New OMA notice - cuts to fees

[apache]

yeah, bureaucrats, lobbyists, and lawyers, who are convincing, turn the public on you in an instant, believe me, making docs (optho, derm, etc.) isn't too hard , but it's definitely an invested skill, and whether you want to call it nothing or not, winning the political battle means saving money, so that bureaucrats worth a lot more than joe blow bureaucrat, which is why they pick up a quarter mil consulting check and 3 months free rent. what about all the unemployed lawyers and lobbyists… eye doctors are technicians are technicians, with enough hard work, anyone can learn it, i remember lasik, the guy supervised the technicians, lol… galvanizing public support on the other hand, that's the sub 1 percent, you can't teach that in school… if i were a lawyer i'd love this, an optho, pissed… see, morals aren't the issue, it's self interest, let's just admit it!

 

This is disgusting.

 

Physician fees represent only the tip of the iceberg in terms of healthcare spending. If they want to save money, they should fire the thousands of bureaucrats who sit around and do nothing all day, and cut the wages of the unionized unskilled labourers who get paid 2x market value for their services. Oh but wait, then Matthews would lose a ****load of votes, but attacking the doctors (the big bad "1%") makes him look like the good guy.

[lostintime]

Here's another list from Globe/Mail:

 

$44 million by cutting in half the fee for "self-referrals" — referring a patients for such tests as x-rays and ultrasounds.

$30 million by 5 per cent cut in fees for interpreting results of diagnostic radiology.

$20 million by cutting pre-operative echocardiograms for elective non-cardiac surgery.

$6.4 million by 10 per cent fee cut in cataract surgery which now takes 15 minutes compared to two hours a decade ago.

 

The self-referral thing is ridiculous, whatever happened to continuity of care? Right, all doctors should just let someone else order tests because they're obviously scheming for more money when they order tests. Uh huh.....

 

And poor cardiac surgeons, their jobs are going bye bye....

[apache]

canada sucks, practice models are way to restrictive…

 

i'm not sure, maybe we'll kick out the saudi's and give the capable img's with canadian citizenships, the phd, awesome american and canadian board scores... a shot (a lot work as cline assistants for half doc wages neways, not like it's new)… it's happening in pharmacy, they're bleeding, personally, img's for stuff like rads works for me, not there's lots of people i know i wouldn't trust getting close to me, and they came from canada… it's so ridiculous, u trained in europe, your a canadian citizen, aced your toefl, have a phd in immunology, 250 usmle, ee mc1 and 2, mmi's… why not select this guy for term, over the girl from mac, who's socially savvy, and finished in percentile 60, not say top 2, like our foreign friend… besides… he's functionally more competent, than a fourth year clerk, especially some of the guys who've done foreign residencies… and really, thats the min expectation, right?

 

maybe it's scary the guy would take 250… how will the other derms afford new lambhorghinis

 

Oh yeah, I can see doctors being creative, rushing through appointments to actually make a living (blah blah *political correctedness* blah blah), or simply moving. The people who suffer are the patients of Ontario. But too bad no one really cares enough about them, well doctors more so than Deb Matthews, but doctors can only take so much b.s.

[Robin Hood]

I always felt that a fee for improper visits would be a great thing. The emergency department isn't your family clinic. If you have a family doctor, book an appointment, and if you don't, go to a walk-in clinic. If you go to Emerg for something stupid, you should have to pay the bill (or a fee). It would be amazing how much faster the wait times would be.

 

Actually I would love to see the statistics on what the wait time for true emergency patients is, instead of the person who comes because they stubbed their toe and then proceeds to sit in the waiting room for 3 hours because they had no reason to be there.

 

If there are walk-in clinics, why do people go to the hospital for non-urgent cases? (Just asking)

[lostintime]

Yeah but it shouldn't be up to the patient to decide if it's urgent or not. That's why you have a public system so people don't have to worry about being "wrong". Patients are not diagnosticians. What if that GERD like pain is a MI? Walk-in clinics are not open 24/7 and in smaller communities, there can be no walk-ins. Would you rather have a patient miss something?

 

I think most people with a life wouldn't like to wait in emerg for nothing. Sure you get the hypochondriacs, malingering, etc. but I think they are still a small portion.

[Robin Hood]

canada sucks, practice models are way to restrictive…

 

i'm not sure, maybe we'll kick out the saudi's and give the capable img's with canadian citizenships, the phd, awesome american and canadian board scores... a shot (a lot work as cline assistants for half doc wages neways, not like it's new)… it's happening in pharmacy, they're bleeding, personally, img's for stuff like rads works for me, not there's lots of people i know i wouldn't trust getting close to me, and they came from canada… it's so ridiculous, u trained in europe, your a canadian citizen, aced your toefl, have a phd in immunology, 250 usmle, ee mc1 and 2, mmi's… why not select this guy for term, over the girl from mac, who's socially savvy, and finished in percentile 60, not say top 2, like our foreign friend… besides… he's functionally more competent, than a fourth year clerk, especially some of the guys who've done foreign residencies… and really, thats the min expectation, right?

 

maybe it's scary the guy would take 250… how will the other derms afford new lambhorghinis

 

Aren't the Saudi seats surnumeral (they don't take away from Canadian seats)? If yes, then as long as KSA pays for their training we shouldn't bother, but if they indeed take away from Canadian seats, then yes, these seats should be abolished.

[lostintime]

Aren't the Saudi seats surnumeral (they don't take away from Canadian seats)? If yes, then as long as KSA pays for their training we shouldn't bother, but if they indeed take away from Canadian seats, then yes, these seats should be abolished.

 

They don't take away from Canadian seats, but they take away from Canadian learning opportunities.

[apache]

they exist… so by that nature, canadian citizens could use them. here's a more sustainable model, rbi will lend img's 100 g a year, to match the saudi donation, they grad gp's owe 300 g, but a former surgeon gets surgical assists, and is a bargain for his skill set. img's will all pay, remember, they don't have school debt, beats working security, especially because for many of them, being a doctor isn't a job, it's a community duty, and responsibility, if you wanna talk about saving money, there ya go, we could even cut equivalent med school spots, with the money we save on education… this is a bit hyperbole, but hopefully it gets people looking at reality.

 

Aren't the Saudi seats surnumeral (they don't take away from Canadian seats)? If yes, then as long as KSA pays for their training we shouldn't bother, but if they indeed take away from Canadian seats, then yes, these seats should be abolished.

[apache]

fully agree, not like these guys just came here either, half have lived here 15 years, longer than canadian grads who immigrated at 10

 

no one knows about it, that's the issue, ****, why are we taking bribes, essentially, from foreigners who leave, when we could ask you to pay a close to equiv fee (some generalist wannabe from the Caribbean coulda had your seat would have ur seat, ud be in rads or something, owe more, but prob be happier, and make more, making the "bribe transfer" an investment for you)

 

Any seat that exists is a seat a Canadian could have.

 

I am surprised that this hasn't been met with as much public scorn as it warrants.

[Birdy]

If there are walk-in clinics, why do people go to the hospital for non-urgent cases? (Just asking)

 

A few reasons. Here, more than a few big employers (call centres in particular) require a doctor's note for absences, and they require it when you report for your next shift. Say you work the overnight shift, or are missing a shift at 4pm on a Sunday - the ER is the only way to get that note and keep your job. I've been in that position. Alternately, the ER doesn't charge for notes, several walk-in clinics do. If they only have enough money to pay for gas until payday, the $20 fee for the note is more than the pt can afford.

 

Or, the pt feels it is urgent but it is not. Or the clinic felt the pt needed DI and can't wait two weeks for an appointment plus two weeks for the radiologist's report to get back to the clinic doc (which it typically takes, here, if a clinic doctor gives a pt a req.)

 

It also is not uncommon here, with such a shortage of family doctors, for the wait at the ER to be less than the wait at a clinic. There are no clinics open past 6pm as well, and no clinics at all in some towns.

 

Lots of reasons for nonurgent patients to go to the ER.

[Birdy]

I always felt that a fee for improper visits would be a great thing. The emergency department isn't your family clinic. If you have a family doctor, book an appointment, and if you don't, go to a walk-in clinic. If you go to Emerg for something stupid, you should have to pay the bill (or a fee). It would be amazing how much faster the wait times would be.

 

That would violate the Canada Health Act. It also isn't always clear-cut to the patient whether they are experiencing an emergency. My mother would be dead if she hadn't been convinced to go to the ER for her persistent 'heartburn.' To a low or fixed income person, even a $20 fee might mean they don't seek medical care they desperately need.

[ac84]

fully agree, not like these guys just came here either, half have lived here 15 years, longer than canadian grads who immigrated at 10

 

no one knows about it, that's the issue, ****, why are we taking bribes, essentially, from foreigners who leave, when we could ask you to pay a close to equiv fee (some generalist wannabe from the Caribbean coulda had your seat would have ur seat, ud be in rads or something, owe more, but prob be happier, and make more, making the "bribe transfer" an investment for you)

 

The extra Saudi spots are a good thing in many fields.

 

For example, if there are only going to be 5 ortho openings a year in your city, but your program needs 10 residents a year to keep the service running, wouldn't you prefer if 5 of those residents left the country when they finish residency?

 

Their government pays our government so we can have free labour and keep the pyramid scheme running, its win win!

 

Could those be CMG spots if our governments would pay for them, sure. The people in those extra CMG spots would just contribute to the glut of residents in the perpetual fellowship hamster wheel so they can finally find work close to their dream city.

 

If you aren't into ortho, substitute any ROAD or surgical subspecialty and the same pretty much applies.

[Robin Hood]

I don't deny that natural remedies could help, but the problem with naturopaths is that a lot of their procedures are un/disproven. Also, you can't practice medicine if you don't use pharmaceutical drugs, since they are the most reliable. The naturopath should be able to deal with both, else, his practice will be lacking.

 

read my posts, i could explain to you 30 different nutritional interventions used in psychiatry, target cells, protein they bind too, polymorphism and feedback control, and how to garget that, a lot of nutrients are just drugs that can't be patented. wanna learn about dismutase oxidase, peroxisomes, catecholamine oxidative, methyl transferase and the methyl donor s-adeonysyl methionine, which you give to parkinsons patients after extended treatment because without comt inhibitors the stuff's done, there's feedback regulation on tyrosine kinase as well as oxidative damage and ph disturbances in the mitochondria, releasing iron, which binds the bi functional mapk, rendering it inactive and unable to donate to tyrosine kinase, even if it could, but you have to use nitrogen scavenging antioxidants like melatonin which removes the dinitriteoxidase which binds to tyrosine kinase, rendering it inactive… and meaning taking adhd medication does more harm than good, if ur not sharp or have someone who is… there's some naturopathic biochemistry, i can also talk about the u shaped inhibitory curve of the magnesium that binds to nmda, which prevents downstream calmodulin release, achich activates protein kinase c… more feedback… sure sounds pseudoscientific, just like listening to a rage against the machine song and thinking it's bull**** because it has to many details, lol

[holiday1001]

A few reasons. Here, more than a few big employers (call centres in particular) require a doctor's note for absences, and they require it when you report for your next shift. Say you work the overnight shift, or are missing a shift at 4pm on a Sunday - the ER is the only way to get that note and keep your job. I've been in that position. Alternately, the ER doesn't charge for notes, several walk-in clinics do. If they only have enough money to pay for gas until payday, the $20 fee for the note is more than the pt can afford.

 

Or, the pt feels it is urgent but it is not. Or the clinic felt the pt needed DI and can't wait two weeks for an appointment plus two weeks for the radiologist's report to get back to the clinic doc (which it typically takes, here, if a clinic doctor gives a pt a req.)

 

It also is not uncommon here, with such a shortage of family doctors, for the wait at the ER to be less than the wait at a clinic. There are no clinics open past 6pm as well, and no clinics at all in some towns.

 

Lots of reasons for nonurgent patients to go to the ER.

broke my bone in ottawa, doc there there told me to go the KGH ER to get referred to othopedics in Kingston. she told me to go at 3/4am lol

[apache]

what's pharmaceutical, pretty much patented by a drug company, there's lots of things in the maobi deprenyl fam that are still nutrients because they gotta classify them as pharms "one at a time", lol.

 

I don't deny that natural remedies could help, but the problem with naturopaths is that a lot of their procedures are un/disproven. Also, you can't practice medicine if you don't use pharmaceutical drugs, since they are the most reliable. The naturopath should be able to deal with both, else, his practice will be lacking.

[apache]

maybe we need more country wide planning do we have residency programs where viable to sustain, or under the auspices of a main hosp, with rotation to maintain coverage… all these guys would love to borrow to hand over the saudi payment for the gp, then maybe a fellowship in their former residency back home, i've lived with one who was speaking bout this on parliament hill for last 5 years, tbh, it actually sounds economical to take the more easily blendable wannabe imgs money and fun foreign res training for 5 orthos, overall, strictly financially...

 

The extra Saudi spots are a good thing in many fields.

 

For example, if there are only going to be 5 ortho openings a year in your city, but your program needs 10 residents a year to keep the service running, wouldn't you prefer if 5 of those residents left the country when they finish residency?

 

Their government pays our government so we can have free labour and keep the pyramid scheme running, its win win!

 

Could those be CMG spots if our governments would pay for them, sure. The people in those extra CMG spots would just contribute to the glut of residents in the perpetual fellowship hamster wheel so they can finally find work close to their dream city.

 

If you aren't into ortho, substitute any ROAD or surgical subspecialty and the same pretty much applies.

[Robin Hood]

what's pharmaceutical, pretty much patented by a drug company, there's lots of things in the maobi deprenyl fam that are still nutrients because they gotta classify them as pharms "one at a time", lol.

 

But pharms are still more reliable than naturos. NDs can do like USDOs, deal with both pharms and naturos, if natural stuff can be used, then the ND can use them, if a pharmaceutical is needed, then he prescribes a pharm, that way, the ND will not have an incomplete medical practice.

[lostintime]

OMA is kind of slow in responding eh? Meh, I think it's a lost cause. What can they possibly say or do that can change this? They can just keep going on about how doctors will leave, waiting list will increase (which is true but right now, no one cares)....and doctors can't ethically/morally be bullies like them and screw over patients by going on strike or reducing patient care.

 

And public isn't really going to be that sympathetic. So yeah, it's a done deal. And even if the public care hates Liberals, it's not like they can vote anytime soon.....so yeah.

[apache]

well lots of stuff is classified as pharmaceutical somewhere else, and nothing here, reboxatine is a good snri example. yeah, some docs don't know anything about nutrition, and i have a couple spa seized ones on nutritional pharmacology… you also have to look at geography, what you call a supplement, may be a drug in russia, with lot's of russian peer review, there's a structure built on a niacin base that binds kava kava used as a drug all over slavic europe for anxiety. people think what's in north america is the full repetoir and what's researched exclusively but in reality it's not even close… and thats frustrating! without a good understanding of these issues i argue md's have poor medical practices, you need to know both.

 

But pharms are still more reliable than naturos. NDs can do like USDOs, deal with both pharms and naturos, if natural stuff can be used, then the ND can use them, if a pharmaceutical is needed, then he prescribes a pharm, that way, the ND will not have an incomplete medical practice.

[apache]

lol, i'd seriously love to be a hired gun by the gov at a press conference

 

just shut down every argument defending that million.

 

OMA is kind of slow in responding eh? Meh, I think it's a lost cause. What can they possibly say or do that can change this? They can just keep going on about how doctors will leave, waiting list will increase (which is true but right now, no one cares)....and doctors can't ethically/morally be bullies like them and screw over patients by going on strike or reducing patient care.

 

And public isn't really going to be that sympathetic. So yeah, it's a done deal. And even if the public care hates Liberals, it's not like they can vote anytime soon.....so yeah.

[lostintime]

lol, i'd seriously love to be a hired gun by the gov at a press conference

 

just shut down every argument defending that million.

 

Lol it is pretty easy. I can even recite it by now. "I respect doctors, but that doesn't mean they should make more money. I can't look at a patient in the eye and take money away from home care (yes the ultimate cushion) so that doctors get paid more. No way could I do that."

*glare*

[apache]

nah, i can make those specialties, lose credibility, look like they're using financial influence to limit training spots… profiteering from suffering, using cold numbers to estimate cost to each ontarian over increase in last 20 years for same hours... even know post match img to optho in not somewhere based on nepotism… this sets stage for future cuts.

 

Lol it is pretty easy. I can even recite it by now. "I respect doctors, but that doesn't mean they should make more money. I can't look at a patient in the eye and take money away from home care (yes the ultimate cushion) so that doctors get paid more. No way could I do that."

*glare*

[DeeDoc]

Lol you're a work of art. Who gives a flying duck? You need a doctor at the end of the day. Nomatter how much of a **** that surgeon is if you need your appendix out then you have no choice.

You also don't need the liberal party.

 

The only unfortunate thing is that these new laws will change the way doctors practice and it'll blow up in the faces of people. It's funny I was recently at an OMA event. Heard a funny story about how a while back the government tried to increase OB fees - the Ob guys got together and said they will stick to Gyney stuff because it wasn't even worth practicing OB. It took 4 days before the government retracted their statement. Apparently you need people to deliver babies.

 

Likewise, just heard a story about radiologists refusing to do mammograms in response to ridiculous government attempts at policy.

 

We'll be okay. It all will blow up in the faces of patients unfortunately.

 

aaaaaaand then the government will pick up the pieces... same way they did after they closed/reduced spots at a bunch of medical schools in the early 90s... WOOPS... didn't see that shortage coming.

[aaronjw]

aaaaaaand then the government will pick up the pieces... same way they did after they closed/reduced spots at a bunch of medical schools in the early 90s... WOOPS... didn't see that shortage coming.

 

That had little to do with the issue in the 90's

 

https://secure.cihi.ca/free_products/chanjun02.pdf

[lostintime]

The changes will affect 37 procedures and services, from family care to cardiac care, diagnostic services, eye care and anesthesia. They’ll also eliminate double payments, such as a fee for inserting a cardiac catheter, which is already included in cardiac services.

 

The regulatory changes include slashing payments in half for doctors who “self-refer” — those who refer their patients back to their own practice for diagnostic services like X-rays. The province currently spends $88 million a year on self-referrals, according to ministry officials.

 

The province is cutting fees in half for electrocardiograms to save $21 million, and reducing fees for interpreting results of diagnostic radiology by five per cent to save $30 million.

 

It’s also lowering fees for colonoscopy and gastroscopy, dialysis teams and cataract surgeries. Cataract surgeries, for example, used to take two hours and now take about 15 minutes, officials said.

 

Some of the changes will affect patients, such as delisting joint/spine manipulation services and limiting optical coherence tomography for patients with retinal disease or glaucoma to four times a year.

 

The province is also putting new restrictions on X-rays, CT and MRI scans for those with chronic lower-back pain, as well as vein surgery and sclerotherapy, which is often used to treat varicose veins and hemorrhoids.

 

There is a silver lining: a new $16 fee for doctors who consult with other physicians via email. Consulting doctors get $20.50.

 

http://www.ctv.ca/CTVNews/Health/20120507/ontario-doctors-labour-talks-120507/

 

E-mailing? Great way to save money, let's just e-mail consults instead of actually getting another doctor to see the patient. That's like tele-health, where they basically tell 99.9999% of the people to go to emerg "if they are worried".