Change Doctors' Pay

[mig174]

I think hospitals should be like sports teams, with televised surgeries, star doctors and gatorade commercials in between. Then, at the end of each "season", the worst hospital gets the first overall pick to select a medical school graduate to an entry-level contract - tons of work and no pay. Of course, all Toronto hospitals will trade their first-round picks for proven "veterans" only to miss out on someone like Takahori Fukushima and be destined to years and years of mediocrity.

[infomeddude]

I think hospitals should be like sports teams, with televised surgeries, star doctors and gatorade commercials in between. Then, at the end of each "season", the worst hospital gets the first overall pick to select a medical school graduate to an entry-level contract - tons of work and no pay. Of course, all Toronto hospitals will trade their first-round picks for proven "veterans" only to miss out on someone like Takahori Fukushima and be destined to years and years of mediocrity.

 

LOL. That made my day.

[AdamP]

I think hospitals should be like sports teams, with televised surgeries, star doctors and gatorade commercials in between. Then, at the end of each "season", the worst hospital gets the first overall pick to select a medical school graduate to an entry-level contract - tons of work and no pay. Of course, all Toronto hospitals will trade their first-round picks for proven "veterans" only to miss out on someone like Takahori Fukushima and be destined to years and years of mediocrity.

 

isn't that how u of t does it already?

 

taking all kinds of old grad students

[ploughboy]

I think hospitals should be like sports teams, with televised surgeries, star doctors and gatorade commercials in between. Then, at the end of each "season", the worst hospital gets the first overall pick to select a medical school graduate to an entry-level contract - tons of work and no pay. Of course, all Toronto hospitals will trade their first-round picks for proven "veterans" only to miss out on someone like Takahori Fukushima and be destined to years and years of mediocrity.

 

This is possibly the funniest thing I've read all month.

 

Don't forget about selling advertising space on the players...er..physicians scrubs. Healthcare funding crisis solved!

[seeking1]

Doctors would be reimbursed, for example, for seeing a specified number of patients in a certain time frame.

 

This is the worst idea ever. Hands down.

[ploughboy]

And for anybody actually interested, here's a link to the report in question.

 

http://www.oha.com/News/MediaCentre/Documents/Bending the Health Care Cost Curve (Final Report - April 13 2010).pdf

 

The first parts of it are actually quite reasonable and sensible, and then it veers off into la-la land partway through.

 

Interestingly, their calculated costs are offered without explicit citation, although I assume they were getting their numbers from the CIHI report cited in that general area of the text. I dug deep into the CIHI appendices and tried really hard to reproduce their numbers last night but couldn't. I'm sure the actual numbers are above reproach, but perhaps some of the assumptions underlying them might not be as solid.

 

CIHI report here: http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_31_E

 

 

OMA's response:

 

“The OHA is comparing numbers that are simply not comparable and doesn’t take into account volumes and differing demographics between provinces. To propose that Ontario’s health-care system should start cutting tests, treatments and surgeries to save money, suggests that the OHA is once again putting dollars before quality patient care.”

 

“The leadership at the OHA is out of touch with the rest of the province’s health-care providers, who are all working tirelessly to improve quality care for Ontario’s patients. While they produce maligning reports and make false allegations about physicians and others, Ontario’s doctors are working closely with hospital administrators, nurses, Ministry officials and other partners in the health-care sector to find innovative solutions to improve quality care to patients.”

 

The OMA statement is posted online for member reference (https://www.oma.org/members/communications/omastatementapril.asp).

[NLengr]

This is possibly the funniest thing I've read all month.

 

Don't forget about selling advertising space on the players...er..physicians scrubs. Healthcare funding crisis solved!

 

I was debating writing Janssen-Ortho when I was on Obs-Gyne clerkship and asking them to pay me a buck every time I said Micronor. Loans woulda been paid off in a month.

[sharpee]

maybe not pay for performance in the sense that patients outcomes would be an indicator of success, but some other measure. I've had way too many docs who do nothing and don't give a rats ass, I'd be nice to see them work for their money.

[UTPEOPLE]

maybe not pay for performance in the sense that patients outcomes would be an indicator of success, but some other measure. I've had way too many docs who do nothing and don't give a rats ass, I'd be nice to see them work for their money.

 

the only other possible measure would be patient satisfaction, which would run into problems if the patients could hold the doctors hostage (if you dont give me want i want, I'll give you a bad review!)

[sharpee]

. .

[UTPEOPLE]

Rather than one patient's rating, maybe based on the average rating of all the patients in a year? There is no perfect system, but it might be better than GPs who run their practice by spending 5 minutes a patient and just ripping OHIP off for 30 bucks. Maybe you guys don't know many docs like this, but I've had many who are like this, they are uncaring and unhelpful, and I'd be nice to see those who not fulfilling their duties as a physician and rather running their practice like volume businesses weeded out. I've even heard of some family doctors who call their patients ever so often to tell them to come in for a visit (no joke, go to MDratings.com, if you want the doc name PM me).

 

but that might turn doctors more yes men to keep their patients happy. For example, its not good to blindly prescribe antibiotics, and currently, doctors have the power to not do that even when the patients insists on getting the antibiotics. Under this proposed system, the doctors would be biased towards just giving into the patient's demands, which would be unfortunate

[Guest success100]

well some, like optho... definitely deserve to get their wages cut, if it happens. but if anything, we need to raise family physician wages so that they reach parity with other specialties

 

True true...

[sharpee]

but that might turn doctors more yes men to keep their patients happy. For example, its not good to blindly prescribe antibiotics, and currently, doctors have the power to not do that even when the patients insists on getting the antibiotics. Under this proposed system, the doctors would be biased towards just giving into the patient's demands, which would be unfortunate

 

I agree that some patients may do this, but not all. How much of the general population is out to seek drugs? maybe 10-20%? i would think that an average patients would score the doctor appropriately, but maybe i am just too idealistic.

[UTPEOPLE]

I agree that some patients may do this, but not all. How much of the general population is out to seek drugs? maybe 10-20%? i would think that an average patients would score the doctor appropriately, but maybe i am just too idealistic.

 

I dont mean hard drugs. You would be surprised how many worried mothers or internet self-diagnoses are convinced that they know that they have a bacterial infection and that they just HAVE to get antibiotics for them and their children (even when the symptoms point towards viral infection). I have seen the arguments that my FP can get into with these people. Right now, at least my FP can refuse these antibiotics based on genuine care for the patients health. I would not want to dangle financial compensation as a potential counterbalance to the weight of his hippocratic oath

[estairella]

I agree that some patients may do this, but not all. How much of the general population is out to seek drugs? maybe 10-20%? i would think that an average patients would score the doctor appropriately, but maybe i am just too idealistic.

 

Your assumption is that the number would be around the same for every doctor and just 'average out'. Talk to a doctor working in inner city health or a doctor working on an Aboriginal commune... compare the rates of serious problems/illnesses of their patients to the 'general population'.

 

Basically, by having some arbitrary measure like health or satisfaction, you penalize doctors who work with our most vulnerable... who incidentally, need our support more than ever.

 

I'm sorry that you've had bad experiences with doctors who won't give you the time of day, but you know what, that's probably because 1) you don't have any major health issues and 2) you have absolutely no idea what having an actual problem means (whether that's drug addiction or a chronic illness like cystic fibrosis or diabetes).

 

How would you feel if you were actually sick and the doctor said "oops, sorry, 15 minutes over, come back in a week"? That's, frankly, inhumane but that is the system that results from measuring 'performance'.

[sharpee]

Your assumption is that the number would be around the same for every doctor and just 'average out'. Talk to a doctor working in inner city health or a doctor working on an Aboriginal commune... compare the rates of serious problems/illnesses of their patients to the 'general population'.

 

Basically, by having some arbitrary measure like health or satisfaction, you penalize doctors who work with our most vulnerable... who incidentally, need our support more than ever.

 

I'm sorry that you've had bad experiences with doctors who won't give you the time of day, but you know what, that's probably because 1) you don't have any major health issues and 2) you have absolutely no idea what having an actual problem means (whether that's drug addiction or a chronic illness like cystic fibrosis or diabetes).

 

How would you feel if you were actually sick and the doctor said "oops, sorry, 15 minutes over, come back in a week"? That's, frankly, inhumane but that is the system that results from measuring 'performance'.

 

15 minutes over? isn't that what the system right now is doing? by paying doctors for the amt of patients they see, you give them incentive to produce volume rather than quality.

[sharpee]

Your assumption is that the number would be around the same for every doctor and just 'average out'. Talk to a doctor working in inner city health or a doctor working on an Aboriginal commune... compare the rates of serious problems/illnesses of their patients to the 'general population'.

 

Basically, by having some arbitrary measure like health or satisfaction, you penalize doctors who work with our most vulnerable... who incidentally, need our support more than ever.

 

I'm sorry that you've had bad experiences with doctors who won't give you the time of day, but you know what, that's probably because 1) you don't have any major health issues and 2) you have absolutely no idea what having an actual problem means (whether that's drug addiction or a chronic illness like cystic fibrosis or diabetes).

 

How would you feel if you were actually sick and the doctor said "oops, sorry, 15 minutes over, come back in a week"? That's, frankly, inhumane but that is the system that results from measuring 'performance'.

10 char 10 char

[UTPEOPLE]

15 minutes over? isn't that what the system right now is doing? by paying doctors for the amt of patients they see, you give them incentive to produce volume rather than quality.

 

You could see it in this light, or, as I consider it, when FP call their patients in to be seen, I dont think its money that motivates them, but rather the importance of regular checkups in the need to prevent disease. Think of it like a dentists' tooth cleanings to prevent a cavity down the line. At these checkups, you might think that very little is done, but thats because our physicians are highly trained and many of the symptoms of important, common illnesses have an observational component that the physician can just pick up by looking at you and hearing you breathe, for example.

[Gooner]

fee per performance actually, which is arguably worse ethically....

 

 

Pay for performance narrows the mind...

http://blog.ted.com/2009/08/the_surprising.php

[rmorelan]

15 minutes over? isn't that what the system right now is doing? by paying doctors for the amt of patients they see, you give them incentive to produce volume rather than quality.

 

A lot of the newer funding models for family doctors are not fee for service directly and do scale for the sort of patients you have in your practise to avoid some of those sorts of problems

[terryann]

Got to wonder,if a system like that come into place, how many doctors would move to others provinces or the US....thus, increasing the shortage of family doctors etc...

[future_doc]

In Quebec, there was quite a flow of doctors into Ontario. So, terryann's suggestion is not farfetched.