New OMA notice - cuts to fees

[lostintime]

huh and how do you think medical training is conducted?

 

Uh we don't exactly just send out newly med grads out on the "job", i.e. the REAL JOB where they practice independently without training, aka slave labourship aka residency. And we don't abbreviate med school into 2 years worth and get people to learn the rest on their own "on the job".

 

Doctors make sacrifices often in surgical specialties earning a couple bucks above minimum wage as a resident for their training. Specialists endure this for much longer and take a greater hit while their GP friends are doing a real job and making a physician's salary.

[aaronjw]

Uh we don't exactly just send out newly med grads out on the "job", i.e. the REAL JOB where they practice independently without training, aka slave labourship aka residency. And we don't abbreviate med school into 2 years worth and get people to learn the rest on their own "on the job".

 

Doctors make sacrifices often in surgical specialties earning a couple bucks above minimum wage as a resident for their training. Specialists endure this for much longer and take a greater hit while their GP friends are doing a real job and making a physician's salary.

 

Doctors Learn on the job. You can't do what you do without on the job training. Read Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande. He talks about this topic a great deal.

 

Regardless of whether it's perceived as 'slave labour' (which is pretty absurd in context of what slave labour actually is ) you're still getting paid to learn and hone your craft and without it, you (and everyone else) wouldn't be Doctors today.

[bloh]

And it doesn't show arrogance and to make that statement? By analogy, that's just like saying that any nurse can made into a GP if you just train them (which ha, by the way is happening as we speak) enough. And GP's shouldn't be paid 25% more than NP's because they're all the same! And next thing you know, we should let RPN's be paid the same as nurses too after 5 years of training. Why don't we just get rid of all extra training for everybody, why bother. Just learn on the job.

 

Just about everyone in medical school is amazing and yes, just about anyone in the class is able to do well in most any specialty if they cared to. We're talking about the best and brightest students here.

 

What about that statement do you disagree?

[battleford]

When I've discussed overhead costs with most physicians working within a hospital, their overhead costs are pretty much limited only to a secretary - they aren't responsible for purchasing equipment (e.g. ophthalmology machines, radiation oncology machines, etc).

 

This argument is only valid outside of the hospital setting... so where does it actually apply (what specialty invests heavily in equipment but still bills the government - for example, LASIK pays for it's own machines, but bills consumers directly, not the government). Do ECG machines cost THAT much?

 

If I'm wrong, I'd love to hear some examples.

 

You're both right and wrong. Hospital equipment is often purchased by the hospital, but they take a percentage of billings from specialists. So, you may not be buying the equipment, but you are still paying for it.

 

I also think people are unaware of all the machines that are out there in certain specialties. Optho isn't limited to LASIK. Step into a non-LASIK office and you will see many other high-tech machines such as visual fields and OCTs that the docs must pay for. Startup costs for these offices are close to half a million, and they need to pay for it somehow.

[bloh]

You're both right and wrong. Hospital equipment is often purchased by the hospital, but they take a percentage of billings from specialists. So, you may not be buying the equipment, but you are still paying for it.

 

I also think people are unaware of all the machines that are out there in certain specialties. Optho isn't limited to LASIK. Step into a non-LASIK office and you will see many other high-tech machines such as visual fields and OCTs that the docs must pay for. Startup costs for these offices are close to half a million, and they need to pay for it somehow.

 

Let's face it though. Even after those overhead costs are accounted for, these specialists still make obscene amounts of money. Why would students flock to these areas if it was not so?

[lostintime]

Just about everyone in medical school is amazing and yes, just about anyone in the class is able to do well in most any specialty if they cared to. We're talking about the best and brightest students here.

 

What about that statement do you disagree?

 

Actually I disagree, people have strengths and weaknesses, and I would honestly say that there are some specialties I would not be able to handle or at least not do as well as my colleagues and some I would choose another career than do due to not liking them or not feeling I have the skills or desire to perfect the skills for them. And I'm certainly not at the bottom of my class. I've discussed this with many other med students and many people feel the same way. I don't know what level of training, if you're even in medicine or not, but props to your amazingness if you think you have the capability to handle anything in medicine. Most people wouldn't have the guts to say that.

 

Doctors Learn on the job. You can't do what you do without on the job training. Read Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande. He talks about this topic a great deal.

 

Regardless of whether it's perceived as 'slave labour' (which is pretty absurd in context of what slave labour actually is ) you're still getting paid to learn and hone your craft and without it, you (and everyone else) wouldn't be Doctors today.

 

I have no comment if we're going to get all politically correct here or play with semantics. I think you know exactly what I'm talking about with learning on the job and your points really have nothing to do with my previous post that actual structured training is necessary rather than throwing someone independently. Many jobs have a training "phase", but few other jobs "trains" someone for 2-5 years.

 

Anyway, I think some things are really difficult to explain to someone who hasn't actually been through the system, gone through clinical rotations. People will see when they have gone through themselves, no point in wasting my time now.

 

Just reading an article is kind of different than actually going through the system, so I'm just not going to reply to these in the future. But it might be helpful to other premeds who are reading so I'd reply to this one.

[Blake]

Yea... I am not going through 10+ years of neurosurgery residency/PhD/fellowship working 90+ hours per week dealing with the sickest patients out there to make close to average GP salary. But life is not very fair anyway, so I won't complain too much. Just a little.

[Lactic Folly]

Comment not directed to anyone in particular: although it's human nature to profess the importance / necessity / difficulty of one's own field (and this is good in the sense that it helps us to take pride in our work), I would not denigrate any other field of medicine, because heaven forbid you or a family member should ever be in need of their expertise or services..

[Prince Medward]

Ophthalmologists make an absolute (and obscene) killing in BC. They routinely bill over $1,000,000. A retinal specialist I know is always over $2,000,000 in MSP billings alone. He easily nets over $1,000,000 a year after expenses.

 

And that's just MSP. Cataract surgeons make hundreds of thousands ON TOP OF msp bilings by charging patients out of pocket for premium intraocular lenses (MSP only pays for the basics) and retinal guys charge patients out of pocket for injections of premium drugs not covered by MSP.

 

The price gouging on intraocular lenses in BC got so bad that the government has now entered the business of selling the premium lenses directly to patients and cutting out the greedy Ophthalmologists.

 

Ophthalmology is a license to print money and thats what these docs do.

 

Incidentally, I don't think that Ophthalmologists in the USA have it this good. I believe that insurance companies cut their fees a long time ago. It's only the inefficient and incompetent Canadian ministries of health that let this go on for decades.

[NLengr]

Any surgeon that does an open procedure instead of lap, for the sole purpose of billing more, should be shot in the back alley. I think the point of the cut is that it's gotten better and more efficient and should take a cut from the original archaic pricepoint.

 

 

 

"Rarer"...haha I see that you chose your words carefully, but your original intent still comes through.

 

It's only a rarer skill because it's less needed. This pervasive superiority coming from various specialties is what's gotten our system into a problem. Not a single week doesn't go by where a specialists in some shape or form doesn't flame an FP for wrongly referring a patient, diagnosing, treating,.. etc.

 

Any monkey from any medical class across Canada can be taught a "superior MRI reading skill" in 5 years. It doesn't warrant a 25+% salary bump.

 

I already addressed the fact that these surgeries take about 25% more time in my experience. Hence the reason 25% was a good number. They also take a bit more skill

 

If any monkey can be trained to be a specialist in 5 years, than certainly any monkey can be trained to be a GP/FP in 1-2 years. Hell, if we took the current stock of docs, I would wager a good many specialists could make passable GP/FP's with a small amount of retraining, but very few GP/FP's could make passable surgeons with the same amount of training.

[cheech10]

But it's not just the FP vs specialist inequality that is huge, the inter-specialty variation is also large. Why do pediatricians make so much less than cardiologists? Why do endocrinologists make less than gastroenterologists? etc. The training length is the same/similar, and the skill sets are comparably uncommon.

 

Most physicians would probably agree that there are significant, poorly justified differences in remuneration, but are less vocal because agreeing to these cuts may open the door to further cuts across other (potentially their own) specialties.

[apache]

cool, ur lucky… not many people end up doing something they're so super passionate bout… n neurosurg can make life changing probs migigated in, almost instantly… these r non~monetary rewards you can value for life.

 

 

Yea... I am not going through 10+ years of neurosurgery residency/PhD/fellowship working 90+ hours per week dealing with the sickest patients out there to make close to average GP salary. But life is not very fair anyway, so I won't complain too much. Just a little.

[apache]

i was singing the praises of egaleteriasm… sarcastically, haha

 

huh and how do you think medical training is conducted?

[NLengr]

But it's not just the FP vs specialist inequality that is huge, the inter-specialty variation is also large. Why do pediatricians make so much less than cardiologists? Why do endocrinologists make less than gastroenterologists? etc. The training length is the same/similar, and the skill sets are comparably uncommon.

 

Most physicians would probably agree that there are significant, poorly justified differences in remuneration, but are less vocal because agreeing to these cuts may open the door to further cuts across other (potentially their own) specialties.

 

I agree the specialty to specialty remuneration is a bit off.

 

For the record, I'm not surprised the cataract surgery cuts happened. Everyone knew that technology had made these a huge cash cow.

[bloh]

If any monkey can be trained to be a specialist in 5 years, than certainly any monkey can be trained to be a GP/FP in 1-2 years. Hell, if we took the current stock of docs, I would wager a good many specialists could make passable GP/FP's with a small amount of retraining, but very few GP/FP's could make passable surgeons with the same amount of training.

 

I totally agree. So, if we're all just a bunch of monkeys why do specialist monkeys get remunerated by more than 25% simply because they trained for several extra years?

 

 

P.S. I disagree with your last statement. An undifferentiated, young medical student can pass in just about any area. The fact that it's difficult to teach an old dog a practical skill isn't a fair comparison.

[bloh]

Actually I disagree, people have strengths and weaknesses, and I would honestly say that there are some specialties I would not be able to handle or at least not do as well as my colleagues and some I would choose another career than do due to not liking them or not feeling I have the skills or desire to perfect the skills for them. And I'm certainly not at the bottom of my class. I've discussed this with many other med students and many people feel the same way. I don't know what level of training, if you're even in medicine or not, but props to your amazingness if you think you have the capability to handle anything in medicine. Most people wouldn't have the guts to say that.

 

There's a difference in ABILITY of doing something and WANTING to do it. And yeah, I think the vast majority of medical students are ABLE to pass in any specialty, if they were interested. The original notion was that specialists hold some amazing skill that others can't obtain and that's simply untrue.

[NLengr]

There's a difference in ABILITY of doing something and WANTING to do it. And yeah, I think the vast majority of medical students are ABLE to pass in any specialty, if they were interested. The original notion was that specialists hold some amazing skill that others can't obtain and that's simply untrue.

 

It's not that others can't obtain a specialist skill set, it's that they don't have a specialist skill set. They are welcome to go back and obtain the training required to join that specialty if they want the benifits of being that type of specialist.

 

If you want the benefits of being an office based GP, then you need to accept the fact that you take a pay cut to gain those benifits.

 

And as I said before, you could take a mid career specialist surgeon and with a few months of retraining mold them into a passable family doc. You couldn't take a mid career Family Doc and make them a passable surgeon in a few months. That was my previous point, not that a fresh med school grad starting family couldn't be a surgeon if they did the training.

[Der Kaiser]

 

This cutting of fees is the tip of the iceberg. Specialists will still make a lot of money, and FP will get hit considerably harder. FPs will cry about it, specialists will scorn the inferior FPs for piping up, and FP will once again become the least popular specialty. The government will fast track FMG doctors into Canada to fill the need.

 

So far FP have been barely hit. 1$ cut from A007 (intermediate assessment) fee code (34.70 to 33.70) and for FHNs and FOHs (blended capitation models) some procedures are inside the basket. It is the specialties like rads, cardiology, and ophto that have been hit the hardest. This is not slash and burn like Harris did it. That said, more cuts are coming next year and this may be part of the liberal's divide and conquer strategy. This year the FPs won't make a fuss 'cause they are not affected, and next year the specialties won't make a fuss 'cause no one supported them the first time around.

[Blake]

In my opinion they should have cut it by 50%.

Not sure if that's the right answer, but I agree that a 5% cut is not going to affect them very much.

 

I can already picture Mcguinty and his gang watching this topic and laughing their way to the bank. Divide and conquer does work well!

[lostintime]

Not sure if that's the right answer, but I agree that a 5% cut is not going to affect them very much.

 

I can already picture Mcguinty and his gang watching this topic and laughing their way to the bank. Divide and conquer does work well!

 

Oh yeah, it's a smart strategy. No matter how much I find them as crooks, I have to admit that they are extremely intelligent people who know how to keep the money in their own pockets while trying to make themselves look good. I can definitely never be such a well-trained politician haha, whether from morals or scheming capability, good job to them. And yeah it's working beautifully, turning everyone against each other always works at times of unrest.

 

That's why all the OMA communications emphasize that doctors should try to come together to support each other. I think it's a beautiful strategy not to hit GP's the first round of cuts. Target specialists that people already think are making too much to soften the blow. By the time they're done in phases, no one will be talking.

[lostintime]

There's a difference in ABILITY of doing something and WANTING to do it. And yeah, I think the vast majority of medical students are ABLE to pass in any specialty, if they were interested. The original notion was that specialists hold some amazing skill that others can't obtain and that's simply untrue.

 

Even if anyone MAY technically pass the Royal College exam for a specialty (which is even a stretch imo) after equal training, how well they can do the job well or not is relative. If I'm getting my hands reconstructed or having someone operate on my heart, I would for sure want someone who was one of the best, not just anyone. And I'm pretty sure not everyone in med school can be that person. And this doesn't just go for surgical specialties, but any specialized skill.

[bloh]

Even if anyone MAY technically pass the Royal College exam for a specialty (which is even a stretch imo) after equal training, how well they can do the job well or not is relative. If I'm getting my hands reconstructed or having someone operate on my heart, I would for sure want someone who was one of the best, not just anyone. And I'm pretty sure not everyone in med school can be that person. And this doesn't just go for surgical specialties, but any specialized skill.

 

Yeah...because only the brightest go for Royal college residencies and the college gets the scraps

[Lactic Folly]

Yeah...because only the brightest go for Royal college residencies and the college gets the scraps

 

I'm not sure that was what was implied. There are certainly medical students who would likewise do less well in family medicine than another field of medicine. If all medical students had equal aptitude for all fields of medicine, there would be no need for programs to solicit letters of reference speaking specifically to a student's suitability for that field of medicine.

[medigeek]

Does 3 extra years of training really warrant a bump in salary in more then 25%?

 

I don' t think it should and unfortunately it's even more than 25%.

 

How many of these specialists actually make like 600k a year? Let's say a family doctor can see tons of patients a day and makes ~400k/year. That family doctor could do this while working a lot less hours than the cardiologist. Then factor in overhead and the difference isn't so great.

[lostintime]

I'm not sure that was what was implied. There are certainly medical students who would likewise do less well in family medicine than another field of medicine. If all medical students had equal aptitude for all fields of medicine, there would be no need for programs to solicit letters of reference speaking specifically to a student's suitability for that field of medicine.

 

Thank you for the clarification.