Your Doctor Won't See You Now -- Or Ever Again
October 30, 2024 8:45 AM Subscribe
Why family medicine in Canada is dying (slTheWalrus)
More Canadian healthcare fun inside!
Stories from Toronto doctors and people without a family doc. All stories are listed below in the initial paragraph. (slTOLife)
Quebec considers scrapping healthy patients with doctors for those with complex care needs. (slCBC)
Ford government to ban international students at Ontario medical schools. (slGlobalNews)
There is a growing healthcare workforce despite the dire news, but we still need more family doctors and nurse practitioners. (slTOStar)
Stories from Toronto doctors and people without a family doc. All stories are listed below in the initial paragraph. (slTOLife)
Quebec considers scrapping healthy patients with doctors for those with complex care needs. (slCBC)
Ford government to ban international students at Ontario medical schools. (slGlobalNews)
There is a growing healthcare workforce despite the dire news, but we still need more family doctors and nurse practitioners. (slTOStar)
I don't know if the foreign students ban belongs in the mix here. My understanding is that our medical schools are underfunded, and foreign students bring in much needed tuition funds. These students ( I believe most are from the middle east) return to their home countries or elsewhere to practice.
Our medical schools are some of the hardest in the world to get into and many, many qualified candidates don't get in. I also understand that these med schools are hard to grow due to the lack of suitable instructors - so, theoretically, banning foreign students will permit more Canadians to receive medical training in our domestic med schools, and these domestic students would practice in Canada. Obviously, the funding issue needs to be addressed as a priority.
posted by sid at 8:55 AM on October 30 [3 favorites]
Our medical schools are some of the hardest in the world to get into and many, many qualified candidates don't get in. I also understand that these med schools are hard to grow due to the lack of suitable instructors - so, theoretically, banning foreign students will permit more Canadians to receive medical training in our domestic med schools, and these domestic students would practice in Canada. Obviously, the funding issue needs to be addressed as a priority.
posted by sid at 8:55 AM on October 30 [3 favorites]
Canadians are getting so frustrated that they think private healthcare is the answer but I don't think that will work out well if you have to worry about medical debt on top of everything else. (I had medical debt when I was a teenager in the US.)
I believe in the Canadian healthcare system and I believe it can be overhauled, but there has to be the will to do so.
posted by Kitteh at 8:58 AM on October 30 [16 favorites]
I believe in the Canadian healthcare system and I believe it can be overhauled, but there has to be the will to do so.
posted by Kitteh at 8:58 AM on October 30 [16 favorites]
Our medical schools are some of the hardest in the world to get into and many, many qualified candidates don't get in. I also understand that these med schools are hard to grow due to the lack of suitable instructors - so, theoretically, banning foreign students will permit more Canadians to receive medical training in our domestic med schools, and these domestic students would practice in Canada. Obviously, the funding issue needs to be addressed as a priority.
Let me tell you as someone who has worked in family medicine: you can build all the schools you want, you can have all the programs you want, but unless a medical student chooses family medicine, it will be all for naught. Ford makes it sound as though international students--*cough*racism*cough*--are the barrier to Ontarians getting family doctors. No one is getting a family doctor because no one wants to be a family doctor.
Limiting this to domestic students just means more medical students choosing a specialty where they can set their own fee schedules, their own work-life balance, and you will still be without a family doctor. No provincial government can magick their medical students to choose cradle-to-grave practice unless they make it appealing for them.
posted by Kitteh at 9:03 AM on October 30 [36 favorites]
Let me tell you as someone who has worked in family medicine: you can build all the schools you want, you can have all the programs you want, but unless a medical student chooses family medicine, it will be all for naught. Ford makes it sound as though international students--*cough*racism*cough*--are the barrier to Ontarians getting family doctors. No one is getting a family doctor because no one wants to be a family doctor.
Limiting this to domestic students just means more medical students choosing a specialty where they can set their own fee schedules, their own work-life balance, and you will still be without a family doctor. No provincial government can magick their medical students to choose cradle-to-grave practice unless they make it appealing for them.
posted by Kitteh at 9:03 AM on October 30 [36 favorites]
This is sounding like what has happened in the US, and it sounds like for similar reasons: generalists get paid the worst and have the most brutal hours; why on earth wouldn’t new docs avoid it like the plague?
Money seems like it would solve this problem: generalists need to be paid more, especially in rural areas. But of course that’s always politically a hard sell to basically subsidize to fix the problem.
posted by techbasset at 9:33 AM on October 30 [26 favorites]
Money seems like it would solve this problem: generalists need to be paid more, especially in rural areas. But of course that’s always politically a hard sell to basically subsidize to fix the problem.
posted by techbasset at 9:33 AM on October 30 [26 favorites]
theoretically, banning foreign students will permit more Canadians to receive medical training in our domestic med schools. Counterpoint: "According to Ontario government figures, there were 3,833 students enrolled in medical schools in 2023-24, with only 10 international students".
Yep, banning those 10 students is definitely a good faith effort to fix Ontario's family doctor shortage, and not at all a craven appeal to racism to distract us from Ford's scandals ahead of a snap election.
posted by Popular Ethics at 9:35 AM on October 30 [44 favorites]
Yep, banning those 10 students is definitely a good faith effort to fix Ontario's family doctor shortage, and not at all a craven appeal to racism to distract us from Ford's scandals ahead of a snap election.
posted by Popular Ethics at 9:35 AM on October 30 [44 favorites]
Popular Ethics, yuuuuuuup. And as you can see: it works!
posted by Kitteh at 9:39 AM on October 30 [4 favorites]
posted by Kitteh at 9:39 AM on October 30 [4 favorites]
It's so frustrating that we don't just train more doctors. So many other countries just train a lot more doctors, but we continue to talk about this problem like there's some fixed supply of doctors. There isn't! We could simply train more doctors. There are plenty of young people who would like to go into medical school and don't get accepted. There are plenty of doctors who would like to teach them in our universities.
And it makes no sense to say that none of the students want to go into family medicine. Of course they don't, they can make more money going into a specialty! If we made it clear before they start studying that not everyone is going into a specialty and there simply aren't enough spaces for all of them to become specialists, then we are going to end up with more family doctors.
Family doctors don't need to be very wealthy (arguably, we might have better doctors if people went into medicine because they really wanted to instead of for money and prestige). There are plenty of people who would happily become family doctors at the current rates of pay. We just need to give them the opportunity to do so.
posted by ssg at 9:44 AM on October 30 [9 favorites]
And it makes no sense to say that none of the students want to go into family medicine. Of course they don't, they can make more money going into a specialty! If we made it clear before they start studying that not everyone is going into a specialty and there simply aren't enough spaces for all of them to become specialists, then we are going to end up with more family doctors.
Family doctors don't need to be very wealthy (arguably, we might have better doctors if people went into medicine because they really wanted to instead of for money and prestige). There are plenty of people who would happily become family doctors at the current rates of pay. We just need to give them the opportunity to do so.
posted by ssg at 9:44 AM on October 30 [9 favorites]
No one is getting a family doctor because no one wants to be a family doctor.
It's me, hi, I'm the problem it's me
I went into med school thinking I would do family practice, but after seeing how my preceptors in family med were living I ran for the hills and ended up in an academic sub-specialty. You spend *so much* of your time on paperwork and *so little* of your time actually seeing patients and doing what you trained to do.
I don't make any more money than the FMDs in our community do. It's not (entirely, for everybody) about the money. It's about the quality of the work. Fixing family medicine means funding full-service family health teams (with NPs/PAs to help with documentation and paperwork), integrated regional electronic health records, and enhanced telemedicine. It costs money but it's not impossible.
Trying to address this at the medical student level (like creating new schools at York and TMU with hundreds more MD spots for students who will still try like hell to match to anything other than FM [or banning those 10 international students]) is such a typical populist Doug Ford move: looks good in a headline, does absolutely nothing else.
posted by saturday_morning at 9:47 AM on October 30 [45 favorites]
It's me, hi, I'm the problem it's me
I went into med school thinking I would do family practice, but after seeing how my preceptors in family med were living I ran for the hills and ended up in an academic sub-specialty. You spend *so much* of your time on paperwork and *so little* of your time actually seeing patients and doing what you trained to do.
I don't make any more money than the FMDs in our community do. It's not (entirely, for everybody) about the money. It's about the quality of the work. Fixing family medicine means funding full-service family health teams (with NPs/PAs to help with documentation and paperwork), integrated regional electronic health records, and enhanced telemedicine. It costs money but it's not impossible.
Trying to address this at the medical student level (like creating new schools at York and TMU with hundreds more MD spots for students who will still try like hell to match to anything other than FM [or banning those 10 international students]) is such a typical populist Doug Ford move: looks good in a headline, does absolutely nothing else.
posted by saturday_morning at 9:47 AM on October 30 [45 favorites]
* Actually I do think there is a potential solution at the medical student level, which is that newly created MD spots could be irrevocably tied to a FM residency and not allow you to enter the CARMS match at all -- but as far as I understand it that's not a permitted model and even programs like this one that are supposed to be a direct MD-to-FM pipeline still have issues because many of the graduates apply out regardless of what they told their interviewers.
posted by saturday_morning at 9:50 AM on October 30 [15 favorites]
posted by saturday_morning at 9:50 AM on October 30 [15 favorites]
And it makes no sense to say that none of the students want to go into family medicine. Of course they don't, they can make more money going into a specialty! If we made it clear before they start studying that not everyone is going into a specialty and there simply aren't enough spaces for all of them to become specialists, then we are going to end up with more family doctors.
It does when you've worked at a Queen's family health clinic that trains new residents in family med and out of the many who walk through those doors, opt out when they are done.
And I don't think forcing med students to be family doctors is the answer either. There is so much paperwork bloat for family doctors that only they can do, not admin or other staff. MTO forms, sick notes (which businesses should stop asking for), ODSP forms, etc. When you have a roster of a 1000+ plus patients, do the math with those forms because they never stop. And you never quit getting phone calls from angry patients as to why those forms aren't done yet (well, all the doctors have stuffed schedules for patients during the day as well as training residents, so really the only they get to them is late at night if they are able to).
The family healthcare system needs a refresh and an appeal for medical students. Again, been working in the Ontario healthcare system for over five years and it is terrible on so many levels.
posted by Kitteh at 9:50 AM on October 30 [11 favorites]
It does when you've worked at a Queen's family health clinic that trains new residents in family med and out of the many who walk through those doors, opt out when they are done.
And I don't think forcing med students to be family doctors is the answer either. There is so much paperwork bloat for family doctors that only they can do, not admin or other staff. MTO forms, sick notes (which businesses should stop asking for), ODSP forms, etc. When you have a roster of a 1000+ plus patients, do the math with those forms because they never stop. And you never quit getting phone calls from angry patients as to why those forms aren't done yet (well, all the doctors have stuffed schedules for patients during the day as well as training residents, so really the only they get to them is late at night if they are able to).
The family healthcare system needs a refresh and an appeal for medical students. Again, been working in the Ontario healthcare system for over five years and it is terrible on so many levels.
posted by Kitteh at 9:50 AM on October 30 [11 favorites]
It's a really weird system where family doctors basically have to run their own business, but they're remunerated on a fee-for-service model in which they don't control which services earn a fee, or what those fees are. Something about that model needs to change.
posted by Kabanos at 9:52 AM on October 30 [18 favorites]
posted by Kabanos at 9:52 AM on October 30 [18 favorites]
I'm sure there's an AI solution!
jk. PAY DOCTORS MORE.
posted by some chick at 9:54 AM on October 30 [4 favorites]
jk. PAY DOCTORS MORE.
posted by some chick at 9:54 AM on October 30 [4 favorites]
Also today I learned I've been saying and spelling "remunerated" wrong my whole life. Gonna go read some Berenstein Bears to comfort myself.
posted by Kabanos at 9:55 AM on October 30 [16 favorites]
posted by Kabanos at 9:55 AM on October 30 [16 favorites]
You spend *so much* of your time on paperwork and *so little* of your time actually seeing patients
sick notes (which businesses should stop asking for)
I was just wondering what the paperwork was for. Theoretically there’s useful documentation only the doctor can do, which should be allowed for in a doctor’s schedule, and then… everything else, which the doctors probably shouldn’t be doing and which possibly shouldn’t be done.
posted by clew at 9:57 AM on October 30 [1 favorite]
sick notes (which businesses should stop asking for)
I was just wondering what the paperwork was for. Theoretically there’s useful documentation only the doctor can do, which should be allowed for in a doctor’s schedule, and then… everything else, which the doctors probably shouldn’t be doing and which possibly shouldn’t be done.
posted by clew at 9:57 AM on October 30 [1 favorite]
I have this vision in my head that, in the past, being a family doctor was Just A Job. But that predates modern methods -- and modern paperwork, alas. There's no turning back the clock on how demanding a job it is.
My son plans to go to medical school in a couple of years, and he has already said that, although he wants to help people, being a GP looks like murder. He'd rather do volunteer medicine in Africa than be a GP in North America!
posted by wenestvedt at 10:00 AM on October 30 [3 favorites]
My son plans to go to medical school in a couple of years, and he has already said that, although he wants to help people, being a GP looks like murder. He'd rather do volunteer medicine in Africa than be a GP in North America!
posted by wenestvedt at 10:00 AM on October 30 [3 favorites]
And I don't think forcing med students to be family doctors is the answer either.
We don't need to force med students to become family doctors. We need to make it clear that there aren't going to be specialty places for the majority of graduates and that the expectation after graduating from medical school is becoming a family doctor for most. We don't "force" law school graduates to become lawyers, but many of them do in fact become lawyers after graduating from law school.
posted by ssg at 10:02 AM on October 30 [3 favorites]
We don't need to force med students to become family doctors. We need to make it clear that there aren't going to be specialty places for the majority of graduates and that the expectation after graduating from medical school is becoming a family doctor for most. We don't "force" law school graduates to become lawyers, but many of them do in fact become lawyers after graduating from law school.
posted by ssg at 10:02 AM on October 30 [3 favorites]
I'm in the US, but even here, where there are specially funded MD programs where students commit to going to a rural area as a general practitioner after their degree, many leave when the commitment is completed (usually 6 years). Rural communities are lacking medical care of all types, but particularly emergency, ob-gyn, and family medicine. The clinics that get put in some of these communities are not sufficient. Both funding for medical school, changes in remuneration for those choosing family medicine, and streamlining of paperwork (get rid of the mid-level authorization process), and forcing insurance companies to treat independent physicians the same way they do those in-network would all be helpful solutions, but as Kitteh says above, you can't force medical students to choose family medicine, and even when they do, many go elsewhere after residency because the job is ridiculously burdened for the amount of pay you make.
posted by drossdragon at 10:35 AM on October 30 [10 favorites]
posted by drossdragon at 10:35 AM on October 30 [10 favorites]
I have this vision in my head that, in the past, being a family doctor was Just A Job. But that predates modern methods -- and modern paperwork, alas. There's no turning back the clock on how demanding a job it is.
When I was young our family MD worked such long hours I fully believe you'd need 2 MDs to replace that guy.
On the other there were no nurses to do the basic checkup (BPs, temp, symptoms, etc...) like we do now so that must save some time? But that was time with the MD where you could discuss your issues... IDK what's best....
posted by WaterAndPixels at 10:42 AM on October 30 [2 favorites]
When I was young our family MD worked such long hours I fully believe you'd need 2 MDs to replace that guy.
On the other there were no nurses to do the basic checkup (BPs, temp, symptoms, etc...) like we do now so that must save some time? But that was time with the MD where you could discuss your issues... IDK what's best....
posted by WaterAndPixels at 10:42 AM on October 30 [2 favorites]
We need to make it clear that there aren't going to be specialty places for the majority of graduates and that the expectation after graduating from medical school is becoming a family doctor for most.
Then they will go to to the US with a much larger population and better pay. They can do specialty in the US and get paid even better than they would here. You can try to limit it but it will backfire. We're already hemorrhaging nurses and docs to the US because they can get a better salary, and in their minds, a better quality of life.
People complain that their family doctors rush them in and out. They're aren't wrong but the way the pay system works, they kinda have to if they want to pay all their overhead. I've yet to meet a family doctor who likes being pressed for time with patients. It's hard to address complex health issues when you're pressured to see more patients in a day just to make sure everyone working for you gets paid and the lights stay on.
posted by Kitteh at 10:47 AM on October 30 [8 favorites]
Then they will go to to the US with a much larger population and better pay. They can do specialty in the US and get paid even better than they would here. You can try to limit it but it will backfire. We're already hemorrhaging nurses and docs to the US because they can get a better salary, and in their minds, a better quality of life.
People complain that their family doctors rush them in and out. They're aren't wrong but the way the pay system works, they kinda have to if they want to pay all their overhead. I've yet to meet a family doctor who likes being pressed for time with patients. It's hard to address complex health issues when you're pressured to see more patients in a day just to make sure everyone working for you gets paid and the lights stay on.
posted by Kitteh at 10:47 AM on October 30 [8 favorites]
I believe in the Canadian healthcare system and I believe it can be overhauled, but there has to be the will to do so.
I am pretty disillusioned. I could go on, I could talk about massive rallies in Edmonton a while back, I'm ready to do that again and I rallied with UNA members recently, but the will of Canadians is not there. It feels like this some days, it feels like at least half of your neighbours are slapping "F*CK TRUDEAU" stickers on their trucks and lining up to vote PP in (if not worse).
in short, it feels like the will is lacking and the tide working against that will is just picking up momentum. We are so lucky here, we could be doing so much to build a better world, and we didn't and we won't.
posted by ginger.beef at 10:52 AM on October 30 [5 favorites]
I am pretty disillusioned. I could go on, I could talk about massive rallies in Edmonton a while back, I'm ready to do that again and I rallied with UNA members recently, but the will of Canadians is not there. It feels like this some days, it feels like at least half of your neighbours are slapping "F*CK TRUDEAU" stickers on their trucks and lining up to vote PP in (if not worse).
in short, it feels like the will is lacking and the tide working against that will is just picking up momentum. We are so lucky here, we could be doing so much to build a better world, and we didn't and we won't.
posted by ginger.beef at 10:52 AM on October 30 [5 favorites]
Then they will go to to the US with a much larger population and better pay. They can do specialty in the US and get paid even better than they would here. You can try to limit it but it will backfire. We're already hemorrhaging nurses and docs to the US because they can get a better salary, and in their minds, a better quality of life.
This is accurate. Canada's medical system has this challenge that no other nation really has, which is "America, with its completely-dysfunctional-but-super-profitable-for-doctors system right next door."
The answer is actually very straightforward: make family doctors provincial employees. No fee-for-service at all, provincial government pensions. Eliminate the majority of non-patient paperwork, most of which is just billing and provincial interaction stuff, and the job becomes much more desirable.
posted by mightygodking at 10:58 AM on October 30 [33 favorites]
This is accurate. Canada's medical system has this challenge that no other nation really has, which is "America, with its completely-dysfunctional-but-super-profitable-for-doctors system right next door."
The answer is actually very straightforward: make family doctors provincial employees. No fee-for-service at all, provincial government pensions. Eliminate the majority of non-patient paperwork, most of which is just billing and provincial interaction stuff, and the job becomes much more desirable.
posted by mightygodking at 10:58 AM on October 30 [33 favorites]
Something I don't really see people talking about is how it is possible for someone to make it all the way through medical school, and then apply for placements in whatever specialty they want, and then fail to be chosen for that specialty.
If this happens, students have no recourse but to wait another year until the process starts again, and then reapply.
My question is, if someone doesn't get accepted to their chosen plastic surgery placement, why are they not automatically placed in family medicine for a year?
posted by Cpt. The Mango at 11:00 AM on October 30 [4 favorites]
If this happens, students have no recourse but to wait another year until the process starts again, and then reapply.
My question is, if someone doesn't get accepted to their chosen plastic surgery placement, why are they not automatically placed in family medicine for a year?
posted by Cpt. The Mango at 11:00 AM on October 30 [4 favorites]
Then they will go to to the US with a much larger population and better pay
This is often a talking point, but the data does not back this up at all. For 2022, the most recent year for which data is available, net migration of doctors out of Canada was a grand total of 22. It has been similar in recent years. 22 doctors leaving the country is not significant.
Doctors leaving Canada is not the problem, the supply of new doctors is the problem. We simply don't have enough doctors to meet demand, so we need to train more doctors.
posted by ssg at 11:05 AM on October 30 [14 favorites]
This is often a talking point, but the data does not back this up at all. For 2022, the most recent year for which data is available, net migration of doctors out of Canada was a grand total of 22. It has been similar in recent years. 22 doctors leaving the country is not significant.
Doctors leaving Canada is not the problem, the supply of new doctors is the problem. We simply don't have enough doctors to meet demand, so we need to train more doctors.
posted by ssg at 11:05 AM on October 30 [14 favorites]
if someone doesn't get accepted to their chosen plastic surgery placement, why are they not automatically placed in family medicine for a year?
If someone doesn't match there is a second round of admissions for all the spots that went unfilled in the first round -- usually a small handful of specialty positions and a whole whack of family med positions. Applicants have the choice whether to enter the second round and take one of the family med spots on offer, or wait until next year and build their CV to reapply for their goal specialty.
posted by saturday_morning at 11:13 AM on October 30 [2 favorites]
If someone doesn't match there is a second round of admissions for all the spots that went unfilled in the first round -- usually a small handful of specialty positions and a whole whack of family med positions. Applicants have the choice whether to enter the second round and take one of the family med spots on offer, or wait until next year and build their CV to reapply for their goal specialty.
posted by saturday_morning at 11:13 AM on October 30 [2 favorites]
Applicants have the choice whether to enter the second round and take one of the family med spots on offer...
How often does this happen?
posted by wenestvedt at 11:17 AM on October 30
How often does this happen?
posted by wenestvedt at 11:17 AM on October 30
The specialty versus family medicine question feels like a bit of a distraction from the fundamental problem. It's not like we have too many specialists in Canada. Wait lists to see a specialist are often very long. We could fiddle with the incentive structures to slowly change the balance of specialists versus GPs, but that won't change the overall number of doctors. We need more specialists and more GPs.
posted by ssg at 11:24 AM on October 30 [9 favorites]
posted by ssg at 11:24 AM on October 30 [9 favorites]
In all my years in Quebec I never had a family doctor and had to wait in a CLSC for anything. When I moved to rural Alberta I didn't even bother getting one until my partner was with child. We have been very lucky in that regard, I even changed family doctors without any effort. Now our original family doctor is retiring (tomorrow!) and the clinic shifted the family over to a new doctor, so we have been very fortunate to be shielded by these situations, but I do think we're the exception, and I'm glad more attention is being drawn to this, but Alberta still seems to be smitten by the UCP and I don't see it getting better any time soon.
posted by furtive at 11:44 AM on October 30 [2 favorites]
posted by furtive at 11:44 AM on October 30 [2 favorites]
We need more specialists and more GPs.
I don't know about that. Specialist physicians/surgeons themselves are usually not the bottleneck to more patients being seen -- it's often nursing or infrastructure issues. I personally would be happy to see more patients but I can't get extra clinic time in my practice environment because there physically aren't enough clinic rooms at our hospital for us to see as many patients as we theoretically could. Surgical waitlists are notoriously long, and many surgeons would love more time in the OR, but there aren't enough OR hours to go around because of shortages in nursing and support workers in addition to the physical ORs that are basically always full across the province. I think we need more FMDs but the issues with specialty care would be better addressed by improving nursing care and modernizing our facilities than by hiring more people like me.
posted by saturday_morning at 11:50 AM on October 30 [11 favorites]
I don't know about that. Specialist physicians/surgeons themselves are usually not the bottleneck to more patients being seen -- it's often nursing or infrastructure issues. I personally would be happy to see more patients but I can't get extra clinic time in my practice environment because there physically aren't enough clinic rooms at our hospital for us to see as many patients as we theoretically could. Surgical waitlists are notoriously long, and many surgeons would love more time in the OR, but there aren't enough OR hours to go around because of shortages in nursing and support workers in addition to the physical ORs that are basically always full across the province. I think we need more FMDs but the issues with specialty care would be better addressed by improving nursing care and modernizing our facilities than by hiring more people like me.
posted by saturday_morning at 11:50 AM on October 30 [11 favorites]
How often does this happen?
All the time. Here's the list of positions that went unfilled after the first iteration this year and here's the list of positions that were still unfilled after the second round. Note that while most of the positions still unfilled at the end were in FM, most of them (especially those from English Canada) were filled in the second iteration.
posted by saturday_morning at 12:03 PM on October 30 [2 favorites]
All the time. Here's the list of positions that went unfilled after the first iteration this year and here's the list of positions that were still unfilled after the second round. Note that while most of the positions still unfilled at the end were in FM, most of them (especially those from English Canada) were filled in the second iteration.
posted by saturday_morning at 12:03 PM on October 30 [2 favorites]
My partner is a PA and has been looking at a program in Nova Scotia that is trying to get PAs to relocate there. I'm not opposed to following along and becoming a Halifax Mooseheads fan.
posted by snwod at 12:03 PM on October 30 [4 favorites]
posted by snwod at 12:03 PM on October 30 [4 favorites]
jk. PAY DOCTORS MORE.
Some of the problem is that the government needs to be willing to pay for the actual costs of what's needing to happen, and acknowledge that in its budgeting. And another portion is that the government needs to stop spending so much money, time, and paperwork on trying to stop "fraud". Does it happen? Yes. But the paperwork to stop "fraud" only works if you don't value the time of everyone who has to fill out the paperwork to stop said "fraud".
I would love to bill the government for the amount of time spent filling out said paperwork, at billable hours, including for the patients. A form takes half an hour for a patient to fill out? Give the the patient a copay credit for half an hour at wage hours. Half an hour for a doctor? Pay the doctor at doctor hours. And I think that would quickly knock out all value.
posted by corb at 12:09 PM on October 30 [8 favorites]
Some of the problem is that the government needs to be willing to pay for the actual costs of what's needing to happen, and acknowledge that in its budgeting. And another portion is that the government needs to stop spending so much money, time, and paperwork on trying to stop "fraud". Does it happen? Yes. But the paperwork to stop "fraud" only works if you don't value the time of everyone who has to fill out the paperwork to stop said "fraud".
I would love to bill the government for the amount of time spent filling out said paperwork, at billable hours, including for the patients. A form takes half an hour for a patient to fill out? Give the the patient a copay credit for half an hour at wage hours. Half an hour for a doctor? Pay the doctor at doctor hours. And I think that would quickly knock out all value.
posted by corb at 12:09 PM on October 30 [8 favorites]
sick notes (which businesses should stop asking for
Scrap sick notes for minor illnesses like colds, says Canadian Medical Association [CBC]
posted by Kabanos at 12:30 PM on October 30 [3 favorites]
Scrap sick notes for minor illnesses like colds, says Canadian Medical Association [CBC]
posted by Kabanos at 12:30 PM on October 30 [3 favorites]
The BC NDP promised to get rid of sick notes during the campaign here, which would be a good step. They also promised to get rid of the fax machine for prescriptions, allow pharmacists to prescribe even more (they already gave pharmacists a fair bit of prescribing power during the last term), and expand the number and role of PAs. We'll see how quickly they actually follow through — and I'm sure it won't be enough to fix the doctor shortage in BC.
posted by ssg at 12:48 PM on October 30 [2 favorites]
posted by ssg at 12:48 PM on October 30 [2 favorites]
I’m fascinated that Canadian doctors are fleeing to the US. I have medicine filed in my head alongside police work as one of those professions with extremely high mental health risk attached. I thought that must be the result of American dysfunction, but if people are coming here on purpose to practice, maybe not.
posted by eirias at 1:01 PM on October 30
posted by eirias at 1:01 PM on October 30
give the the patient a copay credit for half an hour at wage hours. Half an hour for a doctor? Pay the doctor at doctor hours.
Copay? We ain't talking about the US here. We don't have copays when we go to the doctor.
posted by Kitteh at 1:05 PM on October 30 [5 favorites]
Copay? We ain't talking about the US here. We don't have copays when we go to the doctor.
posted by Kitteh at 1:05 PM on October 30 [5 favorites]
Apropos of this whole conversation, two years ago, when I finally got a family doctor in Ottawa after living here for 4 years, she referred me to a dermatologist within the first few weeks to address an awful rash on my face.
The dermatologist's office called me *checks phone* at 10:26 this morning.
Now, I am certain that would have come in faster if she had referred me for a cancer screening, but still. 2 years.
posted by jacquilynne at 1:21 PM on October 30 [7 favorites]
The dermatologist's office called me *checks phone* at 10:26 this morning.
Now, I am certain that would have come in faster if she had referred me for a cancer screening, but still. 2 years.
posted by jacquilynne at 1:21 PM on October 30 [7 favorites]
Theoretically there’s useful documentation only the doctor can do, which should be allowed for in a doctor’s schedule, and then… everything else, which the doctors probably shouldn’t be doing and which possibly shouldn’t be done.
Getting rid of sick notes would be a good step. While we're at it let's get rid of pharmacy pre-authorization. I can't of anything more useless than denying coverage until your doctor fills out paperwork to says "Ya, I really meant it when I prescribed it".
posted by Mitheral at 1:22 PM on October 30 [6 favorites]
Getting rid of sick notes would be a good step. While we're at it let's get rid of pharmacy pre-authorization. I can't of anything more useless than denying coverage until your doctor fills out paperwork to says "Ya, I really meant it when I prescribed it".
posted by Mitheral at 1:22 PM on October 30 [6 favorites]
I’m fascinated that Canadian doctors are fleeing to the US.
There is constant brain drain from Canada in every high-skill profession to the US due to salaries here being multiples higher. An extra 200k a year buys a lot of mental health.
Does Canada have nurse practitioners or physicians' assistants? That's the solution in the US and it works extremely well. You don't need 8+ years of schooling to tell if someone needs antibiotics and order some tests.
I've always found the "everyone becomes a specialist so there is a shortage of general practitioners" kind of suspect. The reason salaries for specialists are higher is that there's higher demand for them. All the specialists are super busy with long waits. People rationally respond to that demand. If there wasn't a shortage of family docs there would be a shortage of heart surgeons. That would kill more people.
There's also the obvious fix of make it easier for immigrants to join the health care cartel. Most would even pay for costs associated with transferring their licenses so you can add tests or a probationary period or whatever gets people comfortable being treated by someone trained abroad.
In the long run health care systems are in crises all around the world, and will continue to be until we find a way to separate the routine care we want everyone to have access to from throwing everything at a 90% dead person on the off chance it makes them better (while enriching drug companies, providers, and hospitals).
posted by hermanubis at 1:22 PM on October 30 [4 favorites]
There is constant brain drain from Canada in every high-skill profession to the US due to salaries here being multiples higher. An extra 200k a year buys a lot of mental health.
Does Canada have nurse practitioners or physicians' assistants? That's the solution in the US and it works extremely well. You don't need 8+ years of schooling to tell if someone needs antibiotics and order some tests.
I've always found the "everyone becomes a specialist so there is a shortage of general practitioners" kind of suspect. The reason salaries for specialists are higher is that there's higher demand for them. All the specialists are super busy with long waits. People rationally respond to that demand. If there wasn't a shortage of family docs there would be a shortage of heart surgeons. That would kill more people.
There's also the obvious fix of make it easier for immigrants to join the health care cartel. Most would even pay for costs associated with transferring their licenses so you can add tests or a probationary period or whatever gets people comfortable being treated by someone trained abroad.
In the long run health care systems are in crises all around the world, and will continue to be until we find a way to separate the routine care we want everyone to have access to from throwing everything at a 90% dead person on the off chance it makes them better (while enriching drug companies, providers, and hospitals).
posted by hermanubis at 1:22 PM on October 30 [4 favorites]
Does Canada have nurse practitioners or physicians' assistants? That's the solution in the US and it works extremely well.
It doesn't work that well, because the corporations that encourage NPs do so because they're cheaper than paying doctors; it's just another form of exploitation at the end of the day.
But yes, Canada has NPs. The problem there is that the brain drain for NPs to the USA is worse than anything else, because although NPs get better compensation than regular nurses, the pay difference between the USA and Canada for NPs is more dramatic than it is for nurses or doctors.
posted by mightygodking at 1:40 PM on October 30 [7 favorites]
It doesn't work that well, because the corporations that encourage NPs do so because they're cheaper than paying doctors; it's just another form of exploitation at the end of the day.
But yes, Canada has NPs. The problem there is that the brain drain for NPs to the USA is worse than anything else, because although NPs get better compensation than regular nurses, the pay difference between the USA and Canada for NPs is more dramatic than it is for nurses or doctors.
posted by mightygodking at 1:40 PM on October 30 [7 favorites]
Last time I visited a NP, ChatGPT was more accurate at diagnosis. But I was offered the requisite antibiotics for my viral infection.
posted by credulous at 1:44 PM on October 30 [4 favorites]
posted by credulous at 1:44 PM on October 30 [4 favorites]
My only exposure to specialists in Canadian health care are through my mother. In the last couple of years she's had her knees replaced and had some laser eye surgery to preventatively deal with cataracts. In both cases the actual specialist was with her for the minimum time required to do their specific operation and the rest was handled by nurses and other doctors. The specialists basically do their high-billing procedure as much as possible and leave the lower billing stuff to others, although that probably comes out of the overhead of their practice.
I don't think family doctors have that high-billing procedure so even when they do things like hire nurse practitioners to do more routine things and run their practice more efficiently the income coming in isn't anywhere near as high as the specialist.
I think the only ways out of this are to train/import more doctors and to increase the fee schedule for family physicians so that their income is a lot closer to other specialists.
posted by any portmanteau in a storm at 1:44 PM on October 30 [1 favorite]
I don't think family doctors have that high-billing procedure so even when they do things like hire nurse practitioners to do more routine things and run their practice more efficiently the income coming in isn't anywhere near as high as the specialist.
I think the only ways out of this are to train/import more doctors and to increase the fee schedule for family physicians so that their income is a lot closer to other specialists.
posted by any portmanteau in a storm at 1:44 PM on October 30 [1 favorite]
The answer is actually very straightforward: make family doctors provincial employees.
The Red Scare-based decisions to compromise and do our fee-based structure instead of making docs public employees was the poison pill when we started this system of health. I think in my lifetime we will get to the crossroad where we will choose between full-public or mostly-private delivery and I don't think it will go well.
You can already see the Danielle Smith UCPs putting their foot down on the accelerator, making the newly Balkanized AHS as bad as possible until they have the social license to sell off the new, smaller pieces to their criminal friends. I can't wait to get out my credit card after I get a stent.
posted by StoicRomance at 1:54 PM on October 30 [7 favorites]
The Red Scare-based decisions to compromise and do our fee-based structure instead of making docs public employees was the poison pill when we started this system of health. I think in my lifetime we will get to the crossroad where we will choose between full-public or mostly-private delivery and I don't think it will go well.
You can already see the Danielle Smith UCPs putting their foot down on the accelerator, making the newly Balkanized AHS as bad as possible until they have the social license to sell off the new, smaller pieces to their criminal friends. I can't wait to get out my credit card after I get a stent.
posted by StoicRomance at 1:54 PM on October 30 [7 favorites]
It's known that's there are problems. Partly it's one of a growing population.
The fixes though all take time. Start a student now and it takes years for them to become a family doctor.
Curiously enough ,even Dougie seems to have realiized this.
They are opening 2 new medical schools.
One at Metropolitan University (Formerly Ryerson) That was announced in 2022 and first cohort starts in September 2025.
another new one at York university will speciifically be focused on family doctors.
" This new medical school will include up to 80 undergraduate seats and up to 102 postgraduate seats starting in September 2028, with up to 240 undergraduate seats and 293 postgraduate seats on an annual basis once operating at full capacity.
By focusing primarily on training family doctors, the York University training model will devote approximately 70 per cent of the new postgraduate training seats to primary care,"
posted by yyz at 1:58 PM on October 30 [3 favorites]
The fixes though all take time. Start a student now and it takes years for them to become a family doctor.
Curiously enough ,even Dougie seems to have realiized this.
They are opening 2 new medical schools.
One at Metropolitan University (Formerly Ryerson) That was announced in 2022 and first cohort starts in September 2025.
another new one at York university will speciifically be focused on family doctors.
" This new medical school will include up to 80 undergraduate seats and up to 102 postgraduate seats starting in September 2028, with up to 240 undergraduate seats and 293 postgraduate seats on an annual basis once operating at full capacity.
By focusing primarily on training family doctors, the York University training model will devote approximately 70 per cent of the new postgraduate training seats to primary care,"
posted by yyz at 1:58 PM on October 30 [3 favorites]
They are expanding the Stay and Learn Grant program 'Starting in 2026, the government is investing an estimated $88 million over three years to expand Learn and Stay grants for 1,360 eligible undergraduate students that commit to practice family medicine with a full roster of patients once they graduate."
That's in addition to the existing programs nursing, paramedics, lab techs.
If you take money for 4 years you have to work 2 years in your region.
They 're not all rural includes Ottawa ,Kingston
There's a lot of little stuff being done as well
this year added 24 more pediatric critical care beds.
add another 3,000 new hospital beds over the next 10 years.
funded the operations for 49 new MRI machines in hospitals across Ontario
Long term care is getting a huge investment.
investing $6.4 billion to build more than 30,000 new beds by 2028 and 28,000 upgraded long-term care beds across the province
Increase in home care
Ontario’s expanded community paramedicine program The program enables paramedics to use their training and expertise beyond their traditional emergency response role.
---
there's lots of stuff . It all takes time .
You'll likely see impacts from from the smaller changes, more MRI, CAT machines, druggists writing prescriptions. renovations additions to existing hospitals first
There's a mind numbing boring bureaucratic article here
Canada-Ontario Agreement to Work Together to Improve Health Care
The first 3/4 is just bureaucratic bullshit. The numbers start about 3/4 of the way down
posted by yyz at 2:27 PM on October 30 [3 favorites]
That's in addition to the existing programs nursing, paramedics, lab techs.
If you take money for 4 years you have to work 2 years in your region.
They 're not all rural includes Ottawa ,Kingston
There's a lot of little stuff being done as well
this year added 24 more pediatric critical care beds.
add another 3,000 new hospital beds over the next 10 years.
funded the operations for 49 new MRI machines in hospitals across Ontario
Long term care is getting a huge investment.
investing $6.4 billion to build more than 30,000 new beds by 2028 and 28,000 upgraded long-term care beds across the province
Increase in home care
Ontario’s expanded community paramedicine program The program enables paramedics to use their training and expertise beyond their traditional emergency response role.
---
there's lots of stuff . It all takes time .
You'll likely see impacts from from the smaller changes, more MRI, CAT machines, druggists writing prescriptions. renovations additions to existing hospitals first
There's a mind numbing boring bureaucratic article here
Canada-Ontario Agreement to Work Together to Improve Health Care
The first 3/4 is just bureaucratic bullshit. The numbers start about 3/4 of the way down
posted by yyz at 2:27 PM on October 30 [3 favorites]
They’re opening three - the third is at U of T Scarborough and is designed around a cool integrated health model where NPs, PAs, and PTs train together in many classes so they form connections and understandings of scope of practice etc.
posted by warriorqueen at 2:39 PM on October 30 [5 favorites]
posted by warriorqueen at 2:39 PM on October 30 [5 favorites]
Making it easier for immigrants who are already doctors and nurses to continue being doctors and nurses would also help, in both Canada and the US. There are a lot of hoops to jump through. Obviously some hoops are good and necessary, but it definitely seems like those pathways could be significantly streamlined!
posted by adrienneleigh at 3:31 PM on October 30 [9 favorites]
posted by adrienneleigh at 3:31 PM on October 30 [9 favorites]
I agree that making it easier for immigrant doctors to return to practice would be helpful, and we shouldn't be admitting professional immigrants because of their profession without also providing a clear and economically achievable path for them to practice their professions but I would also note that draining the third world of their doctors is not exactly an unselfish choice.
posted by jacquilynne at 3:52 PM on October 30 [7 favorites]
posted by jacquilynne at 3:52 PM on October 30 [7 favorites]
Last time I visited a NP, ChatGPT was more accurate at diagnosis. But I was offered the requisite antibiotics for my viral infection.
I do think “mid-level” practitioners are a decent solution to primary care shortages on paper but yeah, it seems like NP training and qualification in particular is very loose right now. And while the principle that lots of things don’t need an MD to treat is solid, the fact that primary care gates access to specialists makes it a problem to fill the role entirely with people who may have the background to catch more unusual conditions or presentations.
posted by atoxyl at 4:20 PM on October 30
I do think “mid-level” practitioners are a decent solution to primary care shortages on paper but yeah, it seems like NP training and qualification in particular is very loose right now. And while the principle that lots of things don’t need an MD to treat is solid, the fact that primary care gates access to specialists makes it a problem to fill the role entirely with people who may have the background to catch more unusual conditions or presentations.
posted by atoxyl at 4:20 PM on October 30
Making it more attractive to be a family doctor is the thing. And aligning that with patients interests. In BC, for example: 700 more family physicians in B.C. since payment revamp: doctors.
posted by lookoutbelow at 6:05 PM on October 30 [17 favorites]
The LFP model, which was launched on Feb. 1, 2023, compensates doctors for the number of patients they see, the complexity of their needs, and the time spent on other necessary tasks like reviewing lab results, consulting with other medical professionals, updating patient lists and clinical administrative work.I've been in a pilot for this for years, and it's a vastly better patient experience. I find my doctor trying to solve as many problems as possible in an appointment (rather than the existing fee for service $30/appointment where they try to keep them below 15 minutes and do a single thing). I'll get a quick call for abnormal lab results instead of having to book. There's no need to book for routine prescription refills, the doctor will just do them on a fax request. The clinic has an on-call doctor (not necessarily going to be a thing for all, but in this case it was a holistic program to try to reduce urgent care visits for patients in this clinic). The doctors actually follow up on referral requests without me rebooking an appointment. They have a reason to handle more patients more effectively than they would in a system where they only get paid for having an appointment. Not all of this will happen just because of payment model, but it's a huge difference.
posted by lookoutbelow at 6:05 PM on October 30 [17 favorites]
I’ll echo lookoutbelow. After the shift in BC my family got assigned a family doctor (after hanging out on the official waiting list for a while). Most people I know here in Vancouver now have a family doctor- and this was not true 2 years ago. So there is a model that works, here in Canada. It’s not perfect, but it’s better.
posted by Valancy Rachel at 6:42 PM on October 30 [6 favorites]
posted by Valancy Rachel at 6:42 PM on October 30 [6 favorites]
FYI Quebec walked back its proposal almost immediately after a public outcry. This is how the CAQ governs, by floating trial balloons.
posted by jordantwodelta at 6:54 PM on October 30 [1 favorite]
posted by jordantwodelta at 6:54 PM on October 30 [1 favorite]
I'm pretty sure when I'm 60 I'm going to have to ask my cat if I can share her vet appointment
posted by credulous at 6:56 PM on October 30 [5 favorites]
posted by credulous at 6:56 PM on October 30 [5 favorites]
The shortage of vets might be more acute than the shortage of doctors, tbh.
posted by jacquilynne at 7:23 PM on October 30 [3 favorites]
posted by jacquilynne at 7:23 PM on October 30 [3 favorites]
I got a referral from a walk-in clinic for mental health. The mental health group got me a family doctor.
Said family doctor is leaving family practice. fml I've got to find someone to continue to prescribe me my psych meds.
posted by porpoise at 10:10 AM on October 31 [2 favorites]
Said family doctor is leaving family practice. fml I've got to find someone to continue to prescribe me my psych meds.
posted by porpoise at 10:10 AM on October 31 [2 favorites]
The LFP model, which was launched on Feb. 1, 2023, compensates doctors for the number of patients they see, the complexity of their needs, and the time spent on other necessary tasks like reviewing lab results, consulting with other medical professionals, updating patient lists and clinical administrative work.
This has existed in Ontario for years, too. This is what I have.
I've had the same-ish family doctor in Ontario for 35+ years now. When I was going through puberty I asked my mom to switch to a female doctor, so we did. That doctor was my doctor through puberty, high school and university. I moved to the U.S. for grad school and would make a point of getting my health care in Ontario from my own family doctor as much as possible whenever I could. Pre-9-11 it was cheaper to get a priceline plane ticket and fly to Toronto for a free vaccine than pay for a vaccine in Massachusetts and I'd get a little vacation out of it, to boot. She got me through major medical problems, fertility treatment, pregnancy, post-natal-care and was my son's family doctor. Then the pandemic and she decided it wasn't fun anymore and retired.
A new young doctor took over her practice. I don't know if she sold it to him or if her practice hired him (she was in a group practice, she was one of the owners. I don't think they were all owners, I think some were employees). Anyway, there's a new guy now, and we had the choice to either have him be our family doctor or not. We watch the news enough to know we sure as hell don't want to give up a family doctor and luckily I like him.
Anyway, it's a group practice (so if he's not in you can usually see or talk to one of the other doctors) and he is on the system where he has patients who are signed up to be his patients and he is paid based on the health/age etc. of those patients, not fee for service. I can usually get advice or an appointment as needed same day or next day. And his group family practice is affiliated with other group family practices and they run their own urgent care clinics evenings and weekends just for patients of those 3-4 clinics, so that's pretty good.
I learned recently that if we go to a walk-in clinic, the fee for service that the walk-in clinic charges OHIP is actually deducted from what he earns. I asked him about this because I've taken my son to walk-ins just so he doesn't miss too much school. He said no problem if it becomes an issue he'll switch my son to fee for service but will still be his doctor.
I'm so grateful to have a family doctor and that they have truly been family doctors for us. My mom, aunt, cousins, etc. are all patients too, which really adds to the depth of knowledge they have and the relationship that's there. I've been through a lot of non-trivial health events and I can't imagine not having someone I trust managing it all and knowing my full history. And i can't imagine a system where you constantly have to switch every time your employer changes or your insurance company decides to make a switch or change a network or whatever. The long-term relationship is so important.
posted by If only I had a penguin... at 10:49 AM on October 31 [6 favorites]
This has existed in Ontario for years, too. This is what I have.
I've had the same-ish family doctor in Ontario for 35+ years now. When I was going through puberty I asked my mom to switch to a female doctor, so we did. That doctor was my doctor through puberty, high school and university. I moved to the U.S. for grad school and would make a point of getting my health care in Ontario from my own family doctor as much as possible whenever I could. Pre-9-11 it was cheaper to get a priceline plane ticket and fly to Toronto for a free vaccine than pay for a vaccine in Massachusetts and I'd get a little vacation out of it, to boot. She got me through major medical problems, fertility treatment, pregnancy, post-natal-care and was my son's family doctor. Then the pandemic and she decided it wasn't fun anymore and retired.
A new young doctor took over her practice. I don't know if she sold it to him or if her practice hired him (she was in a group practice, she was one of the owners. I don't think they were all owners, I think some were employees). Anyway, there's a new guy now, and we had the choice to either have him be our family doctor or not. We watch the news enough to know we sure as hell don't want to give up a family doctor and luckily I like him.
Anyway, it's a group practice (so if he's not in you can usually see or talk to one of the other doctors) and he is on the system where he has patients who are signed up to be his patients and he is paid based on the health/age etc. of those patients, not fee for service. I can usually get advice or an appointment as needed same day or next day. And his group family practice is affiliated with other group family practices and they run their own urgent care clinics evenings and weekends just for patients of those 3-4 clinics, so that's pretty good.
I learned recently that if we go to a walk-in clinic, the fee for service that the walk-in clinic charges OHIP is actually deducted from what he earns. I asked him about this because I've taken my son to walk-ins just so he doesn't miss too much school. He said no problem if it becomes an issue he'll switch my son to fee for service but will still be his doctor.
I'm so grateful to have a family doctor and that they have truly been family doctors for us. My mom, aunt, cousins, etc. are all patients too, which really adds to the depth of knowledge they have and the relationship that's there. I've been through a lot of non-trivial health events and I can't imagine not having someone I trust managing it all and knowing my full history. And i can't imagine a system where you constantly have to switch every time your employer changes or your insurance company decides to make a switch or change a network or whatever. The long-term relationship is so important.
posted by If only I had a penguin... at 10:49 AM on October 31 [6 favorites]
Btw, one advantage to doctors getting paid for their roster of patients not fee for service that I find with my family doc is that he's perfectly happy to do phone consults, send along info by email (over their secure system) etc. I've noticed that other doctors absolutely will not talk to you by phone. It's either in person or their virtual video call appointments.
This is a problem for my mom who doesn't have the tech to do the virtual, so a specialist will set her up virtual and she'll ask to do it by phone but they say if she can't do it virtual she has to come in. It's pretty clear that they only get paid (or get paid as much?) for in person or virtual. And i get it that they don't want to have appointments they're not going to be paid for, but this is really annoying for older people for whom the tech can be a barrier.
It's also annoying when you just have a short quick question and really don't need to set up a whole appointment. I can leave a message with the receptionist and the family doc can just call when he has a few free minutes instead of having to work out a time etc. etc. Since I'm not a brain surgeon or anything I can usually take a break from whatever I'm doing for a few minutes to take the call.
posted by If only I had a penguin... at 11:44 AM on October 31 [3 favorites]
This is a problem for my mom who doesn't have the tech to do the virtual, so a specialist will set her up virtual and she'll ask to do it by phone but they say if she can't do it virtual she has to come in. It's pretty clear that they only get paid (or get paid as much?) for in person or virtual. And i get it that they don't want to have appointments they're not going to be paid for, but this is really annoying for older people for whom the tech can be a barrier.
It's also annoying when you just have a short quick question and really don't need to set up a whole appointment. I can leave a message with the receptionist and the family doc can just call when he has a few free minutes instead of having to work out a time etc. etc. Since I'm not a brain surgeon or anything I can usually take a break from whatever I'm doing for a few minutes to take the call.
posted by If only I had a penguin... at 11:44 AM on October 31 [3 favorites]
Family Health Teams have existed in Ontario for ages. The govt stopped their expansion as the financial model was not scalable. The average gp in a fee for service practice makes something like $250k, out of which they must cover overhead, whereas the average GP in a FHT makes over $400k. I have been rostered with one forever and the level of care and access is exceptional. However they have not been accepting new patients since forever.
posted by sid at 1:35 PM on October 31 [4 favorites]
posted by sid at 1:35 PM on October 31 [4 favorites]
Family Health Teams have existed in Ontario for ages. The govt stopped their expansion as the financial model was not scalable.
Can you clarify, Is it not scalable because they don't want to pay $400K per doctor (so it kind of might be scalable but they're balking at the cost) or not scalable because there aren't enough doctors to provide that level of care to everyone?
posted by If only I had a penguin... at 2:02 PM on October 31 [2 favorites]
Can you clarify, Is it not scalable because they don't want to pay $400K per doctor (so it kind of might be scalable but they're balking at the cost) or not scalable because there aren't enough doctors to provide that level of care to everyone?
posted by If only I had a penguin... at 2:02 PM on October 31 [2 favorites]
The average gp in a fee for service practice makes something like $250k, out of which they must cover overhead, whereas the average GP in a FHT makes over $400k
Why is that? I know this isn't comparable, but the VA here in the US has the equivalent of your one-stop-shop doctors, at least for the women's clinics. I have seen the same general practitioner for the last several years and she has been amazing - but I don't think they're having to pay them particularly high wages, just normal government salaries.
posted by corb at 3:34 PM on October 31 [1 favorite]
Why is that? I know this isn't comparable, but the VA here in the US has the equivalent of your one-stop-shop doctors, at least for the women's clinics. I have seen the same general practitioner for the last several years and she has been amazing - but I don't think they're having to pay them particularly high wages, just normal government salaries.
posted by corb at 3:34 PM on October 31 [1 favorite]
Here in BC a GP who is on a government salary gets somewhere around 300k per year (more if they are paying their own expenses). This is roughly in line with the very highest paid public servants.
posted by ssg at 3:55 PM on October 31 [2 favorites]
posted by ssg at 3:55 PM on October 31 [2 favorites]
Apparently in BC "Under the new framework, the average family physician in B.C. will see a raise from roughly $250,000 to around $385,000." So not dissimilar to the Ontario model described.
There are persistent issues with limited doctor training spots, which is a "not enough doctors" issue.
Not scalable is still a choice, though. BC has been trying to attract doctors from other provinces and internationally (such as running ads in the UK). And I assume wouldn't have been able to pull this off if they didn't offer the new payment model to everyone and make it simple.
posted by lookoutbelow at 3:59 PM on October 31 [1 favorite]
There are persistent issues with limited doctor training spots, which is a "not enough doctors" issue.
Not scalable is still a choice, though. BC has been trying to attract doctors from other provinces and internationally (such as running ads in the UK). And I assume wouldn't have been able to pull this off if they didn't offer the new payment model to everyone and make it simple.
posted by lookoutbelow at 3:59 PM on October 31 [1 favorite]
Why is that? I know this isn't comparable, but the VA here in the US has the equivalent of your one-stop-shop doctors, at least for the women's clinics. I have seen the same general practitioner for the last several years and she has been amazing - but I don't think they're having to pay them particularly high wages, just normal government salaries.
To be clear, none of these are government employees. Virtually all family doctors are in private practice. They bill provincial insurance for care they provide just like U.S. doctors bill U.S. insurance companies for care they provice -- well, not just like -- there are no copays or deductibles or negotiated rates that are sometimes this or sometimes that. There is either fee for service.
So there are a bunch of services and a set of prices for each service that any doctor performing service gets. Or the roster method where family doctors have a roster of patients and are paid based on the number of patients they have and the age and health of those patients. But again, in either case they are in private practice and billing the provincial health plan. They are not government employees.
posted by If only I had a penguin... at 5:48 PM on October 31 [2 favorites]
To be clear, none of these are government employees. Virtually all family doctors are in private practice. They bill provincial insurance for care they provide just like U.S. doctors bill U.S. insurance companies for care they provice -- well, not just like -- there are no copays or deductibles or negotiated rates that are sometimes this or sometimes that. There is either fee for service.
So there are a bunch of services and a set of prices for each service that any doctor performing service gets. Or the roster method where family doctors have a roster of patients and are paid based on the number of patients they have and the age and health of those patients. But again, in either case they are in private practice and billing the provincial health plan. They are not government employees.
posted by If only I had a penguin... at 5:48 PM on October 31 [2 favorites]
NP and PA are not the solution to primary care shortage. They get burnt out even faster than physicians and jump ship to specialities. It happens in our clinic all the time. It is a lot harder to train a generalist and to have a broad differential, which the nature of NP and PA training does not do. Yeah there is stuff you can learn on the job, but there are things I see that are once every few years show up in clinic that you get exposure to being a resident that I have seen seasoned NP miss. It is a lot easier to train a NP/PA to work at a diabetes clinic and adjust insulin levels and medications all day then to train them to manage pregnant women, pediatric patients, geriatric patients, psychiatric issues, and hospital patients at the same time like the docs in the article. My wife did a family medicine residency and went back to do Ob/Gyn residency and the Ob/Gyn can't imagine having to manage a laboring patient and ICU patient at the same, which is something you would have to do in rural/suburban setting like we did. Primary care is not about treating upper respiratory conditions and prescribing antibiotics, but about catching things before they escalate or preparing the patient before they see the specialist that things are easier for the specialist and less work up is required. It's not even about the pay, but the utter lack of respect by the system for primary care and its role. Unfunded mandates for paper work allow people to make up stuff without thinking whether it will actually help with fraud or protect patients. I really wanted to womb to tomb care in the US, but the rural health system was destroyed by lack of desire to finance similar to the Canadian article. I know many doctors who would take a pay cut if their lives and patient lives were administratively easier, but frequently the salary cuts go to administrators or get redirected to other projects as I saw in the county health system I worked at.
posted by roguewraith at 6:48 PM on October 31 [6 favorites]
posted by roguewraith at 6:48 PM on October 31 [6 favorites]
....the utter lack of respect by the system for primary care and its role.
In am USian and not Canadian, but this rings true down here, too.
I have talked to a couple of doctors about my son's medical ambitions, and we all smilewryly bitterly at the disconnect between "he wants to be a doctor to help people...but he'll probably be a specialist" and the reality that no one (including MDs) can find a primary care doctor.
posted by wenestvedt at 6:59 AM on November 1 [1 favorite]
In am USian and not Canadian, but this rings true down here, too.
I have talked to a couple of doctors about my son's medical ambitions, and we all smile
posted by wenestvedt at 6:59 AM on November 1 [1 favorite]
Can you clarify, Is it not scalable because they don't want to pay $400K per doctor (so it kind of might be scalable but they're balking at the cost) or not scalable because there aren't enough doctors to provide that level of care to everyone?
I believe, at the time (I think it was over 10 yrs ago that they paused the expansion) it wasn't so much that they didn't *want* to pay, it's that scaling it up would have required the province to rejig the whole budget / health system, and potentially do one or more of 1) reduce budget of places like hospitals 2) renegotiate canada health act 3) raise taxes significantly 4) take the money out of other areas (Education, health, infrastructure are main provincial expenditures). It wasn't politically possible to do any of those things at the time so it was 'put on hold'. I believe that FHTs were originally designed to suit the highest-need patients, but then, in implementation, anyone could join an FHT and they were very popular.
Now, time has passed, and I believe paying GPs much more is more economically / politically viable, but I don't believe a model for scaleup of team-based care has been landed on in Ontario just yet.
posted by sid at 8:54 AM on November 6 [1 favorite]
I believe, at the time (I think it was over 10 yrs ago that they paused the expansion) it wasn't so much that they didn't *want* to pay, it's that scaling it up would have required the province to rejig the whole budget / health system, and potentially do one or more of 1) reduce budget of places like hospitals 2) renegotiate canada health act 3) raise taxes significantly 4) take the money out of other areas (Education, health, infrastructure are main provincial expenditures). It wasn't politically possible to do any of those things at the time so it was 'put on hold'. I believe that FHTs were originally designed to suit the highest-need patients, but then, in implementation, anyone could join an FHT and they were very popular.
Now, time has passed, and I believe paying GPs much more is more economically / politically viable, but I don't believe a model for scaleup of team-based care has been landed on in Ontario just yet.
posted by sid at 8:54 AM on November 6 [1 favorite]
« Older Blood mixed with soil, then. | Mary River cod log trial an absolute dream come... Newer »
Having a family doctor and regular preventative health care was such a revelation when I initially moved to Canada from the US. It’s quite frustrating that politicians are moving away from that model. Especially since most Canadians want to keep it, from the reporting I’ve read before at least.
posted by eviemath at 8:48 AM on October 30 [9 favorites]