Guest 0T6 Posted September 15, 2003 Report Share Posted September 15, 2003 www.choosechange.ca/en/pl...h_Care.pdf "We believe you should be able to see a family doctor when you need one. To meet the need for more family doctors, we will increase medical school spots by 15% and increase the number of family medicine training spots. We will make family medicine more attractive by creating a better quality of working life through family health teams. And we will make medical tuition more affordable and provide loan forgiveness to students who choose family medicine." Link to comment Share on other sites More sharing options...
Guest aneliz Posted September 15, 2003 Report Share Posted September 15, 2003 We had all three of the liberal candidates for the three London ridings come in to talk to the UWO med students: Their promises are not all that they seem to be: 1. They will re-regulate tuition...a step in the right direction but not necessarily anything close to making it "affordable". This is significantly more than some other parties are willing to do though! 2. Their 'incentive' to go into family practice will be a one-time payment of $12 000....which will of course be taxable and will make relatively little difference to your $125 000 worth of debt and do little to erase the fact that you will only ever make 60% of what a specialist is making... 3. They plan to increase medical school spots by 15%...when asked about corresponding increases in residency spots we got a "huh? what's residency?" They also had no answers to the problem that we already have big issues with availability of teaching space and clinical instructors for the existing number of medical students, because clinicians are NOT well compensated for teaching time and good will can only get you so far. Increasing the number of med students is not going to help this situation...as it is right now, there is a limited capacity to teach more med students and the quality of med education (in terms of one-to-one and SMALL group instruction) has declined since the last wave of increases. At UWO, "small group teaching" is anything less than half the class (67 people!) 4. Increased family residency spots....there were already 100+ vacancies in existing family medicine residency spots after the first round of the match last year...increasing the number of spots without increasing the rewards is NOT going to change anything. I am not bashing the Liberals here....just pointing out that their candidates have significant holes in their understanding of the realities of med school, tuition and career choices... at least they are willing to listen to students (unlike another not to be named party...). So, get out there and talk to the candidates running in your riding and make them aware of the issues! Link to comment Share on other sites More sharing options...
Guest 0T6 Posted September 15, 2003 Report Share Posted September 15, 2003 Thanks for posting that Aneliz, I was kinda wondering about a few of those like residency positions but couldn't find anything that really adressed it. Link to comment Share on other sites More sharing options...
Guest peachy Posted September 15, 2003 Report Share Posted September 15, 2003 Another thanks for posting this information! It sounds awful. (And I say that as someone who will be applying for a residency after any policy changes the next government makes trickle through!) I don't understand how they could have missed the point quite this much - where are the medical lobby groups and what are they doing? Link to comment Share on other sites More sharing options...
Guest 0T6 Posted September 16, 2003 Report Share Posted September 16, 2003 I think your perspective on the whole issue is a lottle different since you're both already in. Think back to when you were in undergrad, if your chances of getting in went up by 15% wouldn't you be excited? Link to comment Share on other sites More sharing options...
Guest peachy Posted September 16, 2003 Report Share Posted September 16, 2003 Personally, I wouldn't be happy if it meant that I would have a hard time getting the residency I wanted, and that medical school itself would likely be a lot more competitive because of it. I remember thinking around this time last year (when I was NOT in) that CARMS sounded MUCH more stressful than medical school applications. Med school is just a binary thing - you get in or you don't. And if you've got the grades and MCATs then you're eventually going to get in somewhere. But what if you just can't get the residency you want? That's scary because it affects what you'll do for the rest of your life. And it's not like you can just keep reapplying and be confident that you'll get it eventually. You can believe me or not, whatever. Link to comment Share on other sites More sharing options...
Guest aneliz Posted September 17, 2003 Report Share Posted September 17, 2003 I agree with Peachy.... I wouldn't be too excited about getting in if I knew that it was going to have to pay record high tuition to receive a medical education of reduced quality.... As an example: Yesterday, our clinical methods group was supposed to be learning newborn exam skills....this is really, really difficult when there are 10 people + the instructor in your group and you are all trying to see a 2-day old on a warmer...you are lucky to be able to see the baby AT ALL over your group members let alone see what the instructor was trying to demonstrate...net learning done = pretty close to zero. Meanwhile, in the old class sizes, the clinical method groups would have been ~6 people MAX...and maybe as small as 4....which is much better for learning - you would have actually have been able to SEE what was being demonstrated and learn something. Then, yesterday afternoon, we had 'small groups' to discuss gyne clinical cases....due to a crisis in the department, two instructors were no shows (because they can either manage patients or teach...guess what they choose - and not only for benevolent reasons....there is much more $$$ for them in staying at the hospital!) So, our 'small group' turned into ~30 people - it was really pleasant in a room designed to hold about 20 people max (people sitting on tables, on the floor, etc). Last year, half of the Med 2's had their pediatrics clinical teaching cancelled due to a lack of instructors and an overlap in teaching time with the Med 1's.... this year, some of us are going to Stratford to do peds...because there isn't enough space for everyone in London....and 24 of our classmates HAVE to go to Windsor for clerkship....because there is already no room for them in London....there is not enough space and not enough instructors. Seeing as Windsor can take a max of 25 people (no more space, no more instructors)...where exactly can we put extra people if they up the class size again? There is no lecture hall in med sci that holds more than the current class size....there is a shortage of small group meeting rooms already....to the point where some small groups are meeting off campus from 4-6 pm when the people that got an on campus room have PCL from 2-4... you already have to line up for computer access in the LRC, the study room and lounge are too small for the current class size and there aren't enough lockers for all of the meds 2007's.... and for the privilege of all this, you would be paying $10 000/year MORE tuition than the class that graduated in 2000 - who fit in the rooms, had enough lockers, etc. As for residency positions: The liberals also have some sort of half-baked scheme that in order to get in you would have to promise (as a condition of admission) to be a family doctor and do a 'return of service' in an underserviced area.... This is kind of like promising that you are going to do a masters in molecular genetics at UofT as a condition of getting into undergrad out of high school... How exactly can you promise that you don't want to be a reumatologist or radiologist when you don't even know what one does? So, imagine that you got in, you survived the overcrowding and you have done all of your clinical electives and you've decided that what you are really interested in is cardiology...and you have $125 000 in debt from your education....and in this time, you have married a non-meds that needs to be in a fairly large urban centre for their job...and the government says: "nope, sorry, we need family docs and we need them in Moosonee...you aren't going to be a cardiologist...you're going to do family and you are going to Northern Ontario...." Now what? Peachy is right...getting into med school is an all or nothing thing....you're in or you're not. CaRMS decides the rest of your life....and without a successful match you have an MD, a pile of debt and no ability to practice. CaRMS determines not only what specialty you are going to spend the rest of your life in, but also WHERE you are going to be for at least the next two years of your life. Given the increase in competition, it means that people are being forced to rank many more programs to try and make sure that they match...so despite the fact that your family and life may be in Southern Ontario, you will likely be ranking programs from Nfld to Vancouver if you are really set on getting a specialty. Meanwhile, people that are really set on staying in a certain location (ie Ontario) may be ranking many disciplines....so it becomes a game where you weigh how much you want to do a certain specialty for the rest of your life against how much you want to stay in a particular city or even province....and the competition can be fierce...CaRMS is much more of a 'who you know' and 'how much they like you' kind of process. Med students are pretty even with each other in terms of marks, etc....so if you think that med school admissions are subjective, wait until you see CaRMS! You will be wishing that there was something like the MCAT! Any government is going to HAVE to increase residency spots...given the existing increase in class sizes. If the Liberals make any new residency spots family med, this is not going to make anything better....it is just going to increase the amount of competition for specialty spots...and this is NOT going to just affect Ontario...because CaRMS is a national match...so, if the Liberals in Ontario increase only the number of family spots, given the increase in class sizes in Ontario, that means that there will be more grads competing for the specialty spots in ALL of the other provinces! Ontario grads are going to be in competion with UBC students for the specialty spots in Vancouver and with Dal students for the spots in Halifax, etc. And, seeing as we came into the system with no word from the government that we might be 'forced' into family med, this all seems a little unfair... Forcing people into disciplines and underserviced areas is not the answer....and Ontario shouldn't think that it can act in isolation....just look at the exodus out of Quebec after that provincial government tried it! Link to comment Share on other sites More sharing options...
Guest jmh2005 Posted September 17, 2003 Report Share Posted September 17, 2003 As Aneliz clearly outlines, the goverment (regardless of who is in power) won't make any head-way in terms of increasing FM practioners unless changes are made to the fee schedules (which ensures that Family Physicians are renumerated more appropriately! I truly believe that this is the only way through which change will happen given the debt load we will all carry in order to get our MD, plain and simple... Link to comment Share on other sites More sharing options...
Guest aneliz Posted September 17, 2003 Report Share Posted September 17, 2003 Amen. Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted September 17, 2003 Report Share Posted September 17, 2003 Please correct me if I'm wrong, but if people want to pay off their loans the fastest way possible, please explain to me how doing 5 years of residency makes this possible instead of getting into the workforce after 2 years of residency, even if the FP "only" makes 60% of a specialist? This may be average, and includes a lot of part-time family docs. If you are willing to work hard, you can make over $200,000 net or more per year. My friends in their first year started at $150,000 and have increased each year in practice. See Ian's post in the Med Student's Discussion forum to put this in perspective! Nobody is going to starve here! From what I can recall a PGY-1 makes about $43,000 in Ontario, going up about $3,000 per year (approximately, correct me if I'm wrong). In a 5 year residency: PGY-1: $43,000 PGY-2: $46,000 PGY-3: $49,000 PGY-4: $52,000 PGY-5: $55,000 TOTAL EARNINGS IN 5 YEARS: $245,000 Family Medicine: PGY-1: $43,000 PGY-2: $46,000 work 1: $150,000 work 2: $175,000 work 3: $200,000 TOTAL EARNINGS IN 5 YEARS: $614,000 (for sake of argument) Who pays off their loans first? This is not even considering the $40,000 tuition repayment plan that is available, and other incentives that are available by individual communities. One husband-wife family doctor couple I know was offered $50,000 EACH on top of the $40,000 repayment plan EACH to go to an Ontario town ($180,000 paid over 4 years on top of whatever their incomes were!) Don't forget that if a family doc wanted to work 80 or 100 hour weeks like a resident in those first 3 years out, they could make more depending how much emerg/walk-in clinic etc you work. Lets not forget those extra three years of residency are "worth something" in terms of personal cost to your personal/family life by always being at the hospital and being tired all the time when you're not. In the long run, the specialist will earn more per year and more total in their career, that is true. Most family docs I know don't begrudge that; especially when they have a reasonable family life and lifestyle, whereas a lot of specialists are doing 1 in 4 (or whatever call schedule) for their whole career. This is not to say I think things are perfect for family docs. I do think that primary care is in desperate need of reform and something has to be done do improve the situation here in Ontario, but family medicine is still a great career choice! Link to comment Share on other sites More sharing options...
Guest kosmo14 Posted September 17, 2003 Report Share Posted September 17, 2003 Amen macMDstudent. BTW family 60% of a specialist??? That's a little underestimated, unless you are comparing a few cardiologists, ent's, and optho's to family. What about peds, rheum, geriatrics? Link to comment Share on other sites More sharing options...
Guest DrSahsi Posted September 17, 2003 Report Share Posted September 17, 2003 I think 60% is reasonable, if slightly generous. One's billings as a family physican might look better on paper, but then you take home a dreadfully small portion of that after you deal with the expenses of running a small business. Overhead from a busy family practice takes a big bite out of your cashflow. - Rupinder Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted September 17, 2003 Report Share Posted September 17, 2003 I too think 60% is definitely a possibility if you are comparing any procedurally based specialty (ie. anything surgical, or some medicine subspecialties), any specialties without significant overhead (Radiology, Anesthesiology, Pathology, Emerg), or any specialties with lots of private/out of pocket income (Derm, Plastics, some ENT). Here's a Canada-wide salary comparison with annual salaries by specialty in each province, posted in the CaRMS forum: pub125.ezboard.com/fpremed101frm25.showMessage?topicID=15.topic Ian Link to comment Share on other sites More sharing options...
Guest jmh2005 Posted September 17, 2003 Report Share Posted September 17, 2003 My friend...you too raise very valid points, but if you think of your 'typical' family practice (you and maybe one or two GPs work out of an office) if you can make 150,000 or 200,000 after overhead, you must be working more than 80 hours per week. The family doc's that are making that money are working very hard for that salary (which you are totally right, is a nice living...) but are also likely working ER and likely not practicing your 'traditional' family medicine as I have described above. They are doing 'hospitalist', 'admissionist' shifts (mainly internal stuff) and walk-in clinics in order to avoid the massive demon...overhead! I have a girlfriend who is doing exactly what I have described above and is making approximately $20,000-22,000 per month depending on how many shifts she agrees to...she wants to open up her own practice, but she loving the income she is making ($240-250,000/year), she is starting to pay down debt, yet she isn't truly doing exactly what she wants, her own office with her own patients, because of the overhead issue. She is also practicing in an area that is underserviced (she got the 40,000 incentive deal), but is barely making a 'difference' to the community. I still believe that the only way to get people to go into FM residencies and practice FM the way it is traditionally practiced is only through a change to the fee schedule. FYI: PGY salaries as of April 1, 2003 in Ontario PGY-1 $43,173 PGY-2 50,394 PGY-3 53,455 PGY-4 57,077 PGY-5 60,867 PGY-6 64,430 PGY-7 66,975 PGY-8 70,765 (if you're that crazy!!) J Link to comment Share on other sites More sharing options...
Guest notold Posted September 17, 2003 Report Share Posted September 17, 2003 www.thepeterboroughexamin...Editorials Link to comment Share on other sites More sharing options...
Guest notold Posted September 17, 2003 Report Share Posted September 17, 2003 In a way it's rather sad that medicine has become more about money than actual service. In the good old days most MD's practiced because they loved the field..not because of earning potential. Anyone who comes from several generations of practitioners and is a bit older likely is more aware of this.(3 generations of medicine in my family) The income should be a bonus to practicing medicine and doing a speciality, not a motivating factor-IMHO. I recommend/suggest that every new med grad be required to serve 3-5 years as an FM in an underserviced area. Make it a condition of practicing medicine. :smokin Perhaps I'm idealistic, but I feel doctors -who are in a healing profession -should put service above income. Those who then enter "for the money" might choose another option and leave more room for those who wish to practice for more altruistic reasons, taking medicine back to where it belongs. and yes of course I like the idea of a good income..but how much is enough? notold Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted September 17, 2003 Report Share Posted September 17, 2003 Yes, the Liberal's approach to health care and medical education is short-sighted. But it's Nirvana compared to anything the Tories have suggested. Seriously. I think I'm going to vote for write-in: The CFMS. Link to comment Share on other sites More sharing options...
Guest jmh2005 Posted September 17, 2003 Report Share Posted September 17, 2003 Who said that people don't go into medicine because they want to help others?? For most it is not about the money...I left a good career to be able to help others even more than I did before as an allied health care professional...and I also definately don't think that it has anything necesarily to do with age, many people in my class who started at medicine at 21 are going the family route... However, when you come out with more than $100,000 dollars in debt and still need to do the things that all others in the work force do...buy a house, a car and everything else that goes with that...a looming debt can become quite a big deal...interest doesn't stop compounding... In the good 'ole days, medicine was no-way near as technical as it is today, equipment, supplies are crazy expensive...things have changed in many respects... I am choosing Family Medicine because that is what I want to do (with ER), and was the reason I left my former career...but getting back to the question at hand...What can be done to attract more people to Family??? Unfortunate but true, it does come down to money. Just my two cents! Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted September 17, 2003 Report Share Posted September 17, 2003 I have mentioned before that the Family Health Network in Ontario gives the average family practioner a sizable raise, in the neighborhood of 40% without changing their practice style at all. I personally know a group of family docs who have switched to a FHN, and love it. They have about 2000 patients rostered each, work 3-1/2 days per week, one overnight on-call once every three weeks. They receive approximately $25,000-$30,000 from OHIP each month, pay about $5,000 in overhead (they have a very tightly run, low overhead office) each month meaning their NET taxable incomes are around $250,000 per year. This is a jump from about $175,000 NET income before switching to FHN. They still see about 40 people each full day in the office. They are definitely not working 80 hours per week, more like 40 hours most weeks and take 6-8 weeks vacation per year with no loss of income in this plan. The FHN is the governments way of reforming primary health care while giving the FP's a raise. It may not work for every practice but I have heard good things about it. Ideally, the fee schedule should be changed so that docs are not put in a situation of "sign up or else" but it is a start. I also know of a Fee-for-service FP who caps out and bills more than $400,000 per year (subtract 30% for overhead so figure $280,000 annual income) so you can make money either way. The only difference is that the FFS doc billing so much IS working 80+ hours per week. The Emerg docs I know personally make about $200,000 per year, depending how many shifts they take, but usually average only 12 to 15 shifts per month. Don't forget with Emerg, the average career is only 7 years. Shift work can be harder than you think, especially once you have a family. My Emerg friends basically tell me that you have to count on 2 out of every 4 weekends a month you will be working at least one day. This is no big deal when you are young and single, but as you have a family of your own and your kids start going to school during the week, the weekends are more valuable family time than ever. JMH, thanks for the PGY pay scale. I didn't have it on hand. Even though the pay is higher than I thought, I still stand by my earlier assertion that working 3 years, plus a bonus from the government would put you in a better financial situation than a 5 year (or longer) residency with respect to paying down a debt the fastest. Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted September 17, 2003 Report Share Posted September 17, 2003 Of course my motivation for entering medicine was in patient care. The reason I am discussing money in so much in this context is that I disagree that choosing Family Medicine is a path to the poorhouse. I have several close friends in practice who have shared with me their financial situation. I want to try and encourage more people to choose family medicine and not be scared away for financial reasons because in my humble opinion, to be a great family practitioner is the greatest challenge in all of medicine and the cornerstone to the healthcare system! Link to comment Share on other sites More sharing options...
Guest notold Posted September 18, 2003 Report Share Posted September 18, 2003 I didn't mean to say all doctors are only interested in money, but certainly some are. that aside,debt is certainly not pleasant. as for the good old days..there is a certain person that has a natural "knack" or talent, an intuitive edge or aspect, someone that is a natural doctor-technology has in many ways banished that type of practitioner, but not entirely. I think that in good old days the philosophy of medicine was much more holistic. It left that arena and now is making its way back. It's hard to say what a Liberal gov might do. The existing trend seems to be towards NP's and Midwifes and other specialized areas to form teams. Its hard to know if FPs will indeed exist in the "future" of medicine if the trend continues that way. They have to fill the shortages to deliver care. Whoever is willing to make up that shortage - I think- will determine the future. Why spend 10 years becoming a FP if as a NP you likely net the same income. in 4 years you can become a Midwife. ( I'm looking at these as back up options as it looks like I will 60 before becoming an FP. I'm also tranferring from another allied health discipline and like you also "want" to practive Family Medicine:b Link to comment Share on other sites More sharing options...
Guest jmh2005 Posted September 19, 2003 Report Share Posted September 19, 2003 Notold: I apologize if my post was a bit harsh and presumptive...one of those days... It's hard to say if any party elected really knows enough about the delivery of health care services to really make an impact and address the crisis we are now facing... Global News (Toronto) did a segment (maybe it will re-run tonight at 11:00pm) about the lack of Family Physicians and outlined the 3 parties strategies...personally I thought that they were all very weak attempts which sound nice on the screen but practically won't translate into medical students chosing Family Medicine as their future career...any other comments? I think I'm up to six cents... Link to comment Share on other sites More sharing options...
Guest notold Posted September 20, 2003 Report Share Posted September 20, 2003 well...no apology needed but thanks. we all have those days:b Maybe if they did actually recruit "older" applicants who were "willing" to serve underserviced areas they could make a bit of a dent. They could start by waiving tuition fees for any med applicant 50 or older:lol The they could set them up in a house or a small RV (for remote practice) in return for a secure contract in FP. Some what like the reimbursment program..but more along the lines of a "special" admission for older students. The older you are the more you get:lol :smokin I think that's worth at least a dollar (CDN):hat Link to comment Share on other sites More sharing options...
Guest Phil667 Posted September 20, 2003 Report Share Posted September 20, 2003 jmh2005, I do agree with the premise of your previous post. Money (or financial incentives) will be the only way to get more doc's into Rural locations. Since we live in a capitalist, democratic society the government cannot force anyone to live somewhere. Thus, they have to make it finacially rewarding for doc's to move out in the boonies. I don't agree with programs that "force" students or residents to move to rural locations for a certain amount of time, and then hope that they stay afterwards. Would you want to have a doctor who is forced to practice in your community? Phil Link to comment Share on other sites More sharing options...
Guest aneliz Posted September 20, 2003 Report Share Posted September 20, 2003 I don't think that they would be too successful trying to force anybody anywhere....as one of our profs is fond of telling our class: "when the going gets rough, just remember that there is a giant MD safety net that is strung out just south of the border" I know of a few docs that live in Windsor yet work in Detroit...best of both worlds (live in Canada with US income) I agree with jmh2005, the piece that global ran yesterday was pretty shallow - however, they did mention that the FP shortage is not the only problem and that there are just as many people per specialist in Ontario and extremely long waiting times to see a specialist too. People are so blinded by the FP shortage (which I don't deny exists) that they haven't realised that we are short of numerous other specialties. As an example: the SOGC predicts that 50% of all OB/GYNs in Canada will retire in the next 5-10 years... Given that it takes 5 years to do an OB/GYN residency, we are in big trouble if they don't up the numbers NOW. As it is right now, we are graduating about 20 new OB/GYN's per year...(for the entire province). There are also HUGE waiting lists to see rheumatologists (9-12 months in London)....this is a really long time in life of the 18 year old that was just diagnosed with rheumatoid arthritis.... There is a similar lack of gerontologists....one or two (in the province!) on a good year finish training. And we are going to be seriously short of cardiologists, respirologists, etc when all of the existing specialists start to retire. As the 'baby boom' ages, they are going to need cardiologists, gerontologists, rheumatologists, orthopedic surgeons and oncologists just as much as a family doctor. The problem is, the government makes all of these promises to increase med school spots, provide tuition incentives, yada, yada, yada....but they don't realise that you can't just snap your fingers, toss out a pile of money and the problem is solved. This is a huge problem involving post-secondary education, immigration and health care. And the chances of any of those different groups actually talking and coming up with a workable solution is remote. The schools are packed now...the physical space is not there to teach more med students....UWO is already dealing with the largest class that they have EVER had. Similarly, the teachers are not there...they are relying on people that are already overworked by their clinical responsibilities, to, out of the goodness of their heart, volunteer to teach as well. For somebody already working 80 hours a week seeing patients, this is not the top of their priority list, especially given the pitiful compensation they receive for doing it. The government has mandated more student spaces but they haven't upped the funding to the schools to match. But, as they are fond of saying - "this is a post-secondary education funding issue/problem" and is "nothing to do with health care". However, residency positions are funded by the ministry of health - not the education ministry - so upping student spaces has had (so far) no impact on the number of residency spaces. By increasing class size, increasing access of IMG's to residency positions and NOT increasing number of residency spots, I don't understand how exactly we are 'increasing' the number of doctors. You are trying to force more people into the opening of the pipe but only the same number can fit out. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.