One in six newly graduated medical specialists can’t find work

[rmorelan]

I don't personally have a problem paying for such a note if it's reasonable and commiserate with the effort required. $50 as indicated by Dongzhuo is not reasonable nor commiserate with the required effort.

 

There's is plenty money to be made as a FP without such tactics. Averaging 40 patients a day allows roughly 12 mins per patient (should include time for non-direct patient care) for an 8 hour day provides around $360K/yr in gross billings and rakes into account 4 weeks vacation time with 5 day work weeks.

 

Add in some uninsured billings and you could easily be at $400K with a cushy lifestyle and good level of patient care. Thinking you can make more by screwing patients with unreasonable uninsured billings is simply greed. It's physicians like this why I think fees should be cut. As a taxpayer of services I'm happy for you to make a good living, not a greedy living and physicians wonder why there's such demand by Gov't for midlevels.

 

yeah I agree completely - the idea that eventually stuff like that doesn't become public is rather naive and that is exactly the sorts of ammunition they use to demand and extract cuts to the general fees etc. In part that was why they were so successful in simply blocking the last round of fee increases etc I think - increasing doctor's income is a very large sell as it is.

[medigeek]

Bad news for those of just beginning med school. Do they indicate anywhere what fields will still have jobs in the larger centers across Canada?

 

lmao most med students probably wouldnt even care or notice this until into their residency.

[medigeek]

I find that for family medicine the billings really depend on how you approach it. If you do it the "right" way, that is you spend 40 minutes with a patient talking about their mood and how they feel about people at their work you'll make less than a high school principal. However if you approach it with a financial mindset you'll do fantastically well. A guy comes in for a work note. Takes 20 seconds. 35 dollar visit fee and 50 out of pocket. 85 bucks for 20s work!!! 700k billings are not unreasonable in family

 

right... spend 40 mins talking about a patient's work buddies while there's physically sick people sitting in the waiting room. seems like a terrific idea.

 

The average GP doesn't make 300k though. The Average billing of a GP is 200-250 depending on the province. Once you subtract all the expenses you can make more driving a truck in northern Alberta with no education.

 

lol no

[Dongzhuo]

You're full of it.

 

The "right" way? Most people don't need 40 minutes of counselling. And even if they did, bill a counselling code and get paid for the extra work you put in.

 

Don't be an as shole and bill 85 dollars for a sick note. No wonder, you have no respect. In my experience, most people bill the fee code if the person is currently sick (and write the note for free), or bill for the sick note ($15-25) if the person was sick yesterday. If you spend 20 seconds you definitely shouldn't earn 35 dollars for your pretend assessment.

 

How many bad apples does it take to ruin the bunch?

 

First off, I didn't bill anything. Still a resident. These are all staff I'm talking about. Second, in my experience, all office visits are billed as such. Preceptors never say to themselves "hmm looks like I didn't spend enough time with them this visit- guess won't bill anything". Third, one of the most money minded preceptors I've had has 5 minute visits regularly is actually extremely well rated on rateMD. People love him. Yet he billed 600k. Not a bad apple.

[aaronjw]

First off, I didn't bill anything. Still a resident. These are all staff I'm talking about. Second, in my experience, all office visits are billed as such. Preceptors never say to themselves "hmm looks like I didn't spend enough time with them this visit- guess won't bill anything". Third, one of the most money minded preceptors I've had has 5 minute visits regularly is actually extremely well rated on rateMD. People love him. Yet he billed 600k. Not a bad apple.

 

Yeah, qualitative data is a really good measure of physician quality. Perhaps his patients are the type that just want scripts? If he says no because they don't actually need one then people will rate him poorly over just handing out scripts like pez in order to appease.

[bloh]

I don't personally have a problem paying for such a note if it's reasonable and commiserate with the effort required. $50 as indicated by Dongzhuo is not reasonable nor commiserate with the required effort.

 

There's is plenty money to be made as a FP without such tactics. Averaging 40 patients a day allows roughly 12 mins per patient (should include time for non-direct patient care) for an 8 hour day provides around $360K/yr in gross billings and rakes into account 4 weeks vacation time with 5 day work weeks.

 

Add in some uninsured billings and you could easily be at $400K with a cushy lifestyle and good level of patient care. Thinking you can make more by screwing patients with unreasonable uninsured billings is simply greed. It's physicians like this why I think fees should be cut. As a taxpayer of services I'm happy for you to make a good living, not a greedy living and physicians wonder why there's such demand by Gov't for midlevels.

 

Paper math is awesome but it just doesn't work in practice like that. 12min visits x 8 hours is simply unsustainable, not to mention that doesn't even include breaks, long visits, bathroom breaks, continual interruptions from your administrative assistants, calls from the hospital, calls from the pharmacy, calls to and from specialists...etc

 

This is why dongzuo is such a bull****ter. 700k is reasonable? lol. I'd be surprised if he was even a medical student let alone a resident.

[rmorelan]

Paper math is awesome but it just doesn't work in practice like that. 12min visits x 8 hours is simply unsustainable, not to mention that doesn't even include breaks, long visits, bathroom breaks, continual interruptions from your administrative assistants, calls from the hospital, calls from the pharmacy, calls to and from specialists...etc

 

This is why dongzuo is such a bull****ter. 700k is reasonable? lol. I'd be surprised if he was even a medical student let alone a resident.

 

plus there is the entire business admin aspect of the practice - billing, tax planning, staff, supplies, equipment.....

 

On large practices with multiple docs that drops of course due to economy of scale etc but that is still part of the job as it were I guess my point is the physical time with the patient is a large part but certainly not the entire job.

[medigeek]

Yeah, qualitative data is a really good measure of physician quality. Perhaps his patients are the type that just want scripts? If he says no because they don't actually need one then people will rate him poorly over just handing out scripts like pez in order to appease.

 

Don't make random assumptions about someone you don't know at all.

[medigeek]

Paper math is awesome but it just doesn't work in practice like that. 12min visits x 8 hours is simply unsustainable, not to mention that doesn't even include breaks, long visits, bathroom breaks, continual interruptions from your administrative assistants, calls from the hospital, calls from the pharmacy, calls to and from specialists...etc

 

This is why dongzuo is such a bull****ter. 700k is reasonable? lol. I'd be surprised if he was even a medical student let alone a resident.

 

Not everything done is a standard 35$, some appointments will lead to higher billings which offsets the time "lost" in those things you named.

 

Of course, 700k is not reasonable no.

[aaronjw]

Don't make random assumptions about someone you don't know at all.

 

That rich coming from the king of random assumptions.

 

Pot or kettle?

[medigeek]

That rich coming from the king of random assumptions.

 

Pot or kettle?

 

Well your post is speaking contrary to the evidence.

[seeking1]

An interesting evidence-based commentary follow-up to the report by Dr. Ben Chan in the Globe and Mail: http://www.theglobeandmail.com/commentary/if-specialists-cant-find-jobs-the-health-system-needs-radical-surgery/article14885250/

 

An interesting quote: "The problem, however, is that most quality defects are not due to lack of provider skill, but to poorly organized patient flow, poor communication and poor teamwork. One in fifty patients in hospital is harmed unnecessarily due to the care they receive. Best practices – such as ensuring the right drug or test is done at precisely the right time – don’t happen about half of the time."

[donnadee]

i thought communication was supposed to be a big part of "provider skill":confused:

i guess he meant technical only.

[rogerroger]

An interesting evidence-based commentary follow-up to the report by Dr. Ben Chan in the Globe and Mail: http://www.theglobeandmail.com/commentary/if-specialists-cant-find-jobs-the-health-system-needs-radical-surgery/article14885250/

 

An interesting quote: "The problem, however, is that most quality defects are not due to lack of provider skill, but to poorly organized patient flow, poor communication and poor teamwork. One in fifty patients in hospital is harmed unnecessarily due to the care they receive. Best practices – such as ensuring the right drug or test is done at precisely the right time – don’t happen about half of the time."

 

Yup, that quote really should strike a cord. QI, resource management and to an extent safety needs more emphasis as a whole. Maybe as a system we are lacking incentives for innovation in this regards? I cant help but think of the famous Harvard Medical Practice study with the jumbo jet analogy. Basically it noted that the deaths from medical error was the equivalent of a jumbo jet a day crashing. US data but same point... Twenty years since that study and the system still has much it could learn from the aviation industry. The snail like pace of progression to universal EMRs in many hospitals is case in point... Considering the system level management of some non-human resources it should not be surprising that workforce resource management is significant factor impacting care in some regions.

[aaronjw]

An interesting evidence-based commentary follow-up to the report by Dr. Ben Chan in the Globe and Mail: http://www.theglobeandmail.com/commentary/if-specialists-cant-find-jobs-the-health-system-needs-radical-surgery/article14885250/

 

An interesting quote: "The problem, however, is that most quality defects are not due to lack of provider skill, but to poorly organized patient flow, poor communication and poor teamwork. One in fifty patients in hospital is harmed unnecessarily due to the care they receive. Best practices – such as ensuring the right drug or test is done at precisely the right time – don’t happen about half of the time."

 

Of note, anyone who is interested in Chan's original report on the topic of physician supply can read it here: https://secure.cihi.ca/free_products/chanjun02.pdf

 

I read it a few years ago and it, combined with more recent works, does well at dispelling the physician shortage myth