

 

There is a fee for just about any service rendered by a doctor in this province. The 29-section list, which is published on the internet by the Medical Services Commission, runs to hundreds of pages and thousands of fees.

 

They go from $8 for injecting a patient with a needle to $3,640 for a neurosurgeon to perform a craniotomy. Along with those fees are a host of ancillary fees for everything from office consultations to the delivery of anesthetic. The lists are detailed right down to variations on procedures, such as whether a patient needs a partial, total or radical hysterectomy.

 

Out of those fees, doctors must cover all of their office, medical supplies and employee expenses.

 

According to the BCMA, from statistics compiled by Statistics Canada and the Medical Services Plan, the average gross annual income for a fee-for-service doctor in B.C. 10 years ago was $191,544 In that year, there were 6,441 fee-for-service physicians billing the medical services plan.

 

Last year, average amount paid to fee-for-service doctors now working here was $213,482. But when adjusted for inflation, the actual amount was $183,553, or a decline of just over four per cent over what they made a decade ago.

 

But those figures also reveal another side of the health delivery problem, according to Robin Hanvelt, a researcher at the Centre for Health Services and Policy Research at the University of B.C.

 

The number of fee-for-service doctors working in B.C. has increased nearly 19 per cent since 1991. As of last year, there were 7,653 doctors billing the Medical Services Plan.

 

That means there is that much more pressure placed on the system by doctors, who are not regulated in how much they can bill, where they live or what services they order, he said.

 

"You have to remember that doctors are not employees. They can't be fired. They are essentially independent contractors who can set up shop, see patients and bill the Medical Service Plan for services rendered," Hanvelt said.

 

On the whole, Hanvelt agrees that general practitioners are worse off than specialists. But he says part of that is of their own making because they have saturated metropolitan areas at the expense of rural communities.

 

"We need more GPs in rural areas, just like we need more specialists in those areas," he said. "We have a lot of GPs in this province, but many of them are concentrated in the Lower Mainland."

 

Hanvelt pointed out that the BCMA's own tariff committee makes recommendations to the Medical Services Commission on fees in the schedule that should be modified, eliminated, or introduced. As long as there is money in the fee-for-service budget, the amounts are generally amended, he said.

 

But sound medical service isn't likely a matter of paying doctors more, he said. It should be about determining what is best for the patient.

 

"The issue is to pose questions about how health care should be delivered," he said. "A large gain in health services could be achieved by a redistribution of doctors in the province."

 

Doctors should also be questioning what services they are ordering, he said.

 

As an example, doctors on average order three ultrasounds for each healthy pregnancy, although the BCMA recommends one ultrasound per pregnancy and a mixed scientific committee several years ago suggested no ultrasounds be given if the parents have no medical histories that would affect the pregnancy, he said.

 

However, doctors continue to recommend large numbers of ultrasounds. Every time they do, the Medical Services Plan pays between $68 and $90 per ultrasound, depending on the baby's age.

 

Hanvelt says doctors could free up more of their time by turning over routine jobs to qualified nurse-practitioners. As an example, he said, a nurse-practitioner can take a patient's blood pressure just as well as a doctor, but the cost to the health-care system is less.

 

Like many older doctors, Turner, the obstetrician-gynecologist, used to employ nurses in his practice.

 

"When I started we had a nurse in the office," Turner said. "We could pay competitive salaries. But now you can't. We can't pay the rate a nurse can get in a hospital."

 

Turner stopped using office nurses five years ago when his last one retired. Now he uses a "medical office assistant" who is more a secretary, he said.

 

At 62, Turner says he's seen many changes in the field of medicine in B.C. But the one that worries him most is that it is getting much harder to attract and keep qualified practitioners.

 

Nearly a third of all doctors who graduated from the University of B.C.'s school of medicine leave the province to work elsewhere.

 

"In very simple terms, it is getting much harder to make a decent income here without having to work virtually around the clock," he said. "I was much better off financially when I was a new doctor. I lived better, I drove better cars and I ate better."

 

Average gross Fee-for-service payments made to B.C. doctors

 

Adjusted for inflation

 

Fiscal year

 

No. of FFS physicians

 

Average gross FFS payment

 

Average payment adjusted for inflation

 

91/92 6,441 $191,544 $191,544

 

92/93 6,771 $181,028 $175,417

 

93/94 6,943 $184,326 $173,073

 

94/95 7,028 $191,273 $176,182

 

95/96 7,167 $194,769 $175,891

 

96/97 7,270 $197,306 $176,863

 

97/98 7,425 $195,300 $173,939

 

98/99 7,500 $196,865 $174,851

 

99/00 7,554 $210,436 $184,369

 

00/01 7,653 $213,482 $183,553

 

Average change 18.82% 11.45% -4.17%

 

Sources: MSP claims files and Statistics Canada

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Hello

 

 

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<dateline>1017616620</dateline>

<title>This year fewer people are matched to their choice...</title>

<pagetext>Please go visit CARMS for the statistics.

[Guest Akamba]

I would like to know what the age range is for

first year med in the different schools.

 

What's oldest age you've seen?

What's the average age?

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<threadtitle>Any body hear of anyone getting kicked out of med school?</threadtitle>

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Scarface

 

 

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<dateline>1018317660</dateline>

<title>Any body hear of anyone getting kicked out of med school?</title>

<pagetext>Has anyone ever gotten kicked out of med school, for any reason ie doing something bad/wrong/evil etc etc?

 

Just curious thanks

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