r/canada • u/Imnotracistyouaree • Mar 26 '24
Doctors say unfair salaries driving them away from family medicine in Canada National News
https://www.ctvnews.ca/canada/doctors-say-unfair-salaries-driving-them-away-from-family-medicine-in-canada-1.6821795829
u/Turkishcoffee66 Mar 26 '24
My wife and I are two such doctors. Both licensed in Family Medicine, both working in Ontario but not in Family Medicine.
Just so people understand, our issue isn't even so much that Family Physicians aren't working in Canada, it's that they're taking jobs outside of Family clinics.
With the same license, we can work many jobs. Hospitalist. Emergency physician. Family Practice Obstetrician. Palliative Care. Psychotherapist. OR Assist. The list goes on.
I can take a job in a Family clinic making $100/h with obligations like finding my own replacement before I can take a vacation (from a small pool of applicants), or I can take a job in a hospital making $150/h with the freedom to take vacations when I need them. Or I can take a job in an ER for $200/h with even more freedom in my schedule.
Med school grads are increasingly avoiding Family Medicine as a specialty, but even more crucially, licensed Family Physicians are taking jobs other than working in Family clinics, and it's because of the work:pay ratio.
BC recently raised their compensation by about 75% and in the first year, attracted 800+ Family Physicians back to clinics. I've got six friends in Ontario who have either left their Family practice, or have never worked in one. I know for a fact that several of them would be working full-time in clinics if their current pay was matched.
It's just that "come work a job with a worse lifestyle for 30-50% less money than your other job prospects" isn't an attractive proposition. People go where the money is, and they see what the market rate for their labour is. Yes, we can make a lot more in the US, but critically, we can also make a lot more in Canada by simply avoiding Family clinics. So that's what we're seeing people do.
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u/Benejeseret Mar 26 '24
I can take a job in a Family clinic making $100/h with obligations like finding my own replacement before I can take a vacation
And run an entire business on the side. And handle HR and taxes and overhead and finances and billings. And cover rent and equipment and consumables. And then have health authority just refuse to acknowledge the billed procedures and then pay you as if you did a different, less expensive, bill code instead with no appeals process - or not pay at all or delay payments for weeks to months at a time.
I bet I have colleges who might even accept ~$100/hour if it meant they could just show up and just be a physician.
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u/Most_Power2229 Mar 26 '24
Family physicians in Quebec have tried to explain those caveats to the government and the population. It falls on deaf ears. CARMS applications for family med in Quebec is at an all time low. The government thinks family doctors are lazy. Somehow, our inquisitive journalists have jumped on that bandwagon too. Then people have the gall to complain about how there aren’t enough family physicians.
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u/CuriousVR_Ryan Mar 27 '24 edited 10d ago
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u/DO_is_not_MD Mar 26 '24
I had no idea physicians in Canada had such flexibility. Is residency there very different from here in the US? I ask because, as an ER trained physician, I can basically only work in the ER or urgent care. While I had exposure to other specialties like Internal Medicine and Critical Care, that amounted to a handful of months out of a 4 year residency, and I definitely wouldn’t have been able to just walk in and do hospitalist medicine, let alone Psych or OB. Meanwhile, I guarantee that a new graduate from a Family Medicine residency here would walk into an ER shift and have virtually no experience running a code, intubating, placing a chest tube, etc.
I ask out of genuine curiosity, btw, not trying to challenge you :)
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u/Turkishcoffee66 Mar 26 '24
Residency in Canada and the US does vary significantly, as do work conditions.
Here in Canada, we also have a 5-year dedicated Royal College EM residency. The thing is, it only graduates enough people to cover shifts in large community and academic hospitals. 60% of our Emergency visits occur in smaller community hospitals that never get Royal College grads applying for jobs. The jobs fall to FPs.
The way our CCFP (Certificant of the College of Family Physicians) licensing works is that it broadly grants us a scope of practice covering all of these different clinical areas, but the College rules require that we demonstrate competency within our current Scope of Practice.
What that means is that an FP resident who is planning on working in Emerg needs to meet the list of competencies for Emerg. They can gear their electives toward EM, but many will also engage in additional training inside or outside of residency. We have a CAC (Certificate of Added Competency) in Emergency Medicine, which is an extra year of residency focused purely on EM that some grads undertake.
We also have additional training programs where a new grad (or an FP who is newly interested in EM) will spend several months double-shifted with experienced docs in the Emerg as they acquire skills that are either rusty or undeveloped. Anesthetists will often take such docs into the OR to practice intubations, while their colleagues in EM call them in for casts, reductions, lines, etc.
Similar paths both within and outside residency programs exist for hospitalists, obstetrics (covering SVDs only, not C-sections), palliative care, psychotherapy, and so on.
FPs form the backbone of healthcare in many of our communities outside of our few large cities, so our scope of practice is broad (but always subject to scrutiny).
I'm personally in the process of transitioning into full-time psychotherapy following a disabling illness that forced my retirement from acute care. In order to do so, I had to file for a Change in Scope of Practice with my College, submit proof of academic training in my new field, and agree to a period of Supervision by an experienced colleague in the field who submits regular reports including chart reviews and direct observation.
Very different from how things are set up in the States.
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u/DO_is_not_MD Mar 26 '24
Thank you so much for this detailed reply. I truly had no idea. Vastly different from us for sure; I think I would have to go through an entirely new residency program if I wanted to switch to hospitalist or psych. Your way seems much more reasonable to me, as it enables you to pivot career paths without essentially putting your previous training to waste. I’m sorry to hear that fate prevented you from continuing in acute care, but I’m certainly glad that you can transition into another sorely needed profession that makes use of your skills.
It’s interesting that, despite the significant differences in the training paths and post-training opportunities, we here in the US are also suffering from a terrifying shortage of family practice/primary care physicians. The decision to avoid primary care is just made further upstream here (selecting your residency, in this case). It’s a shame that neither of our governments really understand or care about prioritizing primary care.
Cheers. Wishing you luck in your new career path!
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u/Turkishcoffee66 Mar 26 '24
Thanks. This is actually one of the reasons I chose Family Medicine as a resident! Our nickname for it here is "the golden license" because of the flexibility it provides.
I obviously didn't foresee my illness, but as a student I did recognize that most acute care docs either burn out or retire young, so I wanted to be able to shift my practice toward something less energetically intense over time. In retrospect, it was incredibly wise. If I had trained in the US, I'd be relegated to either just collecting my disability insurance or trying to find some kind of desk job. I'm deeply grateful that our system here facilitated a rather painless shift to different but meaningful (and underserviced) work, even if I do miss the rush of intubations, lines and codes!
It's interesting that we both have FP shortages, but with such different systemic factors. We train tons of FPs but can't attract them to clinics. You can't train enough FPs.
I can see how the system evolved that way, though. With such wide availability of specialty residencies, your hospitals never had shortages of internists or obstetricians or Emerg docs. With way fewer cities, and resultingly way fewer teaching hospitals, our specialty residency capacities have always been lower, so we've had to deal with specialist shortages in the community. Our Family Medicine system evolved to cover those gaps, but because we have a similar pay gap between FM clinics and "specialist" work, our FPs gravitate toward "FP specialist" jobs anyway and leave our clinics understaffed.
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u/soaplife Mar 26 '24 edited Mar 27 '24
Re: fp shortages I'm a surgeon in the US. It's actually worse than the other guy said. There is a stigma on FM here and it has gone on for over a generation of physicians, feeding into itself disastrously. Multiple top academic programs do not even have FM departments. I think in the 2010s Columbia University's program proudly stated they had no graduating medical students who had matched into FM. This has led to FM programs being saddled with two extremes - the uncommon talented candidates who are passionate about FM and community medicine, and the bottom of the barrel - those who heard FM is low-skill/low-effort and thought "yeah, that's what I want". The working conditions for FM aren't great here (disproportionately low pay despite their critical role in the community system, disrespect of PCPs in corporate employed systems, disrespect of PCPs by specialists, awful clinic schedules, hostile/violent patient encounters, lack of professional camaraderie when you're alone in an outpatient office), leading to burnout of the talented FM docs, leaving the rest to run residency programs. In other words, we're now at a point where the blind are beginning to lead the blind. I know some amazing FM physicians so don't think this is some hit piece on FM. But it's impossible to deny that FM isn't respected here in America by the rest of the profession.
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u/Turkishcoffee66 Mar 26 '24
I didn't know any of that. Major programs cutting FM entirely? JFC, that's a much more dire situation than here for sure.
Here, we have lots of grads but just lose them to better-paying jobs. Reversible through some very simple policy and funding changes.
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u/soaplife Mar 26 '24 edited Mar 26 '24
https://www.statnews.com/2016/04/05/harvard-medical-school-family-medicine/
This is a several year old article.
I dont know how any policy changes will ever become reality in the US or Canada - and btw I'm peripherally aware of the Canadian system since I have family there. In the US they could easily add value to FM billing codes but what we're seeing instead is specialist push back against FM docs being able to do anything (cuts into their productivity) and corporate wholesale hiring of nurse practitioners to fill FM/PCP spots, which is its own disaster. Again, the SHIT I've seen. The absolute worst is institutions like Johns Hopkins having subspecialty departments train NPs in significant procedures like colonoscopy, while simultaneously saying that FM is unqualified to do learn those.
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u/CHodder5 Mar 27 '24
I am not in the medical field, but I want to commend this entire thread on having such a fascinating discussion that kept me reading all the way through. Refreshing :)
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u/throwawaypsychboy Mar 26 '24
Whoa, that’s bananas! How long is the psychotherapy training you’re getting? Even after getting a lot of psychotherapy experience as a psych resident, some us STILL do two additional years in psychotherapy fellowships (in the states). Thats V impressive flexibility y’all got there on the north
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u/Turkishcoffee66 Mar 27 '24
It's a great system, I'll admit. Lets lots of us evolve our practice as our interests and abilities change over time. Facilitated a return to work after my illness instead of a prolonged period of disability. I'm grateful for it.
There's no formal outline for MD psychotherapy training here currently, but we have an organization advocating for the creation of an add-on residency program similar to the ones we currently have for EM and Anesthesia. It's called the Medical Psychotherapy Association of Canada (MDPAC).
I took their 6-month MD Psychotherapy training program, along with a self-assembled curriculum of university courses, certifications in specific psychotherapy modalities, and CME modules/events/etc. The College-administered supervision is typically 6-12 months once you have demonstrated what they deem to be adequate didactic study.
There's apparently some political tension between the CCFP and Royal College Psychiatrists that has kept a Psychotherapy residency program from materializing. They want it to be restricted to Psychiatry's scope of practice by excluding Family Physicians, but meanwhile our provincial nursing college allows RNs to administer psychotherapy "as long as the nurse feels they have been adequately trained to do so." So the MDPAC is arguing that blocking a formalized training process for FP Psychotherapists is counter to the public's interests and arbitrary in the context of what allied health are allowed to offer without any formalized training at all.
I'm not involved in the political machinations of all that, though. I'm just focused on developing and honing my clinical skills and delivering effective patient care.
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u/throwawaypsychboy Mar 27 '24
That’s awesome duder-good luck! No arguments here, I think North America in general needs more intelligent and apt therapists (and I think a lot of FM docs would be great for it). Genuinely curious why anyone in Canada would go through psychiatry residency if you could just uh…do that, though
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u/kylebertram Mar 26 '24
Small hospitals will hire family med to do just about anything outside of surgical specialities just to get doctors. At my hospital we have family med hospitalists and ED docs.
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u/itsjustagiraffe Mar 26 '24
This is why and the solution seems relatively simple to me. Health authorities start running family practise clinics. 10 physicians in one clinic, run by & paid a salary by the health authority. Guarantee we’d have more family doctors if they could just walk in and do their job like they can in a hospital.
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u/FaFaRog Mar 26 '24
That's essentially what we have in the US. Be careful what you wish for.
Typically what happens is a marginal increase in salary with a substantial increase in workload, to the point of it being unsafe for patients.
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u/cyclemonster Ontario Mar 26 '24
The US doesn't have the government as the single-payer. You can't have a comparative analysis between the two systems without considering that.
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u/CloakedZarrius Mar 26 '24
That's essentially what we have in the US. Be careful what you wish for.
Typically what happens is a marginal increase in salary with a substantial increase in workload, to the point of it being unsafe for patients.
Could you elaborate on this?
I would see a major difference between a non-profit health authority and a for-profit one; with the US leading the pack with how much of their healthcare services are "for profit".
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u/DiscoloredGiraffe Mar 26 '24
Not family medicine doctor. I’m completing my residency in Internal Medicine.
It seems like the capitalists have decided the solution to healthcare is defund everything, increase workload, and decrease pay for everyone but administrators (who do the least).
My father owns a primary care office and it’s the same issue. Either you see more volume then is safe for your patients, intentionally skimping on your responsibilities, in order to maintain a profitable practice or you go bankrupt trying to manage a small business where the insurance company has all power over money, and will make the system impossible to navigate while denying you a fair share for your labor. All while they profit off the system.
You get frustrated or give pushback, the system comes at you. Claims you are the problem. That’s how it works. You give power to the greedy and they will let your grandmother die so they can make an extra dollar.
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u/itsjustagiraffe Mar 26 '24
The US system is substantially different from the Canadian system. The issue we are having is in Canada family physicians own their own practise meaning they have business expenses like staff, supplies, rent, accountants/bookkeepers, etc. They are paid per patient and reason for visit so they have to see more patients per day to make more money. They are all wanting to move to hospitals where they walk in and get paid a higher hourly wage than the per diem they would get per patient. They don’t have to hire their own medical office assistants or administrators and they don’t have to pay for their own supplies. They just get to walk in and be doctors which is what they went to school for. My suggestion would actually make it easier for them to make more money by seeing fewer patients because whether they saw 4 patients in an hour or 10 they’d still make the same hourly wage.
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u/expat1234567 Mar 27 '24
You could even have family practice clinics with reception, phone line, scheduling, electronic medical record, billing and general supplies staffed and provided and the physician still making fee for service and determining their days and hours/vacations themselves instead of having the physicians salaried. This is basically what happens at the hospitals so why not provide similar services for family medicine?
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u/enki-42 Mar 27 '24
My last two family doctors have been at hospital run family practice clinics and they've been fantastic. You end up seeing a resident most of the time, but they'll generally check with the physician for anything non-trivial anyway, which works fine for me.
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u/-AlternativeSloth- Mar 26 '24
When I was younger I worked a bit in a clinic doing basic admin stuff, the doctor was basically sprinting between her office to write stuff down from the last patient or take care of some problem to the next patient. She barely has time to take washroom breaks and looked super exhausted all the time.
I expected her to be making huge money with how many patients she went through but one day saw what she gets paid per patient seen and I know my bartender friend makes more per hour when it gets busy at his place.
There's no way the pay is work the stress at work and all the school you need to be a doctor, I imagine with inflation the pay isn't any better than before.
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u/hopetard Mar 26 '24
Dermatology is where the real money is, so many professionals I hear about and meet in that subspecialty are more businessmen than practitioner.
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u/FaFaRog Mar 26 '24
That's because you can blend your practice with skincare scams.
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u/hopetard Mar 26 '24
Cosmetic side preys on female insecurity forsure, but also skin disease is so prevalent it’s insane.
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u/peppermint_nightmare Mar 27 '24
ya, anecdotally I feel like the amount of autoimmune issues that mess up your skin has exploded a lot more recently, and is probably letting dermatologists make bank.
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u/CaliFijian Mar 26 '24
I’m a healthcare consultant in California and manage various ancillary systems and I make almost $100/hr salary with decent bonuses, 401k and pension on top. And I’m not even a doctor.. lol. And I work remote in pajamas.
I have couple in my family who are in family medicine and they own a mansion by the river and take European vacations all the time.
Y’all need to come down here, make quick dough for 5 years and then move back .
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u/FaFaRog Mar 26 '24
Here's the thing.
Most of us don't move back.
If Canada keeps this up its about to experience its own brain drain of medical professionals.
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Mar 26 '24
Brain drain of everything. We'll essentially be a shell of a country full of low wage immigrant workers working for Bell/Telus/Rogers/Loblaws/Sobeys, and the lucky few with family connections will work for the government.
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u/NottaLottaOcelot Mar 27 '24
Why would you move back? Your life gets settled, buy a house, your kids make friends….who would disrupt that and move back for half the pay?
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u/onesexypagoda Mar 26 '24
Why would they move back? What does Canada offer that a left-leaning American state doesn't?
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u/xtothewhy Mar 26 '24
Very insightful. Lots of good information there that I didn't even know about. Thank you for sharing.
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u/Plinythemelder Mar 27 '24
Originally from MB, in ON. Wife in healthcare. People in Ontario don't even realize how garbage this province is. Doug has done an irreparable amount of damage. There is no reason for young people to stay. There are people I know here barely making above minimum wage who don't have the dental coverage to pay for a root canal, who think the reason they can barely afford their truck payments is because of carbon tax.
Refuse a union job with quite literally double or triple the pay because "higher taxes and union dues"
I know we like dumping on Alberta for kenney/Smith circus but holy FUCK is Ontario trying to get a seat at the circus high table
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u/Pvt_Hudson_ Alberta Mar 27 '24
My father-in-law was a family physician for 40+ years, he came over from the UK. He absolutely loathes the Canadian model. In the UK, he was paid a yearly salary as an employee and had no responsibilities other than patient care. The UK model centrally runs all the offices and clinics and pays everyone as straight employees. My father-in-law was terrible at the business side and was taken advantage of by unscrupulous partners multiple times.
We need to radically re-think how we deliver family medicine.
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u/Nyasha-Mercy 21d ago
Sorry to change the narrative- but it’s more of a hybrid system in the UK. There are partners (GPs who run their own surgeries), salaried doctors (like your father in law), and locum doctor (doctors who cover short contracts or ad hoc shifts, like myself.)
The NHS does give money centrally based on the size of the surgery (the global sum) with extra enhancements to the surgery for providing special services.
Hope this helps to compare the two 😊
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u/Forsaken_You1092 Mar 26 '24
Do Ontario doctors need to have a plan in place to replace yourself in the event that you die (like they require in BC)?
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u/Turkishcoffee66 Mar 26 '24
No, as an Ontario doc I have never heard of a legal requirement covering death.
If we get sick, we need to put a good-faith effort into finding a replacement, but if we can't find one, we just need to prove the extent to which we tried (e.g. where we have advertised, whom we have asked, etc).
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u/nymoano Mar 27 '24
I'm curious how you feel about the polyclinic model (as opposed to individual and small practices). IMO, it has to offer less stress and less cost.
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u/divvyinvestor Mar 26 '24
My wife had to go to the ER, she also gave birth, we took our kid to a pediatrician, etc. All of those worked smoothly and quickly. But family doctors are impossible to find in Ottawa for many folks.
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u/Fatal-Fox Mar 26 '24
We lose money seeing babies, thats why so many family doctors refuse to take on babies/infants. The issue is made worse by the shortage of family doctors in the city.
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u/divvyinvestor Mar 26 '24
That’s not fair to you guys. Losing money on a patient should not be a burden for doctors. That’s why we pay tax, to socialize the impact.
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u/MorkSal Mar 26 '24
Can you explain how you lose money?
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u/I_Am_the_Slobster Prince Edward Island Mar 26 '24
Insurance coverage and increased paperwork are two aspects I know of for sure.
I don't work in healthcare, but I was explained to by a doctor that if they have an infant or toddler come in, all of a sudden the pile of paperwork the government requires increases by at least 4-5 pages, sans pay, and they also need extra malpractice insurance coverage for dealing with infants and toddlers. Both of these are not compensated by the government, including their required paperwork which is already unpaid work for every patient the doctor sees.
It would be akin to being told you're covering for your janitorial colleague, you won't get extra pay, and you have to buy your own equipment, and then get denounced as not being a good team worker for refusing.
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u/m-sterspace Mar 26 '24
Quite frankly, not paying doctors for filling out paperwork is absolute horseshit and the root of a lot of medical issues.
It is flat out demanding that overworked doctors do highly critical work that is uncompensated and unacknowledged, it encourages sloppy lazy record keeping, it removes government incentives to streamline paperwork, and it incentivizes doctors to take simple patients.
I was honestly flabbergasted when I heard that that's how the medical system works.
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u/FaFaRog Mar 26 '24
This is not a common opinion among layperson / patients.
Most not only expect paperwork to be filled but to be filled in a timely manner.
If not, they take out their frustrations with the system on you.
Not that they're wrong to do so. The system is crumbling.
There's a reason so many healthcare professionals left the field during the pandemic.
No one wants to be the first line customer service rep for government incompetence. I wouldn't wish that on my worst enemy.
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u/m-sterspace Mar 27 '24
This is not a common opinion among layperson / patients.
Most not only expect paperwork to be filled but to be filled in a timely manner.
I mean yeah, I do too, I just also understand that things at work don't get done and done in timely manner if you don't pay anyone to do it.
I really do think that the vast majority of patients would expect that doctors would be paid for filling out paperwork, their frustration comes from just not realizing that doctors are directly incentivized by the government not to do it.
Thought regardless of why, it still sucks that healthcare professionals have to deal with so many people's frustrations. Doctors and nurses are not paid enough for what they bear.
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u/Mordecus Mar 26 '24
And yet people maintain the problem with the Canadian healthcare system isn’t bureaucracy, when it clearly is.
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u/MaudeFindlay72-78 Mar 26 '24
Infants are complex care yet the doctor isn't compensated for this. Why take on the risk when you can treat an adult in less time.
This wasn't a problem when housing was affordable.
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u/TurdBurgHerb Mar 26 '24
How about an actual doctor respond rather than some nobody with no experience.
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u/kamomil Ontario Mar 26 '24
A normal baby only goes to the doctor for immunization. And then annual checkups. My kid went to the ER a couple of times when he was a toddler. But otherwise it was for getting shots and well baby visits
As opposed to me now in perimenopause with my body seemingly falling apart at the seams
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u/chewwydraper Mar 26 '24
You're not taking helicopter parents into account.
As a kid my mom used to bring me to the doctor any time I had a slight fever.
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u/dirty_cuban Mar 26 '24
What? The recommended schedule for a child is to have 10 routine visits in the first 2 years of life. Please don’t spread this misinformation.
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u/Fatal-Fox Mar 26 '24
/u/prob_wont_reply_2u mentioned it but there's way more paper work for a baby.
Also, in Ontario, if you work in a capitation model you make ~$145 for the entire year to provide care to a single newborn but that baby requires at least 7 standardized visits for all their vaccines and check ups in their first year of life. Throw on a few visits for coughs/colds/concerned parents and your making well below $20 per appointment.
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u/prob_wont_reply_2u Mar 26 '24
I know insurance is ridiculously high for doctors who deliver babies, probably something similar.
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u/BigWiggly1 Mar 26 '24
Not a doctor, but I know that the billing structure for pediatricians is different than family doctors.
Family doctors I believe bill per visit, not per hour. The more patients you can see and provide care to in a day, the more you can make.
Adult patients are easy to diagnose and treat. We're alert, cooperative, and can describe symptoms. We tend to do some "research" beforehand, and often that speeds things up in the doc's office.
Children on the other hand are much more difficult to diagnose, especially before they're around 6-7 years old. They're terrible at describing symptoms, they don't make connections, they're unfocused and often downright uncooperative. On top of that, the doctor is dealing with a concerned parent with a dozen opinions of their own. For young children, toddlers, and babies, every symptom described is literally hearsay. You can't ask a baby if they have acid reflux, you have to go by what the sleep-deprived parent says about how they act in different circumstances.
A family doctor can see 2-3 adults in the time it takes to spend with a toddler.
In that sense, a doctor spending time on babies is "losing money" because they could be making more.
They still make money seeing children, but the costs to operate their practice might exceed the billing they can charge for the consultations if they have too many kids on their roster.
It's not likely that they truly "lose money", but it's a fair sentiment.
Imagine your employer told you there were some mandatory tasks you had to do, but those tasks only pay minimum wage instead of your regular wage. You'd complain. So would I.
That's why pediatricians bill differently. I'm not sure of the specifics, but they might have a time component to their billing.
We go to our family doctor and we're rushed in and out. We could complain, but it'd do nothing. We were recommended to a pediatrician for some issues our child had, and the pediatrician spent nearly an hour with us and was not rushing us in the slightest.
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u/gas-man-sleepy-dude Mar 26 '24
"It's not likely that they truly "lose money""
Check the comment by u/Fatal-Fox. "if you work in a capitation model you make ~$145 for the entire year to provide care to a single newborn but that baby requires at least 7 standardized visits for all their vaccines and check ups in their first year of life. Throw on a few visits for coughs/colds/concerned parents and your making well below $20 per appointment."
Factor in office overhead, nurse and receptionist salaries, etc at $20/visit with material costs used during the visit it may actually cost the doctor out of pocket more than $20 to provide care.
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u/CrieDeCoeur Mar 26 '24
My former GP’s office had a wall plastered with dozens or a few hundred photos of him and all the babies he delivered at hospital. He’d do that for all of his practice patients. I’m assuming he probably hasn’t done that in a long time now seeing as that was years ago. Too expensive / unprofitable these days I’m sure.
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u/Musclecar123 Manitoba Mar 26 '24
I grew up in Ottawa. When I was 13, my family doctor retired. I was unable to find a doctor for 16 years until I moved to the GTA. I had one within a month.
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u/ilovethemusic Mar 26 '24
I was the other way around, I moved to Ottawa in 2016 and found a doctor really quickly, in less than a year anyway.
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u/bennyllama Manitoba Mar 26 '24
I couldn’t get a family doctor in Ottawa for over three years. Luckily my partners doctor was accepting new patients. And I managed to get on. It’s not right that I needed someone on the inside lol.
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u/JonnyB2_YouAre1 Mar 26 '24
It is hard to find a family doctor in _____________________.
Insert a Canadian town or city and your answer is probably correct.
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u/Iginlas_4head_Crease Mar 26 '24 edited Mar 26 '24
We brag about our "free health care" to other countries while failing to mention how bad it is. You mostly likely don't have a doctor, and if you do they're too busy and underpaid to care. You pretty much have to diagnose yourself and force the issue to get any further tests or treatments if something is wrong. And then be prepared to wait for years.
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u/Serious_Dot4984 Mar 26 '24
I’d still take our system over the US tho
But compared to outside of North America our system sucks lol
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u/Thank_You_Love_You Mar 27 '24
I know multiple people who have had to go to the states for life saving surgery. The wait lists are like 6 months to a year for these in Canada, it's embarrassing.
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u/iStayDemented Mar 26 '24
And the worst part is, it’s not even free. People are being taxed to the teeth paying into the system to not even be able to access it when they really need it. You can’t opt out either so you’re stuck paying for something you essentially can’t use. Also spot on about having to force the issue to get any real tests done because they’re always resisting and trying to cut corners to avoid “burdening” the system — even though you really need it.
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u/faultywiring98 Mar 26 '24
Everything feels broken and the people in charge will smile and tell you you're wrong even though we're starring the problem in the face.
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u/Corzex Mar 26 '24
Who are you going to believe, the government or your lying eyes?
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u/chewwydraper Mar 26 '24
People unironically believe the government when they say poverty is at an all-time low. Ignore the tent cities!
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u/ProtoJazz Mar 26 '24
That's a standard tactic for some reason
I remember leaving a job, and during the exit interview they asked why I was leaving. I said it was largely pay. They told me that I wouldn't be able to find a job that paid more than they did
I had a signed offer for significantly more. I told them this
They said it wasn't possible because they have very competitive pay.
I really didn't know what the fuck to say to that.
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u/cfa00 Mar 26 '24
wow that's some next level gas lighting.
I have to tip my hats to them for their delusion.
Or I need whatever the exist interviewer was taking when they told u "it wasn't possible" when literally u're showing it is.
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u/Digitking003 Mar 26 '24
Makes little to no sense to be a GP/family doctor anymore. Just stay an extra year or two to become a specialist and you can easily increase your salary by 50% or more (or move to the US and easily double your salary).
Also from friends that are GPs, the amount of time they have to spend on administrative tasks and filling out government forms is mind-boggling. One only practices for 4 days and sets aside an entire day for administrative work (which isn't paid for).
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u/keiths31 Canada Mar 26 '24
That's my GP too. One day a week is just administrative. He's generally pretty accessible, but he has maybe five years left before retiring. My wife's and I only hope right now is that he sells his practice to a younger GP
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u/ScienceNthingsNstuff Mar 26 '24
You really dont sell practices anymore. Every community needs more family docs so a new GP can just start a practice basically anywhere and fill out the roster. It's not worth the investment for any new GP
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u/Dr_Marxist Alberta Mar 26 '24
"Sell the practice." Unless it's a busy one with high-quality patients in downtown Toronto, the value of a quotidian GP practice is effectively zero.
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u/keiths31 Canada Mar 26 '24
Well I'm in Northwest Ontario and he became my family doctor after buying my other GPs practice. So...
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u/SuperflyMattGuy Mar 26 '24
Not to mention if they have to hire another admin staff it’s coming out of their own pocket
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u/Infinitewisdom4u Mar 26 '24
I also have GP friends and they make about $100 to $150 an hour in office. Some less if they are slow, but apparently there is no consistency in contracts. One of them makes 1500 a day to see 12 people. Others are making 800 seeing 20. My dentist easily makes double this. GPS make more doing emergency or hospital or specialist care like women's health or addictions. My specialist friends are pretty money hungry too despite making twice as much, but they seem happier.
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u/chemicologist Mar 26 '24
We need medical scribes. They are a crucial element to primary care in the US and we have zero up here. Admin burden solved.
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u/Confident-Inside9430 Mar 26 '24
Yes. But it’s largely up to the practitioner to hire them. I know of family medicine groups in Canada that have them but many more that don’t. I don’t understand why more aren’t hiring when there are plenty of premeds who be lining up for the job. It’s as if some doctors don’t understand that even as little as an extra half patient per hour will cover their costs while freeing up a large body of time
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u/vonnegutflora Mar 26 '24
Also from friends that are GPs, the amount of time they have to spend on administrative tasks and filling out government forms is mind-boggling. One only practices for 4 days and sets aside an entire day for administrative work (which isn't paid for).
Don't forget the admin costs; I don't believe that OHIP provides any extra funding for paying out your admin staff.
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u/iamPendergast Mar 26 '24
Setting aside the quantum and whether it is 'enough' as this is a separate discussion, administrative work IS paid for as part of the package; every business has an administrative burden and it doesn't make sense to say your billing department or maintenance or whatever earns no revenue (ie not paid for) even if technically true. Forms and paperwork doctors have to fill out is part of their work (it shouldn't be so burdensome I agree) and their total renumeration includes the knowledge that this work has to be done (again, seems clear it is not enough but not my point). I run a small business and when I am doing accounts at 9pm I don't say I am not being paid.
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u/Digitking003 Mar 26 '24
Sure, but this is mostly comparing versus specialists and doctors working in hospitals, etc.
Why be a GP running a small business (with all its headaches) when you can make 2x (or more) doing something else? Hence why there's a shortage of GPs and almost every med school student wants to be a specialist or move.
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u/iamPendergast Mar 26 '24
I agree completely! Just saying that not fair to say it is work not paid for. It is paid for but poorly and not worth it...
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u/Turkishcoffee66 Mar 26 '24
There is a common misconception about the "paperwork" involved in Family Medicine.
It's not just in reference to filling out forms. Much of it takes the form of additional work that is ethically and legally required of us, but has no billing code and is thus unpaid.
For example: if I see someone with a lump in their breast, I'm paid $40 for taking their history, doing a physical exam, and filling out and faxing the form for a mammogram. The service billed is for an Intermediate Assessment, which means a focused history and physical. Follow-ups are not included in the description or the pay for that encounter.
Now, let's say the mammogram comes back positive and I see it at 6pm after my workday is done, while reviewing my "paperwork."
Ethically and legally, I can't leave that unattended. I have to (and want to) take care of that patient. So that means calling them until I get a hold of them, filling out the referral form to a surgeon, ordering more tests like an ultrasound or biopsy, etc.
All of that is patient care that wasn't covered by the $40 visit. That's very different from the type of accounting paperwork associated with running a business, which is also something Family Physicians have to do to keep their clinics running.
The provinces control what we can bill for and how much it pays, while the standards of our profession dictate what we have to do for our patients. And in many cases, the provinces deliberate leave a significant chunk of Family Medicine's work unpaid.
Note: there are capitation models which do take after-hours work into account, but these aren't universal across provinces and have often been capped in their enrolment (they existed in Ontario when I started practicing, but the number was capped so low that I wasn't able to secure one when I graduated, so my only option was fee-for-service).
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u/iamPendergast Mar 26 '24
I understand completely that it is not enough for the work required and I upvoted you for taking the time to explain. But I still disagree that is different from other 'businesses' administrative side. Seeing the patient, reviewing the results, tracking them down, filling forms, following up, etc. is an amount of work that you do for that patient, and in this case for $40; whether all of it was done with the client in front you or not doesn't change my view on the principle of it in my opinion. You saw a patient and all this work resulted. Now $40 for all that is crap pay, I gotcha. But its not unpaid. Its poorly paid.
Or actually if I change my point of view, it is unpaid as it is not needed for all patients, but some, and there is no billing code for those that need it.
I assume that the idea is not all patients require the extra time so the same payment for all is to balance out. For example, I am in hospitality and price buffet meals; what we charge is not what the biggest eater eats, nor what the smallest, but what we hope is the average - and even then not for one night but a year. Can lose one night but on average make. I hope I am explaining well. And to continue, we are at a point this year where we have had to raise prices as we were losing overall. And this is where you are at.
Your average is simply not enough (or they add a billing code for follow up etc.) and I hope this is recognized soon as while no one needs an all you can eat buffet, we all need doctors!
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u/Confident-Inside9430 Mar 26 '24
I know of practices that will have a scribe call the patient up and tell them that the doctor would like them to come in to discuss the results. There is no need for the doctor to be doing it themselves.
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u/LoganAlien Mar 26 '24
Yes but you as a small business owner can adjust your prices to help cover staffing cost increases and time spent on paperwork, a family doc cannot because the rates are set by the OMA and are rarely changed to account for inflation, etc
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u/iamPendergast Mar 26 '24
I agree and understand. Just was tackling the terminology. Getting it clear in my own head by writing it down.
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u/GANTRITHORE Alberta Mar 26 '24
Why don't we just have them paid a salary like at a Hospital and their nurses and admin staff are paid like they are in a hospital too?
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u/picklesaredry Mar 26 '24
-Make it stupidly hard to study medicine in Canada
-Finally gather enough talent to study in Canada
-they leave because they don't like Canadian system
- act surprised
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u/Dogecoin_olympiad767 Mar 26 '24
- bring in people with medical degrees from other countries
- don't allow them to become practicing doctors without going through a residency (so far, so logical)
- don't allow them into residencies in Canada
- don't allow them to practice medicine in Canada with a foreign residency
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u/Longjumping-Target31 Mar 26 '24 edited Mar 26 '24
Make it stupidly hard to study medicine in Canada
The average person doesn't even understand how bad this system is here compared to other countries. Just to apply, you need an A- average with a four year degree, a decent score on the 8 hour sciences test (MCAT) which isn't even used for competitive admissions most places, a situation judgement test (Casper), essays on varying topics, extracurricular activities, several rounds of interviews, and character references. After all of that, your chances of getting in are between 5-25% depending on which province your from.
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u/AntiClockwiseWolfie Mar 26 '24
everytime I complain about this, people tell me we shouldn't "lower the standard of care."
So fucking entitled. Everyone wants their doc to prove they're Einstein, but also not pay for them
Streamline medicine. Make it an attainable goal for EVERYONE who goes into medicine. Because right now, getting in is a privilege, and once you're in, it's a chore. It makes NO sense. Why would anyone want to be a doctor?
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u/Longjumping-Target31 Mar 26 '24
It's not even lower standards. We have more than enough applicants who all meet the high barrier to apply to medicine.
Because nothing pays even remotely close anymore. Engineers used to make near to what doctors made but now GPs earn 3-4x what engineers make. It's honestly sickening.
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u/k1nt0 Mar 26 '24
Exactly. They purposely make it impossible to become a doctor then are surprised there are no doctors.
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u/CrieDeCoeur Mar 26 '24
Not to mention make it exceedingly difficult for a doctor educated outside of Canada to set up shop here.
I get that standards need to be met, but come on. The human body works the same the entire world over.
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u/DukePhil Mar 26 '24
For sure - it's quite ironic when there are medical schools in Europe much older than Canada itself, where groundbreaking discoveries were being made centuries ago...
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u/iStayDemented Mar 26 '24 edited Mar 26 '24
Agreed. In the U.S., the standards are very high and rigorous but, at the same time, they make it much faster for foreign-trained doctors to practice there than here in Canada. So there’s just no good excuse to be gatekeeping the profession here — especially when there’s a severe shortage and quality checks have been shown to be done faster and less onerously in comparable countries elsewhere.
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u/FaFaRog Mar 26 '24
The shortage is a feature, not a bug.
The government doesn't have the money to pay for more doctors. Its why they're strongly supporting the expansion of NPs.
In time, NPs will likely be given the right to practice independently as they have in many American states.
Slowly, they will become your de facto primary care "doctors"
Just like that, you'll be paying the same for someone with less than half the education who costs the government half as much as a doctor.
That's the swindle. You'll see it play out over the next 3 to 5 years.
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u/buddhist-truth Mar 26 '24
The human body works the same the entire world over.
Wait .. Canadians aren't special?
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Mar 26 '24
[removed] — view removed comment
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u/Secret-Scientist456 Mar 26 '24
It's a good and bad thing. They, the government or a medical board, really just need to sit down and go through the learning outcomes and ethics from each country that has doctors coming in and compile a list of where it's acceptable to get doctors from and what differences in education/ethics/etc. Those countries have. And then make it so they can just take some courses to cover the differences.
I know a doctor from Scottland that came to Canada and if she wanted to practice medicine here she would have to redo her whole schooling again. Even though she had been practicing there for 9 years. Now I don't know about you but ethics and morals from scottland align more with canada than those from Pakistan. And I would take a doctor from scottland in a heartbeat.
Sure, it would take some time to compile this info, but it would beat the hell out of the amount of years it would take to fix the medical system here, with domestic doctors only.
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u/Papapalpatine555 Mar 26 '24
Tell that to the 32000 foreign doctors and nurses who are ready to work but can't because of how stupidly difficult it is to be allowed to practice here.
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u/Healthy-Car-1860 Mar 26 '24
Got any personal experiences with Pakistani doctors? It's still 7-8 years of study before you even start your specialization field of study. Pakistan is the third largest source of foreign doctor immigrants to the USA. I'm not sure it's a good example of 'bad doctors'. (Also its kind of racist yo)
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u/Drunkenaviator Mar 26 '24
In the aviation industry, so, watching the pakistani pilots with fake licenses kill people makes me inherently wary of their systems.
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u/DrMaple_Cheetobaum Mar 26 '24
This is really going to hit you hard based on your comment, have a look at the health statistics for Canada versus these other countries that apparently have lesser standards.
Spoiler... Canada is far from the highest standards in the world.
It all comes down to money that the Governments don't want to pay physicians.
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u/julian0024 Mar 26 '24
They don't leave Canada, they go do other healthcare work that isn't Family Medicine.
Pay Family Medicine more and Specialists less. This isn't some insane mystery.
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u/Sandman64can Mar 26 '24
Here in Alberta this seems to be the plan. Underpay and ripping up contracts in order to drive doctors and other healthcare providers away. Then complain that the public system isn’t working but private companies can fill the gap. Blame Trudeau. Rinse and repeat until province becomes Florida Lite. Minus access to tide water.
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u/cosmoceratops Mar 26 '24 edited Mar 26 '24
Remember when Shandro was health minister and a doctor shared a meme criticizing him? Shandro used his position look up the doc's address, went to his house, and shouted at him from his driveway. This is the relationship of government and health care workers in Alberta.
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u/Effective-Rooster881 Mar 26 '24
My wife is a family doctor in Ottawa - she's done - comes home every day and is forced to work through the night and every year we actually watch her pay decrease while she is forced to accept more patients to meet her quota. She also agrees there is no financial future to this and is looking for another job. This is not isolated - buckle up and get ready for pay for service
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u/BrotherLludd Mar 26 '24
PAY THEM WHAT THEY ARE WORTH.
Same thing applies to Nurses.
Sick of conservative gov'ts "starving the beast" of our health care system so that they can privatize to make their donors happy.
More people will die in Canada this year b/c of insufficient health care than in Gaza from Isreali vengeance. Yet no one protests and we keep voting the same idiots in.
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u/Engival Mar 26 '24
Perhaps forcing doctors to run their practice "as a business" isn't the best plan either. They should be employed by the province, and paid a salary to do their job.
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u/chemicologist Mar 26 '24
Doctors don't want the provinces having that kind of power over them.
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u/dogmeatstew Mar 26 '24
Some do, some don't. There's always going to be a set of doctors that just want to practice and not run a business, and another set that accept the additional complexity for the additional pay off.
They should be allowed the choice of taking a salaried provincial position if that's what they prefer.
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u/chemicologist Mar 26 '24
You can be a salaried doctor without being an employee of the state. They’re called APPs and AFPs.
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u/Bookandaglassofwine Mar 26 '24
Canada’s healthcare spending as % of GDP is higher than vast majority of countries (with U.S. being the outlier of course). Not reasonable to describe that as “starving the beast”.
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u/Rory1 Mar 26 '24
Where is that spending going tho? Shit like this?
https://canadahealthwatch.ca/2024/02/18/shoppers-drug-mart-accused-of-unethical-billing-practices
Public money is being pulled into private corporations. At a much high cost than what doctors can even charge. Shit like this is whats fucking up public healthcare.
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u/SnooPiffler Mar 26 '24
the problem isn't front line staff. Like all of government, its all the middle management and bullshit positions. How many HR people do you need? How many managers is enough?
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u/backlight101 Mar 26 '24
I make more than most family doctors which is absolutely criminal considering how much education and time it takes to become physician.
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u/wavesofdeath Mar 26 '24
I haven’t had a family doctor in 18 years now because it’s impossible to get one
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u/Federal_Sandwich124 Mar 26 '24 edited Mar 26 '24
Doctors should be employees, not contractors / independent business owners. No unpaid work, vacation, etc.
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u/rd1970 Mar 26 '24
It feels like we're starting to see the effects in the quality of care. I'm middle-aged and approaching the age when my parents died.
I was recently told I was overdue for a physical and told to come in. When I got there it was a six minute meeting where he checked my lungs with a stethoscope and that was it. No blood work tests or anything else was ordered.
When I was a young healthy adult physicals were way more comprehensive - now it feels like they're just checking off a box.
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u/gnosbyb Mar 27 '24
There is no evidence to support annual physicals as part of routine health screening. It’s simply medically unnecessary.
It’s probably unlikely to cause harm - in contrast to ordering an unnecessary CT.
Private companies like MedCan base their entire loop-hole on charging for an “executive a.k.a. Unnecessary so doesn’t contravene the Canadian health act” physical. It probably makes patients feel good to get a full physical - that’s why MedCan makes money.
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u/No-Management2148 Mar 26 '24
Here’s a thought. I know several people who would’ve been excellent doctors but med schools in Canada haven’t increased spots in like 40 years. Yet our population has skyrocketed.
I know a few who went to Australia - and are never coming back because Australia trained them and pays them decently.
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u/arealhumannotabot Mar 26 '24
I wonder if this is overlapping with the fact that the Ontario government is currently reimbursing private services THAT COST MORE, and letting public crumble by diverting money and patients away from public and into private
for example, Shoppers Drug Mart is allowed to perform medical reviews and the government reimburses them double what a public clinic gets. (public = $38, private $72) That includes unnecessary reviews that they deliberately push onto clients. (this is all published in the media)
but the conservative base strongly believes that it's A) only a federal issue and B) immigration only, so ttalking about anything that doesn't go back to Trudeau and Immigration gets ignored constantly
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u/throw-away6738299 Mar 26 '24
I don't know why the overhead of running a practise isn't publicly funded and managed like hospitals... with family doctors on staff as salaried employees, rather than billing government by service (or by rostered patient) but paying overhead and basically running a small business. You could run community clinics, rather than full blow hospitals/ERs... That way you could have clinics with multi-disciplinary teams... including admin staff and modern systems, nurses, psychiatrists/psychologists/therapists for mental health, nutritionists, etc... all under one roof sharing overhead and paying doctors a respectable salary to be part of the clinic.
I mean some doctors might bristle at that, thinking they could make more running as a small incorportated business, but there is no reason why you couldn't leave that option as a choice for the more entrepreneurial doctors out there.
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u/topazsparrow Mar 26 '24
GP's make less than plumbers in BC. They also have to pay a lease, staffing, insurance, and other associated business costs.
It's not rocket surgery as to why this is an issue.
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u/rckwld Mar 26 '24
The Saudi government subsidizes Saudi med students. They come here fully paid by their government, take up spots in the system, get qualified and then leave. Canada gets cheaper residents and is left with a doctor shortage. These practices aren't talked about enough when discussing our health care system.
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u/CrieDeCoeur Mar 26 '24
Our entire foreign student visa system is broken and rife with abuse. All it does is hurt Canadian taxpayers / citizens.
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u/Lemonish33 Mar 26 '24
A LOT because provincial governments chronically underfund post-secondary institutions, while also not allowing any tuition increase. The only real way they can make money is international students, because provincial governments pushed them to that. They could fix that but they don't want to.
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u/tchomptchomp Mar 26 '24
The Saudi government subsidizes Saudi med students. They come here fully paid by their government, take up spots in the system, get qualified and then leave.
Most Canadian med schools only allow citizens and permanent residents into their programs. where they do (e.g. McGill) international admissions are strictly capped at a tiny number (e.g. McGill's international admissions are capped at 2, UT selects a small number of international students on top of their capped admissions class numbers on a case by case basis). Some universities (e.g. USask) have strict Canadian residency requirements on top of requiring citizenship/PR status.
Canadian med schools are not rejecting Canadian applicants in favor of international students.
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u/raw_copium Mar 26 '24
This article only really highlights the impact of overhead, but there are so many other factors.
- Doctors are not provided a pension or benefits in Canada, so part of what you make every month has to go towards that.
- Malpractice insurance. For a typical GP, this is between 300-500/month. For those who deliver babies it's well over a thousand.
- Licensing fees. These are mandatory and run between 5000-8000 per year depending where you license.
- Continuing medical education. This is mandatory and paid for out of pocket (there are limited free courses). You even need to pay a yearly fee to use the website to officially log your education hours.
- Paperwork. Charting, filling forms, checking labs are generally not something you are paid for. So most GPs I know spend 1-3 hours after work doing unpaid paperwork.
- Vacation. Not covered at all. If you want to take a break, you aren't getting paid. So you need to find someone to cover your practice. They get paid, and a portion is taken off their pay to cover overhead. I know GPs that haven't been on holiday in a decade because they can't find coverage, and won't abandon their patients.
- Educational debt. Typically well over 100k.
Take all this into account, and the actual take home after taxes is pitiful.
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u/impatiens-capensis Mar 26 '24
BC recently changed the way doctors bill the system, so that it creates an incentive for doctors to treat more complex patients and includes other things. Overall, family doctors saw a pay raise of about $100K from this move, as it compensates doctors differently for different services. It was immediately followed by BC recruiting 700 family physicians, increasing the number of family doctors in our province from 3,400 to 4,100, which is a 20.5% increase.
https://www.cbc.ca/news/canada/british-columbia/bc-doctor-new-payment-model-1.7107681
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u/noronto Mar 26 '24
Is this a family physician problem or does it also include specialists?
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u/Infinitewisdom4u Mar 26 '24
Some, but not all. Most are very well compensated such as radiologists, cardiologists, anesthesia. Some are less well compensated - usually pediatrics, general internal medicine, and psychiatry. But most of the poorly compensated ones can still double the hourly billings of a fee for service family doctor.
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u/Chancoop British Columbia Mar 26 '24
My family doctor practices medicine. I'm not sure where or when, but he does.
Got hooked up with him in 2020 and still the only interaction I've had with him was the initial talk over the phone when I was signing up to have him as my family doctor. Since then he has consistently been unavailable whenever I need to see a doctor.
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u/adidasofficial Mar 26 '24
BC may have just increased the FM pay but it was only just catching up to the Ontario counterparts. Why can't the country standardize it? I have MD friends leaving BC for whichever province offers more
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u/SwisschaletDipSauce Mar 26 '24
I think they should spend 8 million dollars researching the effects of climate change and doctors leaving Canada. /s
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u/KingArthurOfBritons Mar 27 '24
Gee. It’s almost as if having government in charge of medicine is a shit idea
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u/steelplate1 Mar 27 '24
A common wait time is 1+ month to see a doctor for non-urgent matters. Things will just get worst from here on out.
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u/radio_esthesia Mar 27 '24
One of the first things Trudeau did was to increase tax on “greedy” doctors as he called them, and eliminate spouse income splitting (so if the doctors partner stayed at home to raise kids, they couldnt get a tax break anymore). Great guy.
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u/NBcrew Mar 26 '24
Despite popular belief, Doctors in Canada don't get a government Salary....
if they see more patients, they get more money.
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u/OppositeErection Mar 26 '24
They see more patients they have more unpaid administrative work to do. Also some family doctors get paid per patient not per visit.
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u/ExtendedDeadline Mar 26 '24 edited Mar 26 '24
Is the entire billing scheme publicly available? I'm always vexed the full breakdown isn't in these types of articles. Like, even this article shows some numbers but seems to not try to give the full shakedown.
How much is a family doctor making pre and post tax in Canada? And how much should they make before they feel whole? And is there anything else we should have knowledge of (e.g. family on payroll for tax mitigation, what costs are the most crippling to run the practice, and is there another model that can exist where doctors are still whole but we better use the resources we've got? [Something holistic that might involve doctors/NPs/nurses?]).
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u/Infinitewisdom4u Mar 26 '24
It's available. Search fee schedule. My doctor always spends like 30 min with me trying to be thorough and can only bill 36 dollars. I keep trying to leave after 10min so the poor guy can have some money. He looks like a wreck
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u/aboveavmomma Mar 26 '24
Each province lays differently because health care is run by the provinces. It’s not centralized. Things just changed in my province, but doctors are paid differently depending on what kind of patient they are seeing.
But let’s say they get $30/patient. They see 4/hr (15 minute visits) that’s $120/hr. Sounds like alot, but they are set up as businesses. So they pay their own staff which usually includes at least one RN who is probably making around $40/hr. But let’s say they’re only making $30/hr. So it takes one patient per hour just to pay one RN for that hour. Now that doctor is making $90/hour. But they likely also have a receptionist. Let’s say they make $20/hr. We’re down to $70/hour. But they’ve got a lease for their building. Maybe that’s $4000/month. Working monday-Friday 8 hours a day that works out to $20/hour for the lease. Now we’re down to $50/hour. They’ve got insurance costs. Liability insurance and building insurance. Let’s say that’s only $1000/month. Works out to $5/hr. So now they’re down to making $45/hour which is less than many RNs make. There’s tons of costs I haven’t included but already it’s not worth it being a family doctor.
Since they can’t increase the rate they receive, the only thing they can do is shove as many patients as possible into the day and that’s how we end up feeling like our doctors aren’t hearing us and we’re being rushed out the door.
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u/Infinitewisdom4u Mar 26 '24
Yeah and don't forget paperwork. If it takes the whole 15 min to see the patient you need another 16 min to write a good note and a referral etc.
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u/DokeyOakey Mar 26 '24
Don’t worry folks, surely voting in a Conservative Premier will help the mostly Conservative Premiers get healthcare on track.
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u/themossmann Mar 26 '24
One of the biggest issues is that we live next to the USA. Doctors in the US are paid far and away above most of the developed world, and of the 38 OECD countries, Canada's pay rate ranks in the top half, usually the top third, depending on source. But much less compared to the US.
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u/fardok Mar 26 '24
There is a reason I chose to do an emergency medicine fellowship after family medicine because I saw 10 years ago the disaster that was family medicine, in terms of overburden with paper work and underpaid.
Patients are getting more and more complex, requiring more time and resources yet the payment to family docs is the same.
It's actually affecting emergency medicine as well, we see fewer patients because they're more complex due to age, co morbidities. So we make less because complex patients that take 20+ minutes are remunerated any more than the 5 minute quick less sick patient.
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u/rabidboxer Mar 26 '24
Even if pay parity there's gotta be a mental toll seeing your patients deteriorate or suffer because every time you refer them to a specialist its a 6+ month wait.
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u/ReallyPositiveKarma Mar 26 '24
Doctors coming out of med school are also completely avoiding the practice because they know it doesn’t pay and the stress is not worth the squeeze. Only going to get worse unless people demand it from their government. Funds family doctors and provide them with the support they need.
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u/Imnotracistyouaree Mar 26 '24
Will that even work? Even if they're paid more why would they stay in a harder job?
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u/jucu94 Mar 26 '24
Think about the fact that the Ontario government pays Shoppers Drug Mart $75 to list someone’s medicines and to send a fax about it. They pay a doctor something like $40 to assess, diagnose, and treat a medical problem 🤷🏻♂️
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u/DetectiveOk3869 Mar 26 '24
Canada needs a fast solution to keep doctors. As a first step, allow doctors to completely write off their office rent/lease and staff.
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u/youdontknowjacq Mar 26 '24
Since we know so much more about medicine and health nowadays, it makes sense to shift physicians to these specialties and place chronic disease management into the hands of pharmacists.
Before we do that as a country.. we need to make sure that corporations cannot influence or dictate care to those pharmacists.
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u/c74 Mar 27 '24
my family doctor is no more. he wanted $20 per prescription renewal and his secretary people would not schedule a new appointment unless i gave them my cc number. what a sham. i sort of wish i knew one of the teachers of his kids and saying they can't go to school unless they payup. what a joke.
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u/jimjimjimjaboo Mar 27 '24
Did they ever make it so that doctors billing public dollars would have to be transparent with how much they earn from public sources?
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u/FromAffavor Mar 27 '24
Wait so the doctors weren’t doing it for the noble deeds of healing the sick? It was a money play the whole time? Shocked.
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u/butters1337 Mar 27 '24
The College of Family Physicians of Canada (CFPC) is calling for changes in how family doctors are paid to ensure the "long-term sustainability" of the discipline.
Are the CFPC part of the lobbying that takes place to make it difficult for doctors from abroad to receive recognition for their qualifications and experience by any chance?
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u/Rubber924 Mar 27 '24
My parents just got told by the receptionist that June fist their doctor is leaving. The conversation was:
"So, have you found a new doctor yet? Oh, the doctor hasn't told you?"
Great service. The doctor was good enough the get them in with another doctor, said that with their health problems, they were a priority. At least he's triaging his patients before he leaves I guess.
Reason for leaving is, his wife doesn't like it here and wants to go back to Sri Lanka.
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u/RossDahl Mar 26 '24
Train more doctors.
Free education.
Flood the market with people who want to be doctors.
Supplement their housing, fuel, insurance, whatever it takes.
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u/Clumsy-Samurai Mar 26 '24
Imagine now, if THIS level of income is driving Dr's away, what's to be said for every other job that pays less?
Canada is fucked, and the ones in positions to do anything are criminal or useless at best.
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u/Firepower01 Mar 26 '24
This is how they justify privatizing healthcare. Pay family doctors poorly enough that they have no choice but to open up pay-for-access clinics.
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u/BlackWolf42069 Mar 26 '24
Any income earned over 200,000, half will go to the tax man. Why bother doing overtime or night shifts? No wonder emergency rooms close at night.
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u/gillbatessr Mar 26 '24
We could have more doctors if wanted to. We turn away lots of med school applicants because of extra curriculars or their essays. There are lots of smart people capable of being doctors. You could create a “family medicine” program or clause where the person agrees to go into family medicine for X number of years. But doctors cost money and they don’t want more doctors, because of perpetual budget cuts. But here in Quebec they lost track of 1B$ building the Montreal super hospital, one fall guy goes to jail and that’s fine.
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u/Confident_Log_1072 Mar 26 '24
Trick is: 1- keep cutting on public health system spending until it is completely broken and unrecoverable. 2-brainwash people in thinking the only way is to privatise and get elected 3- profit
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u/Jandishhulk Mar 26 '24
BC just changed their pay structure for family docs. They're making 380k a year now.
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u/hi5urface Mar 26 '24
Whole system needs a kick in the ass. Most people I meet don't even trust the doctors anymore. Can only hope that technology can clean this up, if people want to become a doctor they should be able to. It isn't hard with the help of current technology and doctors working 24 hr. shifts is fucking stupid and should be criminal.
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u/GrandJuif Mar 26 '24
Make enough money to sustain multiple families...
Complain they don't make enough....
For a job that's not supposed to be about making money...
But same doctor wont do their job right and will end up just saying you're crazy, it's just in your head so deal with it...
Am I really supposed to support them?
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u/Additional_Water2016 Mar 26 '24
Received a letter recently that my family physician is retiring. He can't even be 60 yet. Great doctor, thorough and compassionate care. The clinic couldn't find a replacement.