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[Guest Shelby]

I was actually a female firefighter for 3 years before I went to med school so I can tell you first hand the hours and shifts are insane and remember you dont bill 600-2000 per fire visit. The training is just as intense sure there is no tuition but a figherfighter in a 30 year career will make was a doctor makes in 5-10 years give the specialty. Personally I would have liked to have my training in a nice warm school building with other posh kids learning and laughing rather than getting second degree burns on my back, passing out from smoke inhalation or spending a 72 hour straight shift fighting a 3 alarm sunoco oil refinery fire. There is another firefighter who is currently doing his general surgery residency and cant believe how relatively easy the lifestlye of a RESIDENT is. He constantly says what a country club it is (you don't even get wet) . The head of surg loves him and constantly says that he has alot of respect for the guy. In the Surg head's words " I like people who put work before everything else, as a Surgeon we wear 100 hour work weeks as badges of honour. If family doesn't like it too bad, they should have known better. These same words are echoed in firehalls and the surg head loves it. again he said " I hate these whiny kids who come in here and dont want to devote their life to the job, go to research if you want a life!"

 

So I think there are people who bust their asses doing alot of good for society, risking their OWN lives and are paid for peanuts, its not all about slapping a PDA on your belt to get your stock quotes.

 

Shelby

[Guest anon guy]

Hi, I agree that firefighters do endure a great deal of hardship in their work. However, I am still trying to justify higher wages for doctors. Excuse my ignorance about firefighting, but I would like to know how extinguishing a blaze is planned out. Does one person or several people draft a "treatment plan" such that they can most efficiently put out the flame? Or do they just listen to the fire chief and shoot water where they are instructed? I am sure that, if medicine involves more intellectual thought and insight, then this would serve as a valid point for higher pay.

 

As for PDAs and stock quotes, I don't like them too. But there are also unprofessional firefighters (didn't a bunch of them sell calendars of themselves in the buff?)

[Guest nonce]

please tell me you are joking when you say that Doctors are the most intelligent people in the country...what the hell are u basing this on???Yourself???I hope not....save me the bullshit...

 

dork

[Guest Liana]

Well, let's say for the sake of non-subjectifying, that a doctor and a firefighter work the same number of hours per week and endure the same level of stress.

 

You still need to factor in the expense of medical school. On average, most applicants these days have completed 4 years of undergrad, let's say at $5000/y plus a modest $7000 in living expenses & books (we're obviously talking about living in a small town and not Toronto here). That undergrad cost $12000x4 = $48,000. Now, let's say that student then went on to a 4-year Ontario medical school, where they paid $13,000/y in tuition, and again an extremely modest $8000 in expenses. This medical education cost $84,000. So the classroom education alone cost $130,000 on average, being extremely modest in estimating living expenses.

 

Now let's say a young firefighter is making $40,000 per year. In the time that the medical student is in school, she is losing 8 x $40,000 = $320,000 in potential wages. Altogether, you're looking at a net loss of $450,000. With maybe 40 solid working years ahead after residency, the physician needs to make over $11,000 a year above what the firefighter is making (who by this point has probably gotten a raise to somewhere near $50,000/y) just to break even. And don't forget, this is totally ignoring interest on student loans, the desire to rent an apartment with no "pets" included, the rising cost of undergrad expenses etc etc.

 

But let's say a new physician makes $60,000/y. After tax, this works out to $40,000, and let's say this physician and her family live in squalor. Then she can probably afford to pay $20,000/y toward her student loan of $130,000. With 8% interest it'll only take about 8 years or about $16 000 in interest to do so, which means that by the time she's 40, she might be able to move her kids into a nice house like her police officer friend has been living in for 20 years.

 

If a medical education were free, then it would be more realistic to propose a physician income nearly on par with other professions that require significantly shorter initial training periods; however, it's not, and I don't think that most physicians would be too receptive to waiting until their friends' children are in college before they can actually afford to begin their own lives.

[Guest anon guy]

no, I am the most intelligent guy, but was rejected from meds. Thus doctors are not as smart as me!

 

Another point to make though, medicine does involve huge amounts of information. If there was a book about everything important going on in the human body, it might be bigger than a book on say, firefighting technique. There are also tons of new literature at various levels that doctors need to digest. Would this make a good reason for higher pay? It seems that most professions that involve large amounts of information are profitable.

 

nonce: what about minimum GPA for entrants? Maybe not for you, but it's a good indicator for schools, anyway.

[Guest strider2004]

I think there's absolutely no justification for physicians being paid so much more than firefighters or policeofficers or teachers. You must remember than public health care has only existed in Canada for the last 3 decades. In the past, the rich got medical service, the poor had none. It's a knowledge industry and just like any other professional industry, knowledge is 'sold'. To attract physicians to the public health care bandwagon, the governments had to provide at least a reasonable compensation plan. We are also next to the United States so competition for physician resources has also kept the salaries high in Canada. I doubt that we would be paid so much in England where health care only counts for 6% of the GDP(those misers!). Private health care - heck, any private sector - has always paid better than the public sector and we have to compete to keep our physicians away from the private sector in the US. It'll get easier in the next decade since HMOs are eroding the incomes of doctors down south.

 

Most of you are probably young to remember that physicians were making much more money 20 years ago and this trend is likely to continue. I think it's fine because it's probably the only way that public health care can be saved in Canada, Physicians are only part of the health care solution so we need to make room for everything else.

 

It's difficult to separate money from medicine sometimes. When I hear somebody complain about the money and lifestyle, I don't hear "screw it, I'll quit and become a police officer!". I hear "I should have gone into dentistry" or "I'll do business instead". These people obviously care a great deal about money. But there are also people who spend half of their year VOLUNTEERING for medecins sans frontieres in a war torn nation. They truly care about the health of individuals and I tip my hat to them.

 

Let's get back to here and now. We have a system where physicians are getting paid so much. I actually looked up the current recommended figures from the OMA for salaried physicians and you should start at $102,000 excluding overhead or additional office costs. Your level of training dictates how much more you get on top of that(top bracket $252,000). For all you med students out there, it's in the latest edition of the Ontario Medical Review.

 

IF(big IF) the Ontario government decides to drop the salary down to a figure that is unacceptable to physicians, they'll just pack up and move somewhere else like Alberta. It's simple supply and demand and health care is not immune to its effects. When the nursing salaries increased in Alberta, adjacent provincial nursing unions protested to ehri respective governments to raise their own salaries to remain competitive with Alberta. That's simple fact. There's no point arguing about the justification of physician salaries because there will always be people(eg. finance) who make more and there will be people(like teachers) who make unjustifiably less.

[Guest UWOMED2005]

Unfortunately, many physicians already are leaving.

 

As I posted earlier - the question of physician earnings is way more complicated than the public realizes. Yes, some people go into medicine for the money. In this day and age, those are the people telling premeds NOT to go into medicine because they won't make enough money.

 

I would much prefer a system where I could be making a reasonable small amount of money and then a smaller salary once I'm done my training. I then wouldn't be burdened with the stress of massive debt (and the fear something might happen so that I might not pay it off. . .) and would have some shance to 'live it up' modestly before I'm middle-aged and bald (noone likes that bald guy with the sports car - nobody. . .) As it stands now, it doesn't look like I'll have any money until I pay off my massive student debt - which could easily be timed just in time for me to pay my own kids tuition!! Seriously though, the system does seem to be somewhat flawed. But, now that I am taking on this amount of debt I NEED a salary a bit above par to pay that debt off. After all, the Harris government's been exceedingly willing to deregulate my tuition and slash funding to the University such that they HAVE to raise my tution based on the argument that my eventual salary will somehow have that make sense. If they want me to practice here, they can't have THEY'RE cake and eat it to. . .

 

Sorry if this e-mail isn't entirely cohesive and not put in the best argument possible. We're in the middle of exams here and I've had exactly 2.5 hours sleep over the last 60 hours.

[Guest nonce]

your an idiot...you assume all smart people apply to med school...what about the genius' in commerce.....education??those that dont goto post secondary school??Not all ppl feel the need to be a doctor...@#%$ you and your 'im better than everyone because im a doctor' attitude...your a herb....

[Guest Liana]

Well, I don't necessarily agree that physicians need to be earning the incomes that they have in the past. If students are applying to medicine claiming to be interested in helping people, then they should truly be that giving person unconcerned with the bottom line.

 

But that of course doesn't mean that they should completely give up cares about money; in Canada, you still need money to care for your family. Mortgage, food, hydro, clothing, these all cost money, not to mention paying off the debtload from tuition. I've never been to Africa, so maybe this is completely based on stereotype, but I would assume that the physicians involved in Doctors without Borders can survive without the monetary benefits of North American practice because the communities in which they practice are less dependent on cash currency, and a physician's well-being (and perhaps even that of a family?) can still be maintained and even nurtured in this environment.

 

Perhaps if medical school was "free" to all students, then there would be less concern with post-graduation income. Let's say successful applicants to med school could be reimbursed for any educational costs associated with undergrad, and receive a free medical education; if they chose to leave the province or country, they would be responsible for reimbursing the government the full expense of this education. In this scenario, I'm sure you could find enough well-suited applicants who would be willing to work for $65,000 after graduation.

[Guest anon guy]

hi nonce, I am quite thrilled that you seem to be "hopping mad" over this. Well, you're quite right that smart people can do all sorts of jobs and be very successful! What I mean by GPA is that, the very barrel-bottom guy accepted into meds is no slouch! I certainly liked many of my high school teachers, but there's a couple that I wonder how they managed to get through university and teacher's college...

 

A "genius" can do anything, firefighting, insurance sales, teaching, healing, and they would succeed because they have ways of getting things done better, faster and cheaper.

 

I think Liana's idea sounds great for levelling the playing field for people of all socioeconomic backgrounds. I wonder if the loss of greedy but smart people will be a significant loss or not? It also starts to sound a bit left-wing hehe...

[Guest UWOMED2005]

I'd sign up for that! As long as it included a pension and a few other benefits (ie dental plan, etc.). . .

[Guest Liana]

Alright, here's the deal:

 

Free medical education, and a rebate on undergrad, if you elect me. I'll give you up to $1000/month for living expenses (kinda like an allowance, aww!) but the rest is up to you.

 

If you choose to move out of Ontario or whatever jurisdiction it is I'm talking about, then you owe my government $150,000.

 

Here's the catch: when you graduate, I'm capping your salary at $70,000. I'll start you off at $45,000 in residency, and offer you $60,000 when you finish that, with a few raises just to keep you interested. This should put you in a good tax brachet, so you get to keep 2/3 of that, maybe more if you volunteer your time with government-initiatives (eg, 2 week rotation-"vacations" to underserviced areas, or one weekend a month volunteered at a clinic outside your practice). In return, you can have a full dental plan, pension, eyeglasses coverage, and one free visit to the Mac monkeys (for clarification, see McMaster threads).

 

I may re-evaluate the scheme if you're in a specialty where you practice long hours or whatnot, but I think I'd rather employ more physicians at lower wages, thus preventing physician-burnout. I'd rather you put in quality hours, not quantity. However, if you do decide to give it your all, I'll see about initiating a non-financially-based employee rewards program. Maybe something like in public school when you got cool prizes for fundraising. Perhaps an extra week of vacation might reward those workaholics, although they probably wouldn't go for that.

 

I think that you would see a different crowd of people graduating from medical school. The psycho-premeds would be drifting more toward the States, and you might even see a more supportive environment at medical schools, assuming these money-grabbers are also the ones driving up the competitive nature of medical school. I don't think the number of applicants will go down too severely; Ontario already has 8 applicants for every available space; we could stand to do something to lower our stats down to the national average (or the American, for that matter). I think the quality of graduating physicians would remain constant, or even improve, because you'd end up with a more genuinely compassionate group.

 

In conclusion, vote for me. I will take medicare out of the 1970s and into the new millenium. Not the crappy millenium envisioned by those politicians who are selling every property they own for a quick buck, but the good millenium about which the people in the 60s dreamed.

[Guest brandonite]

I still see a major problem with that...

 

The US is located right next door. Where doctors, despite the impact of HMO's, still make between $100,000 and $200,000 US on average. Why would doctors work in Canada for drastically lower salaries then they could make in the US? I'm as much of a patriot as the next guy, but I mean, if I could live 50 km further south (I'm right on the border as it is) and triple my salary, I mean, there's not much of a choice there...

 

I don't want a BMW. I just want a comfortable salary! Enough so I can live in a nice house, have a nice car, send my kids to a nice school, go on nice vacations, etc. I don't want the Ritz, just a comfortable life! And I will be giving up the better part of my 20's for this job that I'm willing to dedicate my life to! I mean, my parents are teachers and they make almost $60,000 a year. And they only went to school for 5 years, get two months off in the summer, have basically no stress, etc...

[Guest hmm]

actually, teachers go to school for many many years and they repeat the same grade too! They deserve 60k and maybe more!

[Guest Liana]

Actually, I think I would raise the fee for my medical graduates moving elsewhere.

 

If I give them free education, and they leave my region, they can pay $500,000.

So.. why would one choose to enter my educational system and move elsewhere if it's just going to cost them in the end, anyway?

[Guest democracy]

I wonder if it is unconstitutional to restrict the movement of people like that? There was a big tech brain-drain before the economic downturn and I never heard of a plan like this (even though it would have been helpful). There is also a brain drain of doctors from S.Africa to here, as well as NZealand to Australia, I think.

 

If there was some sort of education for service contract, is it possible to go to the U.S. and declare bankrupcy to avoid the 500k penalty? There are already many cases of loan default for regular grads.

 

I'm not a lawyer, but I think there are some folks with law background here.

[Guest strider2004]

I've heard the declaring backruptcy argument before. It's difficult for physicians to declare bankruptcy because we have a guaranteed income so banks don't believe it.

[Guest Liana]

Well, I'm sure we could manipulate the law to work on our side here.

 

I'm not sure how much it actually costs the government to fund medical education per capita, but someone who exited the contract to practice out of the area should at least be liable for the full expense of the education.

 

This is beginning to look something like what they're trying to work with for med students who want to move into Northern medicine, but I still think that there needs to be something done proactively, when students actually need the money. Although granted, you can argue that a student who finances his education with loans doesn't actually pay anything until graduation, so at least if the government could offer interest-free student loans covering the full costs of a medical education to all students, then we're beginning to talk seriously here. Those students who remain to practice in Ontario for $65,000/y are not responsible for paying back this loan, whereas those who choose to leave the province are responsible for paying back the full cost of their medical education (ie, that would be equivalent not only to the tuition today, but also the subsidized component of the education as well) and interest, at say prime+2.

 

The problem with trying to implement positive policies for the future is that you have to enact change on a grand scale, or none at all. Implementing something like this Canada-wide would be more successful than trying to do it in Ontario only. The problem with the government is that great ideas get introduced, and by the time they're actually passed, they've been so warped that all they are is a fragment of a great idea done half-gluteal. For instance, AIDS: if every country in the world had've implemented control and educational programs back in the 80s, then the disease wouldn't be as widespread as it is now. The US was particularly dumb in this period (I believe that was Reagan & Bush as an underling) because they refused to believe that heterosexuals could contract this disease, and so their lack of action has had serious effects in the long run.

 

Point being: current social medicare in Canada is entering a pathologic state. If you do nothing, your patient will whither and die. If you treat the tumour with a half-hearted attempt, offering the patient one or two mild doses of chemotherapy so as not to make them too sick in the treatment, you're only going to select for chemo-resistant cells which will subdivide and make your current situation admirable. Unfortunately, you need to induce the illness of chemotherapy with the largest dose that you think will be effective while still safe, in order to get the best chance of clearing yourself of the cancer (for the time being anyway!).

[Guest brandonite]

Placing that severe of a restriction on medical students (ie - a 500,000 penalty upon departure) would lead to a fleeing of students to the US before med school. As it is right now, I woudl very much like to stay in Canada for med school, and to stay in Canada to practice after that. But if someone told me that I would be forced to stay in any one place for my entire life, well, I don't know about that. I don't like being forced into any one location, or being forced to stay here. Say I marry someone, and she gets transferred to the US by her company. I'd be stuck here.

 

I applied to both US schools and Canadian schools, and like I said, I'd love to stay here. But under the system you're proposing, I don't know if I could... I still think doctors should me making a salary in the $100,000 range at least. Teachers with seniority make $60,000. RN's make at least $50,000. And doctors have far more work and responsibility than either, and more education as well.

[Guest AniyaSG]

Some of these suggestions remind me of the military way of getting a medical education. Once you're accepted, they will pay your tuition and expenses as long as you agree to a period of work within the Armed Forces after you're done. If you refuse to work for the Forces, you get a bill for your expenses...

[Guest Liana]

I don't see what's so bad about the military's way of doing things.

 

If you decide not to go into service after completing your education, they bill you for the education you received. So what? You pay this back AFTER you're done school, likely when you're working and making an income, and not paying OSAP interest rates on the money you had to take out 4 years previously for your education.

 

The other Canadian schools make you pay for your education too, they just ask you for it upfront, when you have no money. At least the military school has the decency to wait until you have an income to make the payments.

[Guest Leon]

Hello. I am a doc in the US, and I have to agree that while it is distasteful for physicians to complain about hours and wages, it is fast becoming a necessary evil. Generally, if people can't get what they want, they will leave what they are doing. But our training is so long and arduous, that when we finally get into the field, we have a hard time leaving, and seeing the years and tears we put in as a sunk-cost. Also, there are many altruistic people who would stay in medicne for virtually nothing. These add up to the tendency to get abused financially by almost everyone - literally forcing many of my colleagues out of work. (not to mention that there is a litigation crisis in the US). I am not too familiar with what is going on in Canada, but I'd like to hear more.