New OMA notice - cuts to fees

[futureGP]

this may lead to some debate but i'm gonna throw it out there.

 

 

i think there is some legitimacy in cutting fees to radiologists, cardiologists, ophthalmologists -- probably the three richest doctors easily earning high 6 figures to 7 figures.

 

But a problem rises when due to these cuts, these specialists leave the province to move to somewhere else the fees aren't cut yet.

 

even still, it leads me to think that when cuts are made to specialists (the ones above) and those cuts are used to decrease incentives to go into specialties, increase fees/incentives to primary care physicians, it might actually be beneficial for the public (if it indeed leads to increase in family doctors/psych etc)?

[apache]

nah, i talked about boosting the need for primary care and generalists, and providing them more billing options to adress patient concerns, patient education, gen surgs deserve every penny. i'm not really partisan, libs, ndp, cons, so that's a non-issue, the golden pastures of the states are going dry now

 

ultimately if Ontario get's knee deep enough, financial interests and intimidation will polarize opinions if docs pull **** like that, remember, you're a government employee, and the government works for the banks, galvanize some potentially pissed off teachers funds, continual infrastructure deficits, these tricks work short term, but when banks call in the decade of red, there's no mistake who'll be dishing out the orders, plus corruption charges and nepotism are easy to create out of nowhere, you think being a gynaecologist means something, but if finaces get deep enough, you'll see a lot more clinician assistances (not pa's, ca's doing the same job for 125 k… and they realistically function at a par to above par, (i know a few) level) couple years, its the new social zeitgeist and norm, 50 years ago public health care was heresy for docs, remember? lot's of prvinces just need you to have letter from foreign institution that you did fm res there and u get a residency… some do, some pay big for fakes.

 

plus, as an essential service working for gov, your rights are limited, and banks can **** with provincial colleges too, lot's of blackmail, maybe expose that imbezling so a prominent person speaks in favor of cuts… this stuff happens, lol, lot dirtier world than you think.

[apache]

with ontario's booming industrial sector, well least half of rim's emplyees are there, thats good,lol, teachs moving forward… indeed, indeed

 

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.

[lostintime]

I don't think we should be focusing on just optho, rads, and cardio. That's what Deb Matthews wants you to focus on. I have an issue with the whole imaging for chronic back pain. Who the hell is she to dictate what doctors should and shouldn't order? If this came from someone medical, sure. But from someone who probably can't tell apart lumbar vs. thoracic spine, it's very insulting. The self-referral thing is also ridiculous. Why wouldn't you refer your patients back to see you after ordering a test? Why in the world would you e-mail someone advice about a patient? It shows blatant lack of understanding of how healthcare works to begin with.

[apache]

maybe self regulation needs to be tossed, but so should this woman with no health background there's lot of highly educated people, who are non physicians, but very knowledgable about various processes (technicians, nurse practitioners, psychologists, pharm d's genetic counsellors, nurses, physician managers, public health physicians who make their work non-clinically, who can review any conflicts of interest.

 

I don't think we should be focusing on just optho, rads, and cardio. That's what Deb Matthews wants you to focus on. I have an issue with the whole imaging for chronic back pain. Who the hell is she to dictate what doctors should and shouldn't order? If this came from someone medical, sure. But from someone who probably can't tell apart lumbar vs. thoracic spine, it's very insulting. The self-referral thing is also ridiculous. Why wouldn't you refer your patients back to see you after ordering a test? Why in the world would you e-mail someone advice about a patient? It shows blatant lack of understanding of how healthcare works to begin with.

[apache]

ur competing with alberta, seriously… lol

 

Not that I disagree because I hate that prick with an absolute passion (next being Harper) but who do you suggest?

 

All the Ontario leaders are absolute trolling idiots with NO serious plan for Ontario. Sad that this is the best that we have.

[A Second Daniel]

I don't think we should be focusing on just optho, rads, and cardio. That's what Deb Matthews wants you to focus on. I have an issue with the whole imaging for chronic back pain. Who the hell is she to dictate what doctors should and shouldn't order? If this came from someone medical, sure. But from someone who probably can't tell apart lumbar vs. thoracic spine, it's very insulting. The self-referral thing is also ridiculous. Why wouldn't you refer your patients back to see you after ordering a test? Why in the world would you e-mail someone advice about a patient? It shows blatant lack of understanding of how healthcare works to begin with.

 

Obviously she's not a lone actor - policies are developed in conjunction with health care bureaucrats in an attempt to reduce the province's financial burden because we were (are?) headed towards becoming Greece. Of course, this is also political in nature. The traditional dominance of liberals in government bureaucracies also means that these cuts, although necessary, were the absolute minimum that had to be done. You should be lucky more cuts weren't made. Whining goes unwarranted at this stage.

 

Bottom line: If you want the government to protect you with a blank cheque, then it's time to come back down to planet Earth.

[lostintime]

Obviously she's not a lone actor - policies are developed in conjunction with health care bureaucrats in an attempt to reduce the province's financial burden because we were (are?) headed towards becoming Greece. Of course, this is also political in nature. The traditional dominance of liberals in government bureaucracies also means that these cuts, although necessary, were the absolute minimum that had to be done. You should be lucky more cuts weren't made. Whining goes unwarranted at this stage.

 

Bottom line: If you want the government to protect you with a blank cheque, then it's time to come back down to planet Earth.

 

Lol after you've actually gotten in and maybe gone through some of med school, we can talk again about how you feel about all this and what planet Earth entails for you.

[apache]

have fun with hired political guns, no one is untouchable, certain not a useless doctor, there's forums in pakistan that know who prefers pakistani's for neuro fellows (continual fellowships, no license, but 80 g is good for essentially an attending, who's odd's we're 1 in a 1000 and had to know the pharmacological mode of action, and every ounce of the human body, micro to macro, no matter how irrelevant) no one cares how you feel seriously, there's lots of people with your skill set, sure, we'll play captain canada now, whil we have money… but if things go bad, there's lots of surgeons, a quarter, extremely elite, driving taxi's, whole do gen surg for 120 a year… you'd think the second highest payed physicians in the world would be more thankful, especially when standards here are laughable… other countries might not have certain technology, but they can diagnose disease, without wasting a g on a test we've been trained to rely on…

 

Lol after you've actually gotten in and maybe gone through some of med school, we can talk again about how you feel about all this and what planet Earth entails for you.

[A Second Daniel]

Lol after you've actually gotten in and maybe gone through some of med school, we can talk again about how you feel about all this and what planet Earth entails for you.

 

Planet earth is entirely about managing a limited set of resources the best possible way and one does not need to be in medical school to know that. If you're willing to offer meaningful input, I'm all ears. Otherwise, leave the condescension at the door.

[lostintime]

Planet earth is entirely about managing a limited set of resources the best possible way and one does not need to be in medical school to know that. If you're willing to offer meaningful input, I'm all ears. Otherwise, leave the condescension at the door.

 

And I don't need to be a politician to know that the management of resources by the current provincial government has been less than stellar. Make sure you carry this attitude onto the wards (if you ever get there), it'll serve you well.

[apache]

i love the clandesteine creation of enigma, so you avoid explaining the waste of resources, is it the government, or is it the government not paying enough attention to the docs, maybe inappropriate flow of information, being on the wards you see things, influenced by a priori beliefs… in the end, these problems are great in scale, requiring a dynamic systems approach, not a reformer of a nation, that has never left the neighbourhood. to op… do something private practice, get out of the hospital, fast, maybe residency should 7 years, so er docs don't always have to rely on rads… lol, now im being a bit bad!

 

p.s. op, it easy, don't worry, you'll be good!

 

And I don't need to be a politician to know that the management of resources by the current provincial government has been less than stellar. Make sure you carry this attitude onto the wards (if you ever get there), it'll serve you well.

[lostintime]

You can keep quoting my posts lol, but thought I would let you know I don't really respond to posts that are jumbles of text that don't really make any sense. And I should probably stop responding to know-it-all's as well who think they can just go around preaching to everyone about what they think "reality" is. I'm just stating a fact, carrying that type of attitude doesn't carry anyone all that far in life, especially on the wards (although it happens to help in politics if anyone is looking). But hey, people will likely continue doing what they want so meh.

 

Back to the original topic, I wish someone would actually list all the 37 procedures. It's kind of pointless when people argue and argue but the most I've seen listed is like 7 in a news article.

[lostintime]

Found it ! https://www.oma.org/Member/Resources/Documents/OHIPChangesSummary.pdf

[aaronjw]

Found it ! https://www.oma.org/Member/Resources/Documents/OHIPChangesSummary.pdf

 

I'm not an OMA member.

[lostintime]

Hmm, sorry, couldn't find another resource. It wasn't as helpful, just states total costs in millions, but I wanted to know the actual fee to give an idea of how it would affect a single physician. And taking a quick glance, ophtho, cardio, and radiology are DEFINITELY not the only people affected.

[The Journey Man]

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

 

Sorry dude, didnt want to put you on blast, but you states a lot of nonsense right now. Lets take aside there aren't any randomized placebo controlled trials showing any of this. Lets take aside that you couldn't tell any of this in a real clinical patient, lets just state basic science for now.

 

Also lets take aside that these nutritional therapies have to find there way through our acidic stomach and be able to be absorbed by our natural gut transporters, get into the blood stream, diffuse/transport into tissue and actually have cellular function. Lets put that aside.

 

1. In the first sentence, you just state some enzymes, an organelle, then an enzyme that doesn't exist or you misspelled. catecholamine oxidative what? catecholamine oxidate products, or are you referring to an oxidase enzyme? I believe by "dismutase oxidase", you're referring to superoxide dismutase? I cant find the latter two on a google search.

 

There is a lot of jargon you've noted, and doesnt make any biochemical sense because its not quite specific. You aren't describing a coherent biochemical pathway, you're just stating random enzymes. What specific tyrosine kinase are you talking about? Thats a general term for a number of different kinds and yet you've linked it to parkinsons? I'd like to see at the very least some basic science papers concluding this.

 

How do you know there is oxidative damage? What iron stores - in the brain? Because they exist within the bone marrow and liver parenchyma.

 

2. As far as I know melatonin is a hormone, thus with specific receptor. What evidence is there melatonin to be a "nitrogen scavenger", and to that effect why is that a bad thing to have nitrogen within a cell? Excess nitrogen within the blood stream perhaps we can have discussion.

 

3. I tried googling dinitriteoxidase because i have never heard/seen such an enzyme name before, i cant find any hits. Please link to a legitimate scientific paper with this name in it.

 

4. Mg is regulated within the interstitial space as far as I'm aware quite tightly by a variety of glial cells within the CNS. How would giving exogenous Mg effect NMDA receptors as you suggest? There is no question endogenous Mg interacts with these receptors, but exogenous is my question.

 

5. Which ADHD medications are you referring to? Ritalin? Have you actually seen ADHD patients? It works fantastic for these subset of patients and allows them to have function within their school environment. Perhaps there is "over diagnosis" of ADHD within the society and pushing Ritalin at patients who don't need likely occurs. But for REAL ADHD patients, its enormously helpful and enormous amount of literature supporting that conclusion.

 

All in all looking at this from a far, this sounds like a classic technique of investing into incredible detail to try to defend a position they believe in - because most people will not have heard of such detail - when on closer inspection doesn't seem to make any sense. This is a tactic often used by chiropractors I've been around, but didn't know this would be done by Naturopaths as well.

 

As far as your analogy to Rage Against the Machine, I don't know all their lyrics or songs, but the general theme can be supported by vast number of studies conducted by US and International organizations and declassified records from previous administrations of the US government. Plus a vast amount of academic literature often occurring outside of the US. The difference is that Naturopathic jargon doesn't have the vast, accessible and credible sources of literature that one can verify facts from.

 

Perhaps it does all make sense but you made a number of typing, thinking and posting errors in trying to explain all this detail. I hope a reply can address some of the concerns stated, hopefully in a civil way.

[A-Stark]

You can keep quoting my posts lol, but thought I would let you know I don't really respond to posts that are jumbles of text that don't really make any sense. And I should probably stop responding to know-it-all's ( as well who think they can just go around preaching to everyone about what they think "reality" is. I'm just stating a fact, carrying that type of attitude doesn't carry anyone all that far in life, especially on the wards (although it happens to help in politics if anyone is looking). But hey, people will likely continue doing what they want so meh.

 

Thank you. On both counts. Nothing like a premed who scored 1 of 5 interviews to come 'round and tell you how it is.

 

And @muse: Can you PLEASE stop the "intellectual" scarcely comprehensible stream-of-consciousness posts?

 

By the way, we rely on "rads" because physical findings are often non-specific and, in any case, getting an ultrasound is cheaper and safer than going to the OR based on "presumed" cholecystitis. We work with good differentials not certainties, but when definitive choices must be made, the unnecessary invasive procedure must be avoided.

 

Back to the original topic, I wish someone would actually list all the 37 procedures. It's kind of pointless when people argue and argue but the most I've seen listed is like 7 in a news article.

 

Agreed. I'm not in the OMA either - any chance you could copy-paste them?

 

One poorly-explained cut that really annoys me is this:

"As well, doctors will perform fewer ultrasounds and echocardiograms before routine non-cardiac surgery."

 

Meaning what? The government will decide who should get U/S (what kind???) or echos pre-operatively? What's "routine" surgery? Which patient populations does this apply to?

[NLengr]

Thank you. On both counts. Nothing like a premed who scored 1 of 5 interviews to come 'round and tell you how it is.

 

And @muse: Can you PLEASE stop the "intellectual" scarcely comprehensible stream-of-consciousness posts?

 

By the way, we rely on "rads" because physical findings are often non-specific and, in any case, getting an ultrasound is cheaper and safer than going to the OR based on "presumed" cholecystitis. We work with good differentials not certainties, but when definitive choices must be made, the unnecessary invasive procedure must be avoided.

 

 

 

Agreed. I'm not in the OMA either - any chance you could copy-paste them?

 

One poorly-explained cut that really annoys me is this:

"As well, doctors will perform fewer ultrasounds and echocardiograms before routine non-cardiac surgery."

 

Meaning what? The government will decide who should get U/S (what kind???) or echos pre-operatively? What's "routine" surgery? Which patient populations does this apply to?

 

Muse's non-structured, barely cohesive rants are incredibly annoying. Is there any way we can get them removed? They are incomprehensible. It reminds me of trying to read the writings of the psych patients I saw when I was a clerk.

 

I will keep ordering pre-op EKG's on my patients over 40 until the department of anesthesia (you know, the ones who have to keep they guy alive while us surgeons haul out the patients guts) tells me not to.

[Robin Hood]

Muse's non-structured, barely cohesive rants are incredibly annoying. Is there any way we can get them removed? They are incomprehensible. It reminds me of trying to read the writings of the psych patients I saw when I was a clerk.

 

I will keep ordering pre-op EKG's on my patients over 40 until the department of anesthesia (you know, the ones who have to keep they guy alive while us surgeons haul out the patients guts) tells me not to.

 

Many people with ADHD write like muse87.

[apache]

sorry, i have to delete this, i can't make this stuff public, the wards are fun times for office politics, try dealng with real thing, and an organized stack of papers nearing 500 thick, plus the other 400 interactions, with around 12 violations, or seeing copies of files, that make you ashamed of your industry, and the wolves we allow, to watch sheep, sometimes patients get screwed, but so do phyisicians, i've lived more lives than you ever hand, and you know i like to tell, but this stuff is so awful, it's not the time for mention.

 

 

You can keep quoting my posts lol, but thought I would let you know I don't really respond to posts that are jumbles of text that don't really make any sense. And I should probably stop responding to know-it-all's as well who think they can just go around preaching to everyone about what they think "reality" is. I'm just stating a fact, carrying that type of attitude doesn't carry anyone all that far in life, especially on the wards (although it happens to help in politics if anyone is looking). But hey, people will likely continue doing what they want so meh.

 

Back to the original topic, I wish someone would actually list all the 37 procedures. It's kind of pointless when people argue and argue but the most I've seen listed is like 7 in a news article.

[apache]

block me, it stems from ginsbergh, it's like talking, and less formal, but if you'd like neat paragraphs, i'd be glad to make me experiences more clear, cheers.

 

if the psych patient thing is supposed to be an insult, then please grow up, lot's of people go through great difficulties, or are never given oppurtunities, sometimes Iim thankful for my family, do you really thing your not a dice role away from switching positions?

 

on an aside, there's only so much you can do as a single clinician, i admire your work, but it's not more valuable than others contributions, a pen can change the lives of millions.

 

Muse's non-structured, barely cohesive rants are incredibly annoying. Is there any way we can get them removed? They are incomprehensible. It reminds me of trying to read the writings of the psych patients I saw when I was a clerk.

 

I will keep ordering pre-op EKG's on my patients over 40 until the department of anesthesia (you know, the ones who have to keep they guy alive while us surgeons haul out the patients guts) tells me not to.

[Mourning Cloak]

but if you'd like neat paragraphs, i'd be glad to make me experiences more clear, cheers.

 

That's be great, thanks.

 

 

I will keep ordering pre-op EKG's on my patients over 40 until the department of anesthesia (you know, the ones who have to keep they guy alive while us surgeons haul out the patients guts) tells me not to.

 

There is a lot of waste in imaging, to be sure, but there's a lot more (I'd bet) in lab testing. Patients walk in with a shopping list - oh, I'd like to have my ANA panel done, please, no I don't have any symptoms, but my friend from tennis had hers done and now I'm curious - and the family doc is too tired to argue with them. He just orders it. Cha-ching.

 

We don't let people get MRIs because they're "curious" (I hope). But we'll order a TSH because they want to be reassured they're not hypothyroid even though they're completely asymptomic (asides from the crazy), or vWD workup even though there's no family or personal bleeding history.

[lostintime]

Here's the list of 37 on another article.

http://www.ottawacitizen.com/Ontario+seeks+save+338M+cutting+fees+medical+procedures/6578315/story.html

 

I like today's Globe article: http://www.theglobeandmail.com/news/politics/mcguinty-sends-message-by-forcing-lower-fees-on-ontario-doctors/article2424865/comments/

 

I do think there is waste, but that should be a decision made by medical professionals, not the wasteful Liberal government (Actually most governments are pretty crappy, but they really take the cake this time). If they went to seek expert opinion from physicians, they should reference them. I'm willing to bet they didn't. "Let's see which number is high--- slash slash slash".

[mavrik13]

The more I think about it, the more I agree with the principles of cutting fee for service reimbursement for these specialties. I don't think it is right for radiologists, cardiologists and ophthalmologists to be billing in excess of 650k each year (on average), especially considering that the first two generally rely exclusively on hospital resources and don't have high overhead costs. Ophthalmologists in hospital settings have a lower overhead cost than those in private practice (e.g. Lasik).

 

I don't think there should be more than a 25% difference in the payscale of physicians (e.g. family medicine vs. ophthalmology) if they are working equivalent hours and taking overhead costs into account. In the current system, the difference is clearly much, much greater than that.