Doctors Urged To Set Timers To 5 Minutes?

[bruhh]

What are your thoughts?

 

 

http://www.ctvnews.ca/health/ontario-doctors-urged-to-set-timers-to-5-minutes-in-protest-over-pay-1.2247428

 

EDIT: i just realized the doctor still looks after the patients after the 5 minute mark so I'm relieved.

[武田信玄]

Finally the Canadian doctors are ballz enough to stand up for their rights!

[thsc]

I think this is actually a pretty good idea. What else can he do without compromising patient care to voice his frustration?

 

Does the government really think that cutting physician's wages is the way to control our ever increasing health care costs? This idiocy of the idea makes me sick! 

[ralk]

This is a temper-tantrum, nothing more - a childish response to an adult problem.

 

I'm not overly happy with the Ontario government's unilateral actions, but reading through the text of the funding changes, their effect on actual patient care is fairly minimal, despite the rhetoric of the OMA and groups like DoctorsOntario - the group run by the physician mentioned in the article. There are a few instances where incentives have changed and even well-intentioned physicians will respond to those, but the majority of changes are simply going to reduce physicians' salaries. The only way patient care gets hurt in that case is if physicians go out of their way to reduce their standards in treating patients, such as pulling stunts like this.

 

I think this is actually a pretty good idea. What else can he do without compromising patient care to voice his frustration?

 

Does the government really think that cutting physician's wages is the way to control our ever increasing health care costs? This idiocy of the idea makes me sick! 

 

We certainly can't endlessly cut physician salaries without seeing some negative consequences, but right now it's a viable option. There's an overabundance of qualified candidates looking to become physicians, physician salary has risen much faster than inflation or average wage growth over the past two decades, and even after accounting for time and money lost to training, physicians are among the wealthiest professions.

 

There's only two ways to reducing or slow spending on health care - reduce the amount of services provided or reduce the amount each service costs. Physician salaries are only part of why services cost what they do, but they're not an insignificant part either. There are more intelligent solutions to reduce the cost of physicians while minimally impacting, maintaining, or even improving patient care than the ones imposed by the Ontario government, and those should absolutely be discussed. Yet, the OMA wasn't exactly proposing a better solution - they were arguing for the status quo. That's not an approach that will keep health care costs sustainable and, as we've now seen, it's not a great way to maintain fair physician compensation either.

[A-Stark]

Seems pretty unprofessional. 

[rmorelan]

This is a temper-tantrum, nothing more - a childish response to an adult problem.

 

I'm not overly happy with the Ontario government's unilateral actions, but reading through the text of the funding changes, their effect on actual patient care is fairly minimal, despite the rhetoric of the OMA and groups like DoctorsOntario - the group run by the physician mentioned in the article. There are a few instances where incentives have changed and even well-intentioned physicians will respond to those, but the majority of changes are simply going to reduce physicians' salaries. The only way patient care gets hurt in that case is if physicians go out of their way to reduce their standards in treating patients, such as pulling stunts like this.

 

 

We certainly can't endlessly cut physician salaries without seeing some negative consequences, but right now it's a viable option. There's an overabundance of qualified candidates looking to become physicians, physician salary has risen much faster than inflation or average wage growth over the past two decades, and even after accounting for time and money lost to training, physicians are among the wealthiest professions.

 

There's only two ways to reducing or slow spending on health care - reduce the amount of services provided or reduce the amount each service costs. Physician salaries are only part of why services cost what they do, but they're not an insignificant part either. There are more intelligent solutions to reduce the cost of physicians while minimally impacting, maintaining, or even improving patient care than the ones imposed by the Ontario government, and those should absolutely be discussed. Yet, the OMA wasn't exactly proposing a better solution - they were arguing for the status quo. That's not an approach that will keep health care costs sustainable and, as we've now seen, it's not a great way to maintain fair physician compensation either.

 

we should have taken a more leadership role on this a long time ago - now we are the point where we have rising health care costs for a variety of reasons (medicine is simply more costly as we develop better and better treatments, and the population is aging to name two of them). Now we are at crunch time and no one developed a plan over the past 15 years to avoid anything. All steps at this point are reactionary.

 

One minor point - I really hate the term salary for doctors unless it truly an employee/employer relationship which is comparatively rare. Doctor business income have rose over the past decade but that is a combination of incentives given by the government, and increased work flow (ie there is simply more to do in a day) and yes fee increases.  The fact the latter has happened is not appreciated when we are taking just about "salary" It also doesn't factor in the issue since the cuts are NOT to salary they actually are worse than they sound - there are fixed costs here to a practise that cannot be avoided, so if you cut revenue down you actually reduce net profit more (or a say 10% cut in revenue for a standard family practise is more like a 15% reduction in actual end income). 

 

and yes fees can be cut without immediate effects but (hard for doctors to really get good PR on that currently - another issue the OMA has to deal with). By the time this round is done we will be at 5 years of cuts/freezes - at some point it does stop being fair (it is simply easier for the government to cut these fees rather than salary nursing wages. The flip side of that is they simply lay off the nurses instead, along with all the rest of the allied health care workers that has been happening). Particularly when there is no actual plan in place even now to deal with what is about to happen next. Usage of the health care system still is rising faster than inflation/tax revenue etc. Maybe we need to start talking about that(?) 

 

Interestingly we are now seeing groups within the OMA starting to react independently - the cardiologists spring to mind and have started their own efforts outside of the OMA. This is about to get really interesting.

[thsc]

This is a temper-tantrum, nothing more - a childish response to an adult problem.

 

I'm not overly happy with the Ontario government's unilateral actions, but reading through the text of the funding changes, their effect on actual patient care is fairly minimal, despite the rhetoric of the OMA and groups like DoctorsOntario - the group run by the physician mentioned in the article. There are a few instances where incentives have changed and even well-intentioned physicians will respond to those, but the majority of changes are simply going to reduce physicians' salaries. The only way patient care gets hurt in that case is if physicians go out of their way to reduce their standards in treating patients, such as pulling stunts like this.

 

 

We certainly can't endlessly cut physician salaries without seeing some negative consequences, but right now it's a viable option. There's an overabundance of qualified candidates looking to become physicians, physician salary has risen much faster than inflation or average wage growth over the past two decades, and even after accounting for time and money lost to training, physicians are among the wealthiest professions.

 

There's only two ways to reducing or slow spending on health care - reduce the amount of services provided or reduce the amount each service costs. Physician salaries are only part of why services cost what they do, but they're not an insignificant part either. There are more intelligent solutions to reduce the cost of physicians while minimally impacting, maintaining, or even improving patient care than the ones imposed by the Ontario government, and those should absolutely be discussed. Yet, the OMA wasn't exactly proposing a better solution - they were arguing for the status quo. That's not an approach that will keep health care costs sustainable and, as we've now seen, it's not a great way to maintain fair physician compensation either.

I'm curious to know what alternative solutions you have in mind for reducing costs. I can think of several but nothing that we would see take effect anytime soon. 

[aaronjw]

Myth: The aging population is to blame for uncontrollable healthcare costs

 

http://www.cfhi-fcass.ca/SearchResultsNews/2011/02/22/f20f6cb8-bfd0-453e-b470-6fb63c93a629.aspx

 

[ralk]

we should have taken a more leadership role on this a long time ago - now we are the point where we have rising health care costs for a variety of reasons (medicine is simply more costly as we develop better and better treatments, and the population is aging to name two of them). Now we are at crunch time and no one developed a plan over the past 15 years to avoid anything. All steps at this point are reactionary.

 

One minor point - I really hate the term salary for doctors unless it truly an employee/employer relationship which is comparatively rare. Doctor business income have rose over the past decade but that is a combination of incentives given by the government, and increased work flow (ie there is simply more to do in a day) and yes fee increases.  The fact the latter has happened is not appreciated when we are taking just about "salary" It also doesn't factor in the issue since the cuts are NOT to salary they actually are worse than they sound - there are fixed costs here to a practise that cannot be avoided, so if you cut revenue down you actually reduce net profit more (or a say 10% cut in revenue for a standard family practise is more like a 15% reduction in actual end income). 

 

and yes fees can be cut without immediate effects but (hard for doctors to really get good PR on that currently - another issue the OMA has to deal with). By the time this round is done we will be at 5 years of cuts/freezes - at some point it does stop being fair (it is simply easier for the government to cut these fees rather than salary nursing wages. The flip side of that is they simply lay off the nurses instead, along with all the rest of the allied health care workers that has been happening). Particularly when there is no actual plan in place even now to deal with what is about to happen next. Usage of the health care system still is rising faster than inflation/tax revenue etc. Maybe we need to start talking about that(?) 

 

Interestingly we are now seeing groups within the OMA starting to react independently - the cardiologists spring to mind and have started their own efforts outside of the OMA. This is about to get really interesting.

Absolutely agree about using the term salary - it's not the right word and I shouldn't have used it.

 

For fairness of compensation, there has been a short run of freezes or cuts, but these came after a series of rather large increases. Whether these cuts are fair or not depends on what you consider the baseline to be, which naturally involves a bit of cherrypicking of data. If you measure from 2010, these cuts are ridiiculous. If you measure from 1995, they're fairly reasonable. Then again, if you measure from 1980, the interpretation will be different again. No simple answers on this one.

[ralk]

I'm curious to know what alternative solutions you have in mind for reducing costs. I can think of several but nothing that we would see take effect anytime soon. 

 

Well, that's a pretty huge discussion if you include all elements to health care.

 

When it comes to specific items that could be negotiated between the Ontario government and the OMA, I think there are certainly some services that are overcompensated and some specialties with unreasonably high overall compensation. These would be places to start. I think the OMA is aware of these disparities, but they'd get plenty of blowback if they were to try to benefit some physicians over others. Yet, by trying to hold the line for all physicians and all services, they got a result that hit all specialties' bottom lines, not just the ones who could more easily handle a cut in compensation.

 

Also, there's not a huge need for immediate short-term cuts in health care spending. Yes, there's a budget deficit, but financing it is very easy right now and, with Canada's continuing economic weakness, that deficit might be doing as much good as harm. Longer-term spending growth is the main concern, so longer-term solutions to spending are probably the way to go. Cutting physician salaries aren't a long-term solution, but ever-increasing physician salaries and numbers can be a long-term problem. With a massive increase in the number of new medical students over the past decade or so, many of which are just now starting to practice, a cut in income was somewhat necessary to prevent a big jump in overall physician compensation. Having more doctors around but having each work for less money makes some sense from both an economic point of view and a patient-care perspective. Again, I feel the Ontario government's proposals to be too heavy-handed and not discriminating enough between productive and unproductive areas of compensation, but the overall approach does have a certain logic to it.

[Tacrolimus]

Considering a family doctor has never spent more than 5 minutes with me, I don't think this strategy is as alarming it is intended to be... no pun intended. (I've just had awful experiences... I should probably stop going to Medi-clinics) In all seriousness, that is not the right approach. Show your worth and importance by providing meaningful and positive outcomes for the patient. The most annoying thing is when you go to medi-clinics and you see "please only talk about 2 concerns at this visit". Personally, I've never had 2 concerns at the same time, but umm, is that even ethical? I realize you probably can't manage multiple concerns and you have to prioritize, but I think you should still listen just in case the patient doesn't understand what is important and what isn't. 

[rmorelan]

Absolutely agree about using the term salary - it's not the right word and I shouldn't have used it.

 

For fairness of compensation, there has been a short run of freezes or cuts, but these came after a series of rather large increases. Whether these cuts are fair or not depends on what you consider the baseline to be, which naturally involves a bit of cherrypicking of data. If you measure from 2010, these cuts are ridiiculous. If you measure from 1995, they're fairly reasonable. Then again, if you measure from 1980, the interpretation will be different again. No simple answers on this one.

 

ha, no worries - it is just one of those things (which are hopefully few) that I find annoying

 

yeah there is definitely an up and down curve to things - those increases prior were because of massive underfunding of family docs and in no small part where why there was a shortage (plus arguably it was deflecting great talent away from family medicine to other field in medicine which wasn't fair).

 

I think physicians haven't reacted terribly to the news in part because there is some validity to the governments position. It will be interesting if the process continues though!

[aaronjw]

those increases prior were because of massive

underfunding of family docs and in no small part where why there was a shortage

 

Do you have a source or something that backs up this claim because most of the relevant research that I've read in this area is contradictory to your claim.

 

It's good to know, though, that you now acknowledge there is no shortage

[rmorelan]

Do you have a source or something that backs up this claim because most of the relevant research that I've read in this area is contradictory to your claim.

 

It's good to know, though, that you now acknowledge there is no shortage

 

hmmm, don't have my full databank of economic stuff here with me but:

 

https://www.oma.org/Resources/Documents/PrimaryCareFeature.pdf

 

is probably a start (although the source is probably not unbiased I suppose)

 

relative underfunding I think was pretty clear - fee payment indexed for inflation in the 1992 to 2004 period was around 150K. Now it is over 250K. That is a rather dramatic increase - and not the sort of thing the government would do without some form of reason/plan/public pressure to address a need. 

 

Now 250K in fees vs say 350 to 400K for a specialist is comparable with respect to the extra training years and increased number of hours on average they have to work etc.

[Organomegaly]

Considering a family doctor has never spent more than 5 minutes with me, I don't think this strategy is as alarming it is intended to be... no pun intended. (I've just had awful experiences... I should probably stop going to Medi-clinics) In all seriousness, that is not the right approach. Show your worth and importance by providing meaningful and positive outcomes for the patient. The most annoying thing you see when you go to medi-clinics and you see "please only talk about 2 concerns at this visit". Personally, I've never had 2 concerns, but umm, is that even ethical? I realize you probably can't manage multiple concerns and you have to prioritize, but I think you should still listen just in case the patient doesn't understand what is important and what isn't. 

 

The 2-concerns policy seems like a crude way to deal with having too many patients to see and not enough time to see them all - at least that's how I understand the basis for the policy. I think a little common sense would always be useful; if the patient you're seeing clearly has serious issues that can't just be "one concern" then wouldn't it be wise to spend more time with them? I think the policy applies a little more to limiting less urgent concerns so the physician can see more people overall. 

 

Still I think - a pretty uninviting way to go about doing that. 

[Wartortle]

...

[MathToMed]

At the end of the day I think it's rude to the patient.

 

I'm inclined to agree, though I think this would largely depend on the manner that the physician handles it. If it's explained, and how...ie. signs in the waiting room, a brief spiel from the physician themselves, etc.

 

To be honest, I think it's a cute idea - though I would hope physicians who do participate would have sense enough to continue to make their patients feel valued. I can imagine going to two different physicians who treat it differently, and having entirely different experiences.

 

If the physician is essentially saying "We only get paid for 5 minutes, look how short that actually is when compared to a typical visit" that can be spun properly in a way that effectively communicates their message. However I can also see that going poorly, resulting in patients feeling unwanted, reluctant to continue their examination or mention everything they wanted to, because some stupid timer went off and now they're self conscious.

[aaronjw]

Physicians want their time to be respected by being paid what they feel its worth (though one could argue they aren't being paid for time so much as they are for their knowledge regardless of the time it takes) which is a fair consideration yet so many fail to take into account the value of their patients' time.  

 

I can't recall all instances of my doctor visits but I do not recall ever having an appoint start at the time it was scheduled which has included being the first scheduled appointment of the day! My wife included and I am sure I could survey many more people and they would say the same (yes I know anecdotes are not the plural of data). In fact, my wife routinely waits upwards of 2 hours to see her doctor in a JAM PACKED waiting room.

 

As Rodney Dangerfield would say: no respect!