working conditions of ontario doctors

[nerdykilla]

Hi all,

 

What are people’s understandings of the working condition for physicians in Ontario/Canada? What are the main issues they face? Other than lower salary than the US, and the higher taxes...what else our physicians tend to complain/ or praise about their working conditions?

[clkt]

do you have any specific group in mind? type of specialty? academic, community hospitals, clinics, etc?

[nerdykilla]

I was asking in general. I know FPs aren't always happy. I hear a lot of complains about the physician's salary here. But other than financial related issues, Why else are we loosing a lot of doctors to the US?

[Satsuma]

Conditions are specialization dependent. For neurosurgery last year there were not enough positions in Canada...and they lost I believe 5 graduates to the US. They did not go to the US by choice.

 

I think in many cases when people compare US and Canadian incomes, they forget that there is a very huge component of the US income that goes toward overhead, including very high malpractice insurance. So the difference isn`t always as big as it seems (again, depends on your specialization and location of practice).

 

It will be difficult for people to comment "in general" since the issues changed based on location of practice, specialization etc...

[The Soccer Guy]

One of the problems I have seen is the fact that there are not enough physicians out there (ex, rural areas, Southern Ontario, etc.). This forces many doctors to take on more patients, work extra time, work a lot faster (which may sometimes be bad considering that they may not have the appropriate amount of time to treat a patient who really needs the help), etc.

 

All these things can lead to stress, problems with running your own business, difficulties with people who are sick and tired of waiting, taking your time away from your personal life, etc ...

 

There are a lot of other things that can be pulled out of this. Just imagine a life of a family doctor who sees over 60+ people a day and that who sees about 30 people a day ...

[Rock*]

another thing that doctors complain about is the attitude of many patients in general. Because of our universal healthcare, many patients visit doctors with a sense of entitlement and expect the doctor to do all the work in keeping them healthy. Many don't take recommendations to stop smoking or lose weight seriously, and then come back a few years later freaking out because they just had a heart attack and now they need consultations to cardiologists and prescriptions for mountains of blood pressure medications.

[The Law]

another thing that doctors complain about is the attitude of many patients in general. Because of our universal healthcare, many patients visit doctors with a sense of entitlement and expect the doctor to do all the work in keeping them healthy. Many don't take recommendations to stop smoking or lose weight seriously, and then come back a few years later freaking out because they just had a heart attack and now they need consultations to cardiologists and prescriptions for mountains of blood pressure medications.

 

I don't think that has anything to do with our health care system being universal... because that's generally the case, even in a private health care system. Even in a non-health care work setting, many service industry professionals experience the same thing.

[eise]

I don't think that has anything to do with our health care system being universal... because that's generally the case, even in a private health care system. Even in a non-health care work setting, many service industry professionals experience the same thing.

 

 

I wonder if Rock is referring to the fact that since patients in a universal health care system do not have to pay out-of-pocket (for most services), some abuse the system. I have a friend who goes to her doctor once a week just to make sure "everything is ok." She does not have an illness that needs to be monitored. She just wants to ensure her cold or paper cut is progressing as it should. This wastes a lot of a doctor's time and resources. Perhaps if she had to pay out of pocket, or even a small user fee, she would not abuse the system as she does (and I'm sure as many others do as well). I am not for-privatization, I'm just articulating one disadvantage of universal health care.

[Rock*]

eise: bingo. A lot of doctors are much more cynical about universal healthcare--so much so that the profession is fairly evenly divided about whether it's a good thing or not. Personally, I think that universal healthcare is great because it can provide doctors with more opportunities to educate patients and apply preventative healthcare but the fact that there are absolutely no allowed user charges (unless the provinces want less funding) degrades the value of medical treatment. People don't value anything unless they have to work for it and when medical care is given freely for EVERYTHING, a LOT of people abuse the system. While working in a GP's clinic, I've literally seen some people come in who've been to a doctor more than 200 TIMES in the last 2 years and they don't have anything life threatening. They just keep seeing new doctors for 3rd, 4th, 5th, ... opinions because they're in denial about a diagnosis. Selfishness at its worst.

[ploughboy]

I have a friend who goes to her doctor once a week just to make sure "everything is ok." She does not have an illness that needs to be monitored. She just wants to ensure her cold or paper cut is progressing as it should. This wastes a lot of a doctor's time and resources.

 

I respectfully suggest that perhaps your friend's doctor (or your friend's doctor's secretary) is contributing to this cycle as much or more than the Canada Health Act is...pb

[Curious P]

Does anyone know if doctor service fees are linked with inflation? I believe Ontario FPs make something around $28 per basic visit, how long has this been the rate and how often does it get increased?

 

If everything around me went up with the rate of inflation but my pay was stagnant, I'd be pretty miffed!

[Dal07]

Most doctors in Ontario are moving away from fee for service. The government has created the option for what's called Family Health Groups/Family Health Networks, which is just a minimum of 4 physicians sharing a clinic. Basically you get paid for how many patients you have in your clinic. So, you can have a maximum of 2500 patients and you get paid $x per pat. under 16, more if they're elderly, and receive stipends for patients with chronic illnesses such as diabetes. You can also receive preventative care "bonuses" for doing yearly pap tests on all female patients, flu shots on patients over 65, etc. This way you aren't billing per visit, just for how many patients you roster.

 

BUT, in doing so, you have to offer increased access. So, you have to hold say a night clinic Mon-Thurs 5-8 and Sat morning 9-12. AND if your patient accesses Urgent Care, you get charged an access fee.

 

The good thing is you can take, say a weeks vacation in the summer, and still get paid, and your patients will still have access to the other physicians in your clinic group.

[agregson]

I have a friend who goes to her doctor once a week just to make sure "everything is ok." She does not have an illness that needs to be monitored. She just wants to ensure her cold or paper cut is progressing as it should.

 

 

I think it could be argued that this person does have an illness, more in the psychiatric realm. Perhaps hypochondriasis, somatization what have you. It is not normal for a "healthy" person to go to the doctor everytime they get a papercut.

[eise]

I think it could be argued that this person does have an illness, more in the psychiatric realm. Perhaps hypochondriasis, somatization what have you. It is not normal for a "healthy" person to go to the doctor everytime they get a papercut.

 

I wouldn't call her "normal", per se. She is definitely neurotic. But she is not an exception. I know many people who frequent their FD's office just because they can. And ploughboy, I'm not sure a doctor can ethically turn away a patient, because they don't think they need to be there. I think the doctor has to see every patient who makes an appointment to see him (and similarly, is it the secretary's responsibility to ensure every patient who makes an appt has a 'worthy enough' condition?).

[paulchemguy]

I wouldn't call her "normal", per se. She is definitely neurotic. But she is not an exception. I know many people who frequent their FD's office just because they can. And ploughboy, I'm not sure a doctor can ethically turn away a patient, because they don't think they need to be there. I think the doctor has to see every patient who makes an appointment to see him (and similarly, is it the secretary's responsibility to ensure every patient who makes an appt has a 'worthy enough' condition?).

 

or maybe your friend is in love with the doctor? and isn't there also a syndrome where the patient always wants doctor's attention and care? i first heard about it on House....

[eise]

or maybe your friend is in love with the doctor? and isn't there also a syndrome where the patient always wants doctor's attention and care? i first heard about it on House....

 

Munchausen (sp?) syndrome. i think she's just neurotic (read crazy) though. although her doc is a male...

[peachy]

Perhaps if she had to pay out of pocket, or even a small user fee, she would not abuse the system as she does (and I'm sure as many others do as well).

I am not so sure that user fees are an effective disincentive to inappropriate use of healthcare resources. I recall reading somewhere that when trials are done with user fees, all that happens is that people who can afford the fees go even more often (they feel even more entitled, since they are "paying" for their visits), and people who are poor avoid going at all, and end up with worse health care.

[Maxime]

"Perhaps if she had to pay out of pocket, or even a small user fee, she would not abuse the system as she does (and I'm sure as many others do as well)."

 

Not to mention it would go against one of the 5 fundamental health care laws in Canada, which is accessibility.

 

Max

[Rock*]

"Perhaps if she had to pay out of pocket, or even a small user fee, she would not abuse the system as she does (and I'm sure as many others do as well)."

 

Not to mention it would go against one of the 5 fundamental health care laws in Canada, which is accessibility.

 

Max

 

Those aren't laws. They're just tenets of the Canada Health Act. A province can disregard any or all of those laws, but the Federal government will react by reducing their yearly healthcare fund transfer accordingly. So if a province starts to institute user fees, the feds will reduce their transfer by the same amount.

 

Personally, we should stop looking at the Canada Health Act as something like the 10 commandments from God. Maybe it would be a good idea to analyze the situation pragmatically with an open mind and run small pilot experiments to try different methods of delivering healthcare and settle for modifications that work. If we're too hesitant to do that, at least we can look at healthcare lessons from other countries and try to adapt those to our system. Practically all of the rest of the world use a public/private system and many of them offer better medical treatment than us for a cheaper price (not the US. They spend 50% more inferior coverage).

 

Personally, I'm all for very small user fees in the range of 1/2 to 1/3 the general OHIP rate for GP visits, putting the fees at something like $6-$15/visit.

[eesanr]

In sweden, they have a user fee of $20 per GP visit. They found that the average # of times a patient visited their GP dropped from about 6 to 3 times per year with the user fee.

 

As to the issue with accessibility, if a person is in need of health care, they will go see their GP even with a small user fee charged (i.e. $20). How come we can expect people to pay much much more than $20 for prescription drugs to treat their illness once they see their GP for "free", yet we don't expect them to pay a small nominal fee to see their doctor even though they are sick?

I'm not saying we should charge a user fee or not, the point i'm trying to make is that "accessibility" and "universal" is a term that gets tossed around and polarizes the health care debate, but the reality is that we have a system that is neither universal nor completely two-tiered.

 

Think of all the supplemental medical benefits that people can have. Dental, Pharmacare, Optometry, etc. These all contribute to maintain the "health" of individuals, but those that are not insured for these services are the people least able to afford them out of pocket; those in low-skill, low-wage, and/or non-standard work.

 

While the Canada Health Act was/is a good guideline as to how to model our health care system, health care has changed in the last couple of decades. Yet politicians hide behind the CHA and stiffle innovation in health care. What has that left us with? A health care system where costs continues to outpace inflation and government revenue growth (most years), a unsustainable formula in the long run.

 

It's not all doom and gloom, because there are solutions. For example, changing the remuneration method of GPs such that their labour supply incentives are in line with those of a gatekeeper. This is an example of finding efficiencies within the system.

In Britain, there is a separate tax dedicated to health care. Ppl know exactly how much of their earnings is going to health care and if u need to raise more money for health care, u can increase that tax. (But i doubt any politician in Canada has the balls to raise taxes in the current political climate).

 

Wow, I just realized I wrote an incredibly long post. I'm sure many ppl will not be too impressed with certain aspects of my views. The point I want to get across is that there are many ways we can take our health care system to solve the problem, and many diff. countries with good/bad experiences to model after (not just the U.S.). What will make our health care system sustainable is innovation, not just throwing money at the problem every year around budget time.

[sars]

As to the issue with accessibility, if a person is in need of health care, they will go see their GP even with a small user fee charged (i.e. $20).

 

$20 is not a "small" fee for everyone...

[Rock*]

Eesanr is right. The price of medications and the dispensing fee at a pharmacy can easily top $20 and usually goes up to the hundreds. What is the point of providing free GP visits when pts can't afford the medications afterward?

 

I'm totally for adding a small user fee to discourage wanton use of the medical system for tiny things but pts need to be able to afford medications that are prescribed to them. We need a more comprehensive pharmacare plan that will increase the number of drugs covered in the provincial formularies and also subsidize a greater proportion of the drug's cost.

 

I think blindly trusting in the 30 year old CHA is as good as groupthink. It stifles innovation like the Eesanr said and keeps our minds closed to better options

[xylem29]

In sweden, they have a user fee of $20 per GP visit. They found that the average # of times a patient visited their GP dropped from about 6 to 3 times per year with the user fee.

 

As to the issue with accessibility, if a person is in need of health care, they will go see their GP even with a small user fee charged (i.e. $20). How come we can expect people to pay much much more than $20 for prescription drugs to treat their illness once they see their GP for "free", yet we don't expect them to pay a small nominal fee to see their doctor even though they are sick?

I'm not saying we should charge a user fee or not, the point i'm trying to make is that "accessibility" and "universal" is a term that gets tossed around and polarizes the health care debate, but the reality is that we have a system that is neither universal nor completely two-tiered.

 

Think of all the supplemental medical benefits that people can have. Dental, Pharmacare, Optometry, etc. These all contribute to maintain the "health" of individuals, but those that are not insured for these services are the people least able to afford them out of pocket; those in low-skill, low-wage, and/or non-standard work.

 

While the Canada Health Act was/is a good guideline as to how to model our health care system, health care has changed in the last couple of decades. Yet politicians hide behind the CHA and stiffle innovation in health care. What has that left us with? A health care system where costs continues to outpace inflation and government revenue growth (most years), a unsustainable formula in the long run.

 

It's not all doom and gloom, because there are solutions. For example, changing the remuneration method of GPs such that their labour supply incentives are in line with those of a gatekeeper. This is an example of finding efficiencies within the system.

In Britain, there is a separate tax dedicated to health care. Ppl know exactly how much of their earnings is going to health care and if u need to raise more money for health care, u can increase that tax. (But i doubt any politician in Canada has the balls to raise taxes in the current political climate).

 

Wow, I just realized I wrote an incredibly long post. I'm sure many ppl will not be too impressed with certain aspects of my views. The point I want to get across is that there are many ways we can take our health care system to solve the problem, and many diff. countries with good/bad experiences to model after (not just the U.S.). What will make our health care system sustainable is innovation, not just throwing money at the problem every year around budget time.

 

agree with u

[peachy]

In sweden, they have a user fee of $20 per GP visit. They found that the average # of times a patient visited their GP dropped from about 6 to 3 times per year with the user fee.

It's not at all clear to me that this is a good thing. Who wasn't going to the doctor? Does this average reflect that a subpopulation just stopped getting health care entirely? Were people waiting until their illnesses became much more severe (and costly to treat) before visiting the doctor?

 

It seems to me that the number of people who are frivolously visiting their doctors for fun is not all that large and unlikely to be a major public health problem! I get that there are some weird people out there such as the anecdotes in this thread, but most people just don't consider visiting the doctor to be all that enjoyable, no? And a ten-minute doctor's appointment just isn't that expensive in the context of the healthcare system, is it?

[eise]

And a ten-minute doctor's appointment just isn't that expensive in the context of the healthcare system, is it?

 

I don't think the issue is with the cost of the ten-minute visit, it is with the time itself. Family doctor's have limited time within the day to see an infinite amount of patients, some of which don't need to be there. Maybe nurses or nurse practitioners can help filter the patients so only the ones who need to see the doctor do?

 

I agree that some people would be deterred from going to the doctor if they had to pay. Maybe the fee can be reflective of their income like taxes are?