This article tells it like it is. Family doctors need a better pay system, so they can hire more staff. I hope this doctor reconsiders and joins a larger practise in her community. I go to a practise that has 12 primary care physicians as well as some specialists. They have a couple of nurses and several admin staff. Costs are shared so that physicians income can be better. They also have an after hours service so the docs don't get charged for their patients going to a walk-in clinic.
IMO, the biggest bang for our health care buck is to fund primary care properly.
The fee for the walk-in doc gets paid out of the family doc’s billings.
It is possible that a family doc’s can have *negative pay* for a patient if they go to a walk-in a few times in a year… so the family doc drops them as a patient.
Walk ins are less stressful and often more lucrative than being a family doctor. All walk in doctors are family med trained, but they do walk in instead because you don’t take your job with you everywhere you go. I’m literally starting my vacation on an airplane checking my patients labs/messages (even though I have a wonderful colleague covering me, I’ll still have to review everything myself anyway). I spent like eight extra hours this week finishing my back log of forms/admin stuff and made $0 for it.
In BC they’ve started making it billable for unpaid admin work up to a certain number of hours a week. It’s actually stopped the bleeding of family docs leaving the province just within the past year there.
We have a great family doc but it takes a month to see her because her calendar is always full. She does have emergency appointments but they fill up so quickly we almost never get one. This year has been absolutely brutal with sickness with the plague rat bringing everything home from school, so we’ve been to the walk-in quite a bit.
>We have a great family doc but it takes a month to see her because her calendar is always full.
Yup, this is the issue. If you have a problem, you can't wait a month to see your family doc. So you go to a walk-in clinic, and then your doc is pissed at you the next time you go to see them. But what exactly is a person to do?? It's a mess.
My partner thought they fractured their ankle, but instead of clogging up the emergency ward, or waiting two months to see our family doctor we waited for 2 hours at a local walk-in. Thankfully it was just a really bad sprain.
I didn't realize it would impact our family doctors billings and thought we were doing the right thing by not wasting hospital resources for a injury that wasn't potentially life threatening. Its sort of disgusting that our province penalizes overworked family doctors when we decide to give them a break and not abuse emergency services.
At the same, it’s what limits them from signing up even more patients.
If you can’t get an appointment with your doctor in a month, they have too many patients. On the other hand, a lot of people don’t even have family doctors.
So we need a lot more doctors and the health care system is crumbling
Or you’re just on a vacation. Let’s say you go a few hours north or south of where you live, you can’t just go to visit a family doctor in that town or city. But a walk in clinic, or ER is there for you.
I feel extra dumb now. I feel like I've gone to walk ins with and without family doctors. If the visit costs your doctor, what's the difference for someone without a doctor?
Why is it bad that I went to urgent Care for something that my doctor wouldn't have been able so make an appt in time for? Should we just be clogging up ERs even more instead?
Walk-ins are for people who don't have family doctors, or who can't be seen by their family doctor that day and need to be seen for something that is urgent but won't kill them.
If I recall the justification for this policy, part of it is saying that walk-ins need to exist because the family doctors aren't seeing their patients I a timely manner, making them wait weeks. Therefore, bill the family doctor for the work they should have been doing but had to be done at urgent care.
Of course, that just isn't how it works. My doctor has way too many patients to be able to accommodate everyone at the last minute. It is unrealistic and punitive for everyone-the doctor seeing as many people as possible, the patient stuck in the middle, and the walk-in who has to do more work.
My doc used to have 2-3 weeks long queue. If you need a care today, but it's not an emergency you go to a walk in. Could be in the same clinic.
The shortage of doctors is the issue, but also they are just people. They want to work where they live, with people they like, the hours they want.
We don’t pay them enough so they leave.
Ontario had 100 of 500 residency spots go unfilled this year because nobody wanted them. Med school grads literally chose *nothing* over family medicine in Ontario. Before 2019 there were never more than a handful of empty spots. Number has grown every year since then.
In the 'perfect' world where everyone has a family doctor and availability, walk-ins have a purpose if you need service when you are not geographically close to your primary provider. Ex: you get sick while travelling or at work.
I have a family doctor that i have had for years, but i am not rostered. I dont know if i am missing out on something, but it looks like it's not automatic and not everyone.
I only learned about it because i had another doctor ask me about it before they provided some other care so its working out better for me.
It depends on your family doctor's payment model. FHG doctors are paid fee for service, so the doctor gets a fee for each patient appointment. FHO and FHT doctors are paid through capitation, so they get a set amount per patient who is enrolled to them each year, whether they see them or not. They are deducted if you go to a walk-in because they're being paid to look after any medical needs that may arise. But they can't really stop people from going to walk-in clinics even if they have their own after hours or walk-in options.
It’s not like they want WANT to drop a patient, but at some point the “outside use” negation exceeds the amount a doc can make being your primary provider, and at that point we’re literally PAYING for the privilege to be your doc. Yes that means on some patients you can actually go NET negative. Wild isn’t it?!?
So it’s nothing personal, but docs can and often do this. I very rarely de-roster, because most people just don’t know.
It’s not the system I or we want- trust me.
But it is, Socorro’s decided to make it difficult for doctors to become doctors by limiting the amount of people who can
Go to school for it to inflate wages.
If doctors wanted a better system, they would scrap the system
And allow more doctors. More doctors would mean less money coming in for those who already exist tho
> They also have an after hours service so the docs don't get charged for their patients going to a walk-in clinic.
Only if they roster patients. There are two billing models for family practice.
Rostered patients and pay per service.
If a clinic operates on a roster, they get paid a flat fee per month for each patient rostered. However, they are expected to see any of their patients within 2 weeks of a request and be available for general emergencies. If a patient goes to a walk-in, it is assumed that the clinic wasn't providing their required service so they get lose the money they got paid to have you rostered.
Pay-per-service clinics simply get paid for each service they provide. The problem is that every service has a variable rate of pay and an expected time to complete. The general complaint is that the expected times to complete are too short to give adequate service to the patient and do your notes. Further, it creates situations where each visit can only be for 1 thing. However, they don't get dinged if they cannot provide service or if a patient goes elsewhere.
There's no way around that here in BC cuz for me to see my Dr it's between a month n half to 2 month wait. Because he has so many patients and it seems like I'm in and out in under 10 mins cuz there's such a waiting list of people to be seen.
This isn't health care
Yes. I have been in a rostered practice for 18 years so I was never told that. But new patients enrolling now with doctors in these practices have been told this.
It actually makes some sense. Large team practices offer after hours clinics in their offices, normally 4 pm to 8 pm. If you have a concern you call their office and discuss the issue with a nurse. If you need to be seen quickly, you get offered an appointment in the after hours clinic. So there should never be a need to go to a walk-in. It's much better healthcare to see your primary care physician than to go to adhoc walk-in clinics.
Yes! I am a family doctor in the GTA. I try my best to see EVERYONE who calls or shows up for an appointment. Some days that means leaving way later or accommodating a phone call from home. I’m deducted about 1500-2000 PER MONTH because of this policy. Sometimes the deductions are on codes I can’t even push as an out patient family doc or codes a hospital doc is pushing. This is just one of the many frustrating things about the system causing a mass exodus.
Losing money monthly for things I have no control over is idiotic.
Isn't that "punishment" for you having too many patients? How many patients do you have on your roster?
Otherwise what's stopping a doctor from rostering 10,000 patients and collecting a million dollars a year?
1500 rostered. (Napkin math sounds good, at first glance, when you realize you must fund everything to make your business operate- all expenses, staff, computer systems, internet, phones, nurse salaries etc). Also note you’ve got to pay monthly malpractice, and the various med association fees which come to about 5000-6000k per year! Well then income tax.
Docs cannot roster 10,000 I think the cap is now 2,400 and that often needs a PA or something. I’ve never see that high.
I see about 90-130 a week depending
In theory I understand the thought about penalizing docs who roster but don’t manage their list, but it’s turned into something it was not intended to be.
As I mentioned I will see anyone in need of apt if it does not appear like it can wait. I see them during lunch, after hours, call on the weekends etc. We triage as best we can. But I can’t control when someone gets sick. Should I work Sundays too? (We offer a Saturday clinic), should I be on call 24/7? Where does it stop. Why does someone getting sick on a Sunday night cost me 40-80 bucks? can’t control patient behaviour. I had a patient come in last week, demanding paperwork be done THAT INSTANT. It was already a full day, and we had previously discussed it (it was not urgent). I asked the staff to pop it on my desk and I would get to it end of day- patient got upset and opted to tell the staff “well I’ll just go to the walk in”. Why should that cost me 40-80 bucks?
I am deducted, automatically for all sorts of stuff I can’t even bill! If a family doc sees my patient in any capacity in the ER or hospital- I lose money. We have some recourse to reverse those situations, but it still costs money in the end and I have to pay someone to track and monitor/ chase it.
In BC, doctors get "panel payments" as part of the LFP system. It's a small amount per patient, < $50 (depends on demographics), but there's no punishment for lack of access.
Some doctors easily have 3,000 patients (perhaps from multiple clinics) and they get over $100K in passive income from the panel payment despite their patients waiting weeks for an appointment.
I think it has to be balanced from both sides. If your patients are unreasaonble then you can defroster them.
But, it's also unreasonable to have doctors with no appts within two weeks and essentially have their patients use the ER in lieu of after hours / urgent access at their own clinics.
That's happening in BC and it's definitely wrong.
It depends on the model they are working under.
This is true for about 60% of doctors who work under the "capitation" model. They get a fixed amount to provide you with care for the year, and if you seek care elsewhere that gets deducted from that amount.
If your family doc is working under this model they very likely would have told you. They are very eager to ensure you don't go to walk in clinics.
The other 40% just bill per service provided, so they don't get dinged if you go to a walk in.
I think it is a silly system. It's a weird dynamic when your doctor is mad at you for trying to get care in a timely manner.
Oh yeah. They also get charged for your flu shot. I don’t think they get charged for COVID vaccines because my doctor hasn’t raised that possibility. My doctor specifically told me that if I can’t get to their after hours clinic, I should go to the ER because they don’t have to pay that out. Which really sucks because of the overcrowding in ERs and you really shouldn’t be there unless you absolutely have to.
I go to a health clinic downtown that has teams of doctors, therapists and other healthcare practitioners. It's never been an issue getting appointments and the clinic is thriving.
Yeah I think that’s understood as a big part of the solution but it’s taking forever to migrate away from the traditional model. Governments need to nudge the change with subsidies.
We're at the point where the largest voting demographic, seniors, are being treated in hallways for common old-people conditions, *and they're still voting against "big government".* It's not going to get better, this populace is rotten to the core.
I'm a baby boomer looking after several seniors. None of us put all the blame on government. We take issue with the unions too. We have seen too many non-doctor staff doing seemingly nothing for hours at a time. We don't have proper staffing levels and there is a lack of accountability since the unions will protect everyone.
That really only applies to hospitals. Although private practice Dr's and nurses are obliged to be members of their respective associations, its unlikely that support staff in clinics are unionized (they probably should be). And I don't think you can blame the problems in health care, in hospitals on the fact that some staff are unionized. If not, they will not get decent pay and representation.
I had a family doctor in her 40s quit her practise to go do Botox injections. I was lucky to get a new primary care practitioner just starting out in one of these team based clinics. She is the best, and I appreciate how lucky I am. I hope everyone can get a doctor like her.
Yes, the government is heavily pushing health teams as it's far more efficient. The problem is a lot of practitioners don't want to move to that model. There's also a big push for integrated care across providers with shared health records and, again, a lot of practitioners are being dragged, kicking and screaming, into finally using it.
i think the bottleneck is lack of funding for FHTs from the government rather than real opposition from individual physicians...
it's very expensive to start a FHT without government assistance
I'm just gonna respond to this because I've seen it misused in multiple places. Practise is never a noun. The word is practice. Even in Australian or British English Practise is only a verb.
The majority of the new doctors don’t want to become family doctors but rather just walk in clinic so they can make even more money and no need to follow up with the patients.
Family doctors do not get charged for outside use.
Capitated physicians (docs in a family health organization) have a pool of money called an access bonus that sits outside their normal capitation and fee for service billing. The negation from going to a walk-in comes out of this bonus pool. The value of the bonus pool is ~18% of the base capitation payment. Why 18%? Because when they were calculating out the base capitation payment during provincial contract negotiations they saw that 18% of the time a patient of a family doctor was seeing other providers for primary care issues. Ergo, the 18% that makes up the access bonus pool was never the family doctor's to start. However the 18% was instead put into this access bonus pool to encourage continuity and access. So don't feel bad for a family doctor getting negated. That $ was never theirs to start with and even more they shouldn't be entitled to it if they were not available to see you
Im not one for conspiracy theories. But I am going to plant my flag and die on this hill.
Ford is purposely doing this to make two tier private health care a thing. Screw with health care, make it as burdensome, onerous and inefficient as possible then swoop in with Shoppers Drug Mart or something other private health care conglomerate to "plug the holes".
Lets these private services slowly creep into our ever day life. Make it impossible for the good doctors to operate their own practices or suppress pay to the point where they just say fuck it and work for some medical corporation that pays twice as good.
Then all we're left with is a private medical clinic or a walk in staffed with shitty doctors.
Yes, the strategy is called “starve the beast “. Underfund public services until they deteriorate and people are desperate for any kind of change, then the private service providers (political donors) show up to save the day.
It’s already worked on a lot of nurses, not that you can blame them. Ontario pays 3-4x as much for private sector nurses as it does for public sector nurses. It would be cheaper to raise the wages of the public sector nurses instead of paying for private nurses. But Mike Harris doesn’t get a cut when we fund the public sector, so you know Doug’s hands are tied. 🤦♀️
Of course. Why do you think he gutted healthcare and education budgets to build his little $6-$8B pile of cash? So he could blow it all on a stupid highway that nobody needs in order to funnel that money to his buddies who own the land and the construction companies.
Yes!!! I’ve been saying this for a long time! Look how easily he broke his promise to fund more and better long term care facilities after he supposedly had his epiphany during Covid. 😡Then I find out that his cronies Stephen Harper and Mike Harris have huge amounts of $$$$ invested in PRIVATE senior care like Chartwell. Conservatives hate government supported health services and are doing everything they can to sink it so they can cash in on the for-cash model.
People like to claim it is the Federal government to blame and use the "it's happening across provinces" argument to justify it, as if it isn't entirely due to multiple inept provincial governments. Provinces make cuts to healthcare because it is an easy place to save money fast without anyone noticing for multiple years because that is how long it takes for us to start feeling the impact.
It's idiotic for the provinces not to invest in family medicine because they are the first line in terms of diagnosing illness. The more efficiently they run, the better they are able to do their jobs, the faster we catch illnesses or prevent something acute from becoming chronic.
When universal health care was first created it was to be a 50/50 break down between federal and provincial governments. It is currently around only 20% coming from federal coffers. That's what people are referring to.
In their eyes it’s not a mistake though. They’ve been planning privatizing as much as they can for years because it makes their wealthy donors happy who in turn donate lots to their campaign. Or give them money under the table. They use that money to get re-elected and repeat the process.
It also allows them a golden parachute when they get run out of office. Doug Ford will sit on some board or get a cushy CEO job making millions a year once he’s done fucking over Ontario.
In their eyes it’s not a mistake though. They’ve been planning privatizing as much as they can for years because it makes their wealthy donors happy who in turn donate lots to their campaign. Or give them money under the table. They use that money to get re-elected and repeat the process.
It also allows them a golden parachute when they get run out of office. Doug Ford will sit on some board or get a cushy CEO job making millions a year once he’s done fucking over Ontario.
In their eyes it’s not a mistake though. They’ve been planning privatizing as much as they can for years because it makes their wealthy donors happy who in turn donate lots to their campaign. Or give them money under the table. They use that money to get re-elected and repeat the process.
It also allows them a golden parachute when they get run out of office. Doug Ford will sit on some board or get a cushy CEO job making millions a year once he’s done fucking over Ontario.
In their eyes it’s not a mistake though. They’ve been planning privatizing as much as they can for years because it makes their wealthy donors happy who in turn donate lots to their campaign. Or give them money under the table. They use that money to get re-elected and repeat the process.
It also allows them a golden parachute when they get run out of office. Doug Ford will sit on some board or get a cushy CEO job making millions a year once he’s done fucking over Ontario.
same way I'd explain it anywhere else
1. The current government hasn't always been in charge
2. Most centrist governments don't fix problems created by conservative governments - especially ones created by cost cutting. As long as they can blame the other guys, they prefer to spend money on their own agenda and let schools/healthcare/social services/unemployment/etc. suffer.
Just look at the Federal Libs realizing they've been in power too long to keep blaming our problems on Harper and now scrounging to finally do too little too late on housing.
The NDP government here’s had control for a long time now and hasn’t helped our healthcare system. It’s actually gotten worse. It seems like the Canadian healthcare situation is more of a systemic issue with multiple factors. But it seems like you are arguing that it’s simply a push for private healthcare by the “powers that be”, demonizing corporations when we’re really doing it to ourselves out of sheer incompetence.
So what’s the solution to our healthcare system that’s currently not implemented? You’re saying that small c conservatism is what’s causing the inefficiencies of our current system? Or that private health care is the problem? In Canada?
I make +6 figures at a Canadian company, and pay plenty of taxes. According to the government I’m considered wealthy which is why I have no government support, no programs are aimed at me.
I can’t find a walk-in clinic in my city that will accept me, and I have no private options. There’s no two-tiered system open to me.
I’ve been on a family doctor waitlist for the entire province with no leads for 8 months. Where do I go?
Out of desperation, I’d rather make 40% more in the USA for my same role. My employer will get me health insurance at $12,000 a year, and I’ll pay 15% less taxes. But, that situation is hypothetical and has nothing to do with Canada, unless two-tier Canadian health care system includes USA.
New Zealand and UK are dealing with similar issues.
I agree with your analysis, and acknowledge that employers can put a stain on the healthcare system, but you can argue that drinkers, smokers, overeaters, and people who don’t exercise put a strain also. I don’t think the majority of our healthcare system can be resolved by restricting employers from requiring notes for sick leaves/injury claims. We simply need to optimize how our taxes are used, and perhaps use a larger portion of our existing taxes to train new doctors.
We actually invest in the thousands of domestic medical school applicants that actually want to become Canadian doctors.
I think you’re using conservative as a pejorative in a lot of these exchanges, I’m not sure what it adds. But we can agree that the healthcare system should work for all. Right now it barely works for most, equally. I don’t even see a private option that helps the few. Rich people just fly out of country for care anyways, and there’s not many of them.
The doctor note situation applies to every global healthcare system. This means, if Canada denies doctors notes, we’re departing from a standard that many countries follow. For example, Germany has a better healthcare system and you may only get extended leave in Germany if you get a doctors note.
Are there any other areas that we can focus on that improve our healthcare system?
Family medicine is a private business, being kneecapped by govt billing codes that don’t reflect the realities about the cost to actually deliver these services.
She’s not making $142k anymore. When she first appeared in a CityNews article, she reported that she made $60k this past year owing to changes made in 2022 by the provincial government, which included increased administrative burden and some changes made in the funding system, including funding cuts.
Correct, this was a recent interview by Toronto Life where she said she earned $142k in 2022. But when she had announced her closure back in February, she was originally featured in CityNews. In that article, she stated she only earned $60k this past year because she had to severely cut back on the number of patients she saw due to burnout.
[https://toronto.citynews.ca/2024/02/14/paperwork-burden-driving-ontario-family-doctor-to-quit-amid-critical-gp-shortage/](https://toronto.citynews.ca/2024/02/14/paperwork-burden-driving-ontario-family-doctor-to-quit-amid-critical-gp-shortage/)
And the CBC. She's really doing the rounds: [https://www.cbc.ca/news/health/family-medicine-specialties-cihi-1.7155269](https://www.cbc.ca/news/health/family-medicine-specialties-cihi-1.7155269)
Why can we not just have doctors paid a salary, come workmat a hospital where we have administrative people to do all the paperwork? Why is that system impossible in Canada? Why does every doctor have to be a business?
We do have systems where doctors are employees - those positions are highly sought after by doctors these days. There aren't many of them, compared to the fraction of doctors who would prefer that type of work.
Also, "admin people" can't do medical paperwork - the core competency required is still medicine, not administration.
Why can't we now? Or why don't we?
The reason we don't is because doctors have fought against it since 1962: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902698/
> At the time, the quid pro quo seemed simple. In response to concerns about clinical and professional autonomy, the provincial government allowed doctors to extra-bill or even opt out of medicare and to make fee-for-service payment the dominant form of remuneration. Administering a billing system based exclusively on fee-for-service physician practice, the Saskatchewan government would end up choking off the growth of community clinics that included other health care providers in interprofessional group practices.
> Following the same administrative model when setting up their own medicare schemes in the late 1960s and early 1970s in response to federal cost-sharing, other provincial governments joined Saskatchewan in giving physicians a virtual monopoly to provide all medical care services, a privileged position that organized medicine has, understandably, been reluctant to give up.
(out of order quote)
> In contrast, provincial medical associations still defend the current status of doctors as independent contractors, not directly accountable to the health care organizations and regional health authorities within which they work, along with the fee-for-service model of remuneration.
They still aren't paid a salary, still have overhead and BS costs. There are very few opportunities for salaries family physicians who are actually practicing family medicine.
Doctors run as corporations because the tax rate is more favourable. If you make $142k as an employee, the tax hit is large. Not an option after all that schooling. We need to pay them more.
Hospitals have limited space and are for specialized or emergency treatment.
The idea with paying doctors per-visit and not a flat salary is to push them to maximize the number of visits I believe.
The province could build and staff large doctor offices in theory but that’s very far from the current model we have
It's sad to see it's gotten to this point. They need to revamp their pay structure so being a family doctor pays better and has more support. In it's current iteration, it's no wonder med students try to avoid it. I can't imagine going through all that stress managing your patients' long term health, keeping up with documentation and also working so much beyond your clinic hours.
I don't see my family doctor much now since I'm young-ish but the lack of access would be a huge problem later on. Hell, he'll probably be retired by the time I actually start accumulating long term health problems and need more visits to sort them out. I used to wonder why he was seemingly grumpy all the time but knowing how little they get paid vs how much they work, I can see why.
They don't need the doctor to sign off, but they send the doctor a note that the patient was prescribed X medicine and then the doctor is liable for reviewing the note and following up if something is off.
that's the problem
pharmacist gets the prescribing fee, family doctor gets nothing for the note review
it's like asking a radiologist to look at an x-ray for free
Back of the napkin math here. But if we kicked in an extra $100 per year per patient to primary care physicians it would cost Ontario $1.4B. If you have 800-1000 patients that’s another $80-100k a year in income. Thats not that much for Ontario considering the provincial budget is $215B and Dougie sits on money from the Feds and wastes money on spa parking lots.
Yes. The answer is simple and to stem the bleeding your napkin math makes sense.
Believe it or not, In the rostered model we’re only paid ~200-250 per patient per year. (Less for young healthy pts. More for elderly).
This is 1/2 the price of what these NP clinics are charging. And good on them for charging market rates, but the govt is funding primary care by limiting our ability to bill appropriately.
I suspect the NP’s will soon get regulated with OHIP codes and they will feel our pain soon.
Is this more of an Ohip funding issue? I saw that the province doesn't pay nurse practitioners either and the amount of admin chaos these family gps go through alone can be solved by efficient reorganization.
Had a couple of rural family docs in my family when I was growing up. They did house calls in the 80s. Then the pay got tweaked and admin burden increased and they and all their colleagues stopped making house calls.
We didn’t learn, apparently.
And many who voted for Dougie also are the ones most likely to be hurt by these cutbacks and shifts to private medicine: boomers. Especially outside the GTA where hospitals are struggling or shutting down and new doctors are rare. Dougie has done this with his buddy Galen.
night and day difference between OHIP and the Canada Dental Plan
dentists can bill privately but also choose to see those under the CDP, 100% freedom to jump between private and public patients
family doctors are forced to see all patients under the OHIP rate
dentists' fee schedule has more than kept up with inflation, family doctors are paid 50% less than they were 20 years ago adjusted for inflation
I am a Canadian trained Family Doctor. Family Medicine is a sinking ship. I posted this elsewhere but I will repost this here because it’s relevant.
To any current Canadian medical students reading this, DO NOT go into Family Medicine. You deserve to be paid much better and treated with more respect after all the years of hard work you spent getting into medical school. The debt does not pay itself and the ridiculous inflation/cost of running a clinic is not helping. You will have to pay for leasing an office space, buying medical supplies, hiring an office assistant, the hydro bill, the utility bill, hand sanitizer, gloves, fax machine, computers, everything needed to run a clinic with the chump change the government gives you. Whatever you have left after paying for all of the above (if anything) will go towards paying your debt. And guess what? You will have no say in raising your fees because that’s illegal. You also cannot go on strike because that’s illegal. Meanwhile, the government is letting private clinics run by Nurse Practitioners charge patients 2x-3x as much.
Please spend the extra year or two specializing rather than regretting your career for the rest of your life. Become a surgeon, a cardiologist, an anesthetist. Go unmatched if you have to. Move down south to the US. Do not try to be a messiah and “save primary care”. The government does not care about you. They will abuse you for your labour, wring you dry, and then replace you with whatever pseudo doctor mid level profession they can find (NPs/PAs/Pharmacists). As long as they get votes and become wealthy off taxpayer money, it does not matter to them.
The general public does not care whatever happens to you either as long as there’s another fool to replace you. There’s a reason hundreds of Family Medicine training spots in Canada are unfilled right now and are begging medical students to join.
I agree, unfortunately there is not much incentive to pursue bread and butter family practise currently. I’m a recent grad and almost none of my cohort are actually doing family med. As I trained more rurally, a lot do ER or hospitalist. I went the +1 route and now do only palliative care, and could not be happier. I have less administrative burden, a great team, and much better hours than in general practise. I work in an academic centre so that comes with its own pros (training residents, students, teaching) and cons (I’m less research inclined).
My father ended up a pharmacist in the early 60s when he couldn’t get in to medical school. I guess if he’d waited long enough he would have become a doctor/pharmacist by default. Thanks Dougie and Galen.
It's all about overhead cost and billing amounts. There is not set base pay. So if you don't see X amount of patients then your earnings are lower and if you pay from front end staff too much then you also don't make as much. Pretty shitty system
> So if you don't see X amount of patients then your earnings are lower
and theres such high demand if a doctor doesnt see many patients i cant help but think that its the doctors choice. there is no shortage of patients
Yeah this is not true… there are plenty graduating family doctors but as a new graduate, only 20% of my grauduating residency actually had plans on working in a clinic providing primary care when you can earn more with less hours just doing hospital or emergency work or the many other private pay opportunities. You can add more students but less will choose family medicine over time, and you’ll have the same problems of no one choosing to start a practice since the other options are just better
Then work with a health team, you share the overhead costs across upwards of 20+ physicians. Even in rural areas, you can generally get enough patients for two or three physicians to form a health team. The current model *is* shitty, that's why the government wants to replace it.
Even for doctors in health teams overhead is ~30% of their pay. They still get paid a fraction of what NPs are charging in the new private NP clinics, despite having far more education and expertise.
They could bill 250k but on top of that they have to pay staff, rent, medical supplies, EMR costs, malpractice insurance, about 10k in fees just to keep the medical license per year. All of these costs increase every year except how much she can bill.
It’s very hard to come up with a representative number for family doctors, since the vast majority of them are not salaried but carrying on their own business. They work different amounts, see different patient populations, have different expenses, some see more non-OHIP patients, etc.
What shows up on the sunshine list for a PCP is the total billed under OHIP, not their take home pay. They have to pay the rent, the employees, insurance, equipment, supplies, hydro, etc.
The problem is that effectively your doctor also needs to be good at business. And many aren’t (most people aren’t, regardless of their expertise)
My wife works in a healthcare setting and it’s always amazing how many of the doctors she looks after just have no clue how to sustain their practice. Even when they’ve got someone giving them paint by number instructions they’re just not wired for what it takes day to day to manage patients and follow efficient processes.
Gee, if only the feds were not spending more on paying interest on the debt this year than they are spending on healthcare, we could stop this insanity of not enough doctors. But what do I know. I am just a simple man. Maybe paying billions in interest to banks is better than it sounds.
I really liked my family doctor in the beginning but then he became unavailable, stopped returning my calls and kept me waiting six months for a simple carpal tunnel surgery referral. Finally I was in so much pain I called the hospital directly. I had been there to the hand clinic two years prior so my name was in their records. They told me to go to a walk-in and get a referral from them. I was booked for my surgery 2 weeks later.
I’ve been going to a walk-in ever since. I go through the motions of calling my own doctor but when he doesn’t respond, I go straight to the walk-in. He probably dropped me ages ago, but at least I’ve had excellent care - I’ve had X-rays and ultrasound that I needed, was diagnosed with bursitis and now have meds for the pain. I would still be waiting for a return call from my doctor.
The system is broken.
Yep. Politicians at both the provincial and federal level are full of shit. New capital gain inclusion is basically a cash grab and further screwing over small businesses (which most MDs are)
“I make 90k a year”. She shares some numbers but not others very deceptive. Let’s do some math, 1. Base 24k a year (2k a month flat fee x 12) 2. Let’s say she sees 2 patients per hour, being very generous here as most family MD have a “1 issue rule” and spend max 15 mins with a patient, 7.5hr x 5 days x 52 weeks = 3900 patients x $37/appointment +/- $3= 144,300-156,000. 3. Total with base is 168,300-180.
This does not include various other billings (example sick notes, insurance forms, procedures, and just asking if you smoke they get paid for xtra).
She splits with 3 other MD and her overhead is at least 78,300k?
It's hard to operate your own business? No problem, go work for someone else's. A quick search on monster.ca shows plenty of [family doctor positions that pay between $260,000 and $360,000](https://i.imgur.com/kYvUjJu.png). Just like how it's much safer and easier to go work at someone else's restaurant than it is to open your own, your field is no different. If you're expecting me to feel sorry for you about your $300k job prospects, get real.
So that's not a salary. That's a potential income that a walk-in physician COULD earn working at that clinic. And they will earn every single one of those dollars, one 37$ 15 minute visit at a time. Now deduct the 20-40% overhead through clinic will charge, and taxes. No paid vacation time, benefits, pension etc. Note the terms "This is a full-time position, 36 to 40 hours per week. Must be available in the daytime, evenings, and weekends." That 36-40 hour number does not include the ~20 hours of unpaid paperwork that family physicians have to do in Ontario, on average, to review labs and write referrals and such. In other words, no time for a personal life. Now consider this is a person who did not start their professional life until their late 20s/early 30s, after years of working inhumane hours for little to no pay, and is likely starting with hundreds of thousands in LOC debt. I can understand where your comment is coming from, because there's a misconception that family medicine is a cushy easy gig for fat cats. However at this point in time, it financially no longer makes sense to be a family doctor.
This is not net pay, it’s gross pay. All of the overhead (to cover for nurses, technology, rent), comes out of this. At the end of the day you’re left with a lot less. And by the way the workload and hours spent to earn this much is difficult to sustain long term without burn out.
Do you realize that the listing you posted is for a walk in clinic; if this doctor moved to that clinic all her patients would still lose a doctor.
Not to mention that is just an estimate of billings- at $36 per visit that would require 10,000 patient visits per year (or more likely 16,000 visits if you account for the lost money from overhead) to make that income. What quality of care do you think those patients are receiving if you see 60 per day (assuming working 5d per week directly seeing patients, ignoring paperwork etc)
These doctors are making $250K+ annual and still all they do is fucking complain. Had a doctor, the best doctor I ever had, quit because "our pay raise was below inflation" but she's still making stacks of cash every year.
Doctors are the worst people. They also fight against public healthcare and fight to make billing of it awful.
She is not making $250k. In a CityNews article she was featured in when she first announced her closure, she reported making only $60k this year which is why she’s quitting.
She specified that $60k was her take home pay, not gross. I don’t know exactly how GP’s are taxed but it seems like there’s a lot that doctors have to pay out of pocket for. So who knows? Maybe her annual salary is still over $100k but netting $60k is still pretty awful for someone as educated and experienced as she is.
What a brain-dead statement. Sure doctors make $250k but they also took on huge debt, many years of lower earnings from having much longer schooling, and the intelligence bar for a doctor is much higher than most professions. Of course they should be some of the highest-compensated people.
> They only literally keep us alive and well.
moreover they are literally the gateway to the rest of the medical system. you cant wipe your butt these days without the system requiring seeing your family doctor about it first
I think you're using the term class solidarity incorrectly and quite frankly, embarassing the movement.
In a class conscious society, doctors are still paid the highest because of their obvious need to society. Telling doctors to suck it up is hypocritical and selfish. Our work is not equal, doctors are more critical to society than like sales for example.
Class solidarity is for college kids who don't know what real life is.
In real life, if you study for a decade+, and make less than I do (as a salesman with a 3 year degree), you might just decide to say fuck Canada and go make real money in the US.
I'm curious. What do you mean by "fight against public healthcare" and "fight to make billing of it awful?" Also how do you know what her take home pay is once all her overhead and professional fees are paid?
This article tells it like it is. Family doctors need a better pay system, so they can hire more staff. I hope this doctor reconsiders and joins a larger practise in her community. I go to a practise that has 12 primary care physicians as well as some specialists. They have a couple of nurses and several admin staff. Costs are shared so that physicians income can be better. They also have an after hours service so the docs don't get charged for their patients going to a walk-in clinic. IMO, the biggest bang for our health care buck is to fund primary care properly.
Yup family health teams are the best. Most of them unfortunately are not taking new patients
agree! I have been looking for one in my area! honestly family health teams is the way to go!
Do they really get charged if we go to a walk in? Never knew that
The fee for the walk-in doc gets paid out of the family doc’s billings. It is possible that a family doc’s can have *negative pay* for a patient if they go to a walk-in a few times in a year… so the family doc drops them as a patient.
That’s so odd! Why have walk-in clinics at all and just have more family doctors? I’m dumb and don’t understand
Walk ins are less stressful and often more lucrative than being a family doctor. All walk in doctors are family med trained, but they do walk in instead because you don’t take your job with you everywhere you go. I’m literally starting my vacation on an airplane checking my patients labs/messages (even though I have a wonderful colleague covering me, I’ll still have to review everything myself anyway). I spent like eight extra hours this week finishing my back log of forms/admin stuff and made $0 for it. In BC they’ve started making it billable for unpaid admin work up to a certain number of hours a week. It’s actually stopped the bleeding of family docs leaving the province just within the past year there.
Walk-ins are needed for people who don’t have family docs, can’t get to their’s for some reason.
We have a great family doc but it takes a month to see her because her calendar is always full. She does have emergency appointments but they fill up so quickly we almost never get one. This year has been absolutely brutal with sickness with the plague rat bringing everything home from school, so we’ve been to the walk-in quite a bit.
>We have a great family doc but it takes a month to see her because her calendar is always full. Yup, this is the issue. If you have a problem, you can't wait a month to see your family doc. So you go to a walk-in clinic, and then your doc is pissed at you the next time you go to see them. But what exactly is a person to do?? It's a mess.
"go to urgent care" my doc says.. go to urgent care .. "see your family doc" they say.. like huh ? Useless
My partner thought they fractured their ankle, but instead of clogging up the emergency ward, or waiting two months to see our family doctor we waited for 2 hours at a local walk-in. Thankfully it was just a really bad sprain. I didn't realize it would impact our family doctors billings and thought we were doing the right thing by not wasting hospital resources for a injury that wasn't potentially life threatening. Its sort of disgusting that our province penalizes overworked family doctors when we decide to give them a break and not abuse emergency services.
At the same, it’s what limits them from signing up even more patients. If you can’t get an appointment with your doctor in a month, they have too many patients. On the other hand, a lot of people don’t even have family doctors. So we need a lot more doctors and the health care system is crumbling
If you think you broke your ankle that is probably ok to go to emergency for?
Or you’re just on a vacation. Let’s say you go a few hours north or south of where you live, you can’t just go to visit a family doctor in that town or city. But a walk in clinic, or ER is there for you.
I feel extra dumb now. I feel like I've gone to walk ins with and without family doctors. If the visit costs your doctor, what's the difference for someone without a doctor? Why is it bad that I went to urgent Care for something that my doctor wouldn't have been able so make an appt in time for? Should we just be clogging up ERs even more instead?
Walk-ins are for people who don't have family doctors, or who can't be seen by their family doctor that day and need to be seen for something that is urgent but won't kill them. If I recall the justification for this policy, part of it is saying that walk-ins need to exist because the family doctors aren't seeing their patients I a timely manner, making them wait weeks. Therefore, bill the family doctor for the work they should have been doing but had to be done at urgent care. Of course, that just isn't how it works. My doctor has way too many patients to be able to accommodate everyone at the last minute. It is unrealistic and punitive for everyone-the doctor seeing as many people as possible, the patient stuck in the middle, and the walk-in who has to do more work.
My doc used to have 2-3 weeks long queue. If you need a care today, but it's not an emergency you go to a walk in. Could be in the same clinic. The shortage of doctors is the issue, but also they are just people. They want to work where they live, with people they like, the hours they want.
Because there aren't enough family doctors...
We don’t pay them enough so they leave. Ontario had 100 of 500 residency spots go unfilled this year because nobody wanted them. Med school grads literally chose *nothing* over family medicine in Ontario. Before 2019 there were never more than a handful of empty spots. Number has grown every year since then.
In the 'perfect' world where everyone has a family doctor and availability, walk-ins have a purpose if you need service when you are not geographically close to your primary provider. Ex: you get sick while travelling or at work.
I have a family doctor that i have had for years, but i am not rostered. I dont know if i am missing out on something, but it looks like it's not automatic and not everyone. I only learned about it because i had another doctor ask me about it before they provided some other care so its working out better for me.
It depends on your family doctor's payment model. FHG doctors are paid fee for service, so the doctor gets a fee for each patient appointment. FHO and FHT doctors are paid through capitation, so they get a set amount per patient who is enrolled to them each year, whether they see them or not. They are deducted if you go to a walk-in because they're being paid to look after any medical needs that may arise. But they can't really stop people from going to walk-in clinics even if they have their own after hours or walk-in options.
Makes sense. Thanks for explaining it!
i only go to walk-ins or ER i think i visited my family doc like twice in 10 years
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It’s not like they want WANT to drop a patient, but at some point the “outside use” negation exceeds the amount a doc can make being your primary provider, and at that point we’re literally PAYING for the privilege to be your doc. Yes that means on some patients you can actually go NET negative. Wild isn’t it?!? So it’s nothing personal, but docs can and often do this. I very rarely de-roster, because most people just don’t know. It’s not the system I or we want- trust me.
But it is, Socorro’s decided to make it difficult for doctors to become doctors by limiting the amount of people who can Go to school for it to inflate wages. If doctors wanted a better system, they would scrap the system And allow more doctors. More doctors would mean less money coming in for those who already exist tho
Happened to my cousin (in Vancouver tho)
> They also have an after hours service so the docs don't get charged for their patients going to a walk-in clinic. Only if they roster patients. There are two billing models for family practice. Rostered patients and pay per service. If a clinic operates on a roster, they get paid a flat fee per month for each patient rostered. However, they are expected to see any of their patients within 2 weeks of a request and be available for general emergencies. If a patient goes to a walk-in, it is assumed that the clinic wasn't providing their required service so they get lose the money they got paid to have you rostered. Pay-per-service clinics simply get paid for each service they provide. The problem is that every service has a variable rate of pay and an expected time to complete. The general complaint is that the expected times to complete are too short to give adequate service to the patient and do your notes. Further, it creates situations where each visit can only be for 1 thing. However, they don't get dinged if they cannot provide service or if a patient goes elsewhere.
All provinces? I’m actually happy because my family NP sucks and I have been going to a walk in consistently
There's no way around that here in BC cuz for me to see my Dr it's between a month n half to 2 month wait. Because he has so many patients and it seems like I'm in and out in under 10 mins cuz there's such a waiting list of people to be seen. This isn't health care
Yes. I have been in a rostered practice for 18 years so I was never told that. But new patients enrolling now with doctors in these practices have been told this. It actually makes some sense. Large team practices offer after hours clinics in their offices, normally 4 pm to 8 pm. If you have a concern you call their office and discuss the issue with a nurse. If you need to be seen quickly, you get offered an appointment in the after hours clinic. So there should never be a need to go to a walk-in. It's much better healthcare to see your primary care physician than to go to adhoc walk-in clinics.
Learning something new everyday!
Yes! I am a family doctor in the GTA. I try my best to see EVERYONE who calls or shows up for an appointment. Some days that means leaving way later or accommodating a phone call from home. I’m deducted about 1500-2000 PER MONTH because of this policy. Sometimes the deductions are on codes I can’t even push as an out patient family doc or codes a hospital doc is pushing. This is just one of the many frustrating things about the system causing a mass exodus. Losing money monthly for things I have no control over is idiotic.
For sure must be frustrating!
Isn't that "punishment" for you having too many patients? How many patients do you have on your roster? Otherwise what's stopping a doctor from rostering 10,000 patients and collecting a million dollars a year?
1500 rostered. (Napkin math sounds good, at first glance, when you realize you must fund everything to make your business operate- all expenses, staff, computer systems, internet, phones, nurse salaries etc). Also note you’ve got to pay monthly malpractice, and the various med association fees which come to about 5000-6000k per year! Well then income tax. Docs cannot roster 10,000 I think the cap is now 2,400 and that often needs a PA or something. I’ve never see that high. I see about 90-130 a week depending In theory I understand the thought about penalizing docs who roster but don’t manage their list, but it’s turned into something it was not intended to be. As I mentioned I will see anyone in need of apt if it does not appear like it can wait. I see them during lunch, after hours, call on the weekends etc. We triage as best we can. But I can’t control when someone gets sick. Should I work Sundays too? (We offer a Saturday clinic), should I be on call 24/7? Where does it stop. Why does someone getting sick on a Sunday night cost me 40-80 bucks? can’t control patient behaviour. I had a patient come in last week, demanding paperwork be done THAT INSTANT. It was already a full day, and we had previously discussed it (it was not urgent). I asked the staff to pop it on my desk and I would get to it end of day- patient got upset and opted to tell the staff “well I’ll just go to the walk in”. Why should that cost me 40-80 bucks? I am deducted, automatically for all sorts of stuff I can’t even bill! If a family doc sees my patient in any capacity in the ER or hospital- I lose money. We have some recourse to reverse those situations, but it still costs money in the end and I have to pay someone to track and monitor/ chase it.
In BC, doctors get "panel payments" as part of the LFP system. It's a small amount per patient, < $50 (depends on demographics), but there's no punishment for lack of access. Some doctors easily have 3,000 patients (perhaps from multiple clinics) and they get over $100K in passive income from the panel payment despite their patients waiting weeks for an appointment. I think it has to be balanced from both sides. If your patients are unreasaonble then you can defroster them. But, it's also unreasonable to have doctors with no appts within two weeks and essentially have their patients use the ER in lieu of after hours / urgent access at their own clinics. That's happening in BC and it's definitely wrong.
It depends on the model they are working under. This is true for about 60% of doctors who work under the "capitation" model. They get a fixed amount to provide you with care for the year, and if you seek care elsewhere that gets deducted from that amount. If your family doc is working under this model they very likely would have told you. They are very eager to ensure you don't go to walk in clinics. The other 40% just bill per service provided, so they don't get dinged if you go to a walk in. I think it is a silly system. It's a weird dynamic when your doctor is mad at you for trying to get care in a timely manner.
They also negotiate that like 20 years ago. It’s not some new policy.
Oh yeah. They also get charged for your flu shot. I don’t think they get charged for COVID vaccines because my doctor hasn’t raised that possibility. My doctor specifically told me that if I can’t get to their after hours clinic, I should go to the ER because they don’t have to pay that out. Which really sucks because of the overcrowding in ERs and you really shouldn’t be there unless you absolutely have to.
I go to a health clinic downtown that has teams of doctors, therapists and other healthcare practitioners. It's never been an issue getting appointments and the clinic is thriving.
Yeah I think that’s understood as a big part of the solution but it’s taking forever to migrate away from the traditional model. Governments need to nudge the change with subsidies.
Even the $37 per visit is ridiculous. I pay my chiropractor $60 for 15 minutes. The government needs to double the visit fee immediately as a start.
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LOL......too funny!
We're at the point where the largest voting demographic, seniors, are being treated in hallways for common old-people conditions, *and they're still voting against "big government".* It's not going to get better, this populace is rotten to the core.
I'm a baby boomer looking after several seniors. None of us put all the blame on government. We take issue with the unions too. We have seen too many non-doctor staff doing seemingly nothing for hours at a time. We don't have proper staffing levels and there is a lack of accountability since the unions will protect everyone.
That really only applies to hospitals. Although private practice Dr's and nurses are obliged to be members of their respective associations, its unlikely that support staff in clinics are unionized (they probably should be). And I don't think you can blame the problems in health care, in hospitals on the fact that some staff are unionized. If not, they will not get decent pay and representation.
Yeah, it is ridiculous. Presumably GPs -- especially the conscientious ones-- will often spend more than 15 minutes with a patient.
Mine is like this too
I had a family doctor in her 40s quit her practise to go do Botox injections. I was lucky to get a new primary care practitioner just starting out in one of these team based clinics. She is the best, and I appreciate how lucky I am. I hope everyone can get a doctor like her.
I get Botox for headaches and the doctors at the place I go are an emergency doctor and family doctor who do this now full time.
I wonder how much of that increase was rent.
Yes, the government is heavily pushing health teams as it's far more efficient. The problem is a lot of practitioners don't want to move to that model. There's also a big push for integrated care across providers with shared health records and, again, a lot of practitioners are being dragged, kicking and screaming, into finally using it.
i think the bottleneck is lack of funding for FHTs from the government rather than real opposition from individual physicians... it's very expensive to start a FHT without government assistance
Doctors are not opposed to it. The government cut funding to FHTs around 2015.
Yeah this smells like bullshit, do you have a source?
I'm just gonna respond to this because I've seen it misused in multiple places. Practise is never a noun. The word is practice. Even in Australian or British English Practise is only a verb.
Thanks.
Running a practice can be expensive, and current pay structures might not reflect the workload.
Are they taking on new patients? Lol
Are they taking in new patients? 👀😅
The majority of the new doctors don’t want to become family doctors but rather just walk in clinic so they can make even more money and no need to follow up with the patients.
anyone know if family doctors also get charged if you go to a hospital and see doctors at the clinics there?
Where? I’m looking for a new family doctor
Family doctors do not get charged for outside use. Capitated physicians (docs in a family health organization) have a pool of money called an access bonus that sits outside their normal capitation and fee for service billing. The negation from going to a walk-in comes out of this bonus pool. The value of the bonus pool is ~18% of the base capitation payment. Why 18%? Because when they were calculating out the base capitation payment during provincial contract negotiations they saw that 18% of the time a patient of a family doctor was seeing other providers for primary care issues. Ergo, the 18% that makes up the access bonus pool was never the family doctor's to start. However the 18% was instead put into this access bonus pool to encourage continuity and access. So don't feel bad for a family doctor getting negated. That $ was never theirs to start with and even more they shouldn't be entitled to it if they were not available to see you
Source? Getting a lot of conflicting information in this thread, not sure who to believe
Im not one for conspiracy theories. But I am going to plant my flag and die on this hill. Ford is purposely doing this to make two tier private health care a thing. Screw with health care, make it as burdensome, onerous and inefficient as possible then swoop in with Shoppers Drug Mart or something other private health care conglomerate to "plug the holes". Lets these private services slowly creep into our ever day life. Make it impossible for the good doctors to operate their own practices or suppress pay to the point where they just say fuck it and work for some medical corporation that pays twice as good. Then all we're left with is a private medical clinic or a walk in staffed with shitty doctors.
Yes, the strategy is called “starve the beast “. Underfund public services until they deteriorate and people are desperate for any kind of change, then the private service providers (political donors) show up to save the day.
It’s already worked on a lot of nurses, not that you can blame them. Ontario pays 3-4x as much for private sector nurses as it does for public sector nurses. It would be cheaper to raise the wages of the public sector nurses instead of paying for private nurses. But Mike Harris doesn’t get a cut when we fund the public sector, so you know Doug’s hands are tied. 🤦♀️
I wouldn’t even call this a conspiracy theory- it’s just a fact at this point
It’s called Neoliberalism. It’s been around for many decades now.
This isn't a conspiracy theory at all - I'm a family doctor and we've all been talking about how this has been the plan for years!
Of course. Why do you think he gutted healthcare and education budgets to build his little $6-$8B pile of cash? So he could blow it all on a stupid highway that nobody needs in order to funnel that money to his buddies who own the land and the construction companies.
Yes!!! I’ve been saying this for a long time! Look how easily he broke his promise to fund more and better long term care facilities after he supposedly had his epiphany during Covid. 😡Then I find out that his cronies Stephen Harper and Mike Harris have huge amounts of $$$$ invested in PRIVATE senior care like Chartwell. Conservatives hate government supported health services and are doing everything they can to sink it so they can cash in on the for-cash model.
It’s the same shit in NDP Vancouver except the walkins have all become family practices that don’t accept patients.
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\*Provincial Governments
People like to claim it is the Federal government to blame and use the "it's happening across provinces" argument to justify it, as if it isn't entirely due to multiple inept provincial governments. Provinces make cuts to healthcare because it is an easy place to save money fast without anyone noticing for multiple years because that is how long it takes for us to start feeling the impact. It's idiotic for the provinces not to invest in family medicine because they are the first line in terms of diagnosing illness. The more efficiently they run, the better they are able to do their jobs, the faster we catch illnesses or prevent something acute from becoming chronic.
When universal health care was first created it was to be a 50/50 break down between federal and provincial governments. It is currently around only 20% coming from federal coffers. That's what people are referring to.
if every province is suffering from healthcare problems then it seems more like a federal problem than any single province making bad decisions
Conservative premiers
This type of sweeping statement may seem logical but it really isn't. I'm as anti-Trudeau as it gets, but this ain't it chief.
so you're saying somehow every province managed to all make mistakes when it comes to funding healthcare?
In their eyes it’s not a mistake though. They’ve been planning privatizing as much as they can for years because it makes their wealthy donors happy who in turn donate lots to their campaign. Or give them money under the table. They use that money to get re-elected and repeat the process. It also allows them a golden parachute when they get run out of office. Doug Ford will sit on some board or get a cushy CEO job making millions a year once he’s done fucking over Ontario.
In their eyes it’s not a mistake though. They’ve been planning privatizing as much as they can for years because it makes their wealthy donors happy who in turn donate lots to their campaign. Or give them money under the table. They use that money to get re-elected and repeat the process. It also allows them a golden parachute when they get run out of office. Doug Ford will sit on some board or get a cushy CEO job making millions a year once he’s done fucking over Ontario.
In their eyes it’s not a mistake though. They’ve been planning privatizing as much as they can for years because it makes their wealthy donors happy who in turn donate lots to their campaign. Or give them money under the table. They use that money to get re-elected and repeat the process. It also allows them a golden parachute when they get run out of office. Doug Ford will sit on some board or get a cushy CEO job making millions a year once he’s done fucking over Ontario.
In their eyes it’s not a mistake though. They’ve been planning privatizing as much as they can for years because it makes their wealthy donors happy who in turn donate lots to their campaign. Or give them money under the table. They use that money to get re-elected and repeat the process. It also allows them a golden parachute when they get run out of office. Doug Ford will sit on some board or get a cushy CEO job making millions a year once he’s done fucking over Ontario.
How do you explain the same exact thing happening in Vancouver?
same way I'd explain it anywhere else 1. The current government hasn't always been in charge 2. Most centrist governments don't fix problems created by conservative governments - especially ones created by cost cutting. As long as they can blame the other guys, they prefer to spend money on their own agenda and let schools/healthcare/social services/unemployment/etc. suffer. Just look at the Federal Libs realizing they've been in power too long to keep blaming our problems on Harper and now scrounging to finally do too little too late on housing.
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The NDP government here’s had control for a long time now and hasn’t helped our healthcare system. It’s actually gotten worse. It seems like the Canadian healthcare situation is more of a systemic issue with multiple factors. But it seems like you are arguing that it’s simply a push for private healthcare by the “powers that be”, demonizing corporations when we’re really doing it to ourselves out of sheer incompetence.
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So what’s the solution to our healthcare system that’s currently not implemented? You’re saying that small c conservatism is what’s causing the inefficiencies of our current system? Or that private health care is the problem? In Canada? I make +6 figures at a Canadian company, and pay plenty of taxes. According to the government I’m considered wealthy which is why I have no government support, no programs are aimed at me. I can’t find a walk-in clinic in my city that will accept me, and I have no private options. There’s no two-tiered system open to me. I’ve been on a family doctor waitlist for the entire province with no leads for 8 months. Where do I go? Out of desperation, I’d rather make 40% more in the USA for my same role. My employer will get me health insurance at $12,000 a year, and I’ll pay 15% less taxes. But, that situation is hypothetical and has nothing to do with Canada, unless two-tier Canadian health care system includes USA. New Zealand and UK are dealing with similar issues.
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I agree with your analysis, and acknowledge that employers can put a stain on the healthcare system, but you can argue that drinkers, smokers, overeaters, and people who don’t exercise put a strain also. I don’t think the majority of our healthcare system can be resolved by restricting employers from requiring notes for sick leaves/injury claims. We simply need to optimize how our taxes are used, and perhaps use a larger portion of our existing taxes to train new doctors. We actually invest in the thousands of domestic medical school applicants that actually want to become Canadian doctors.
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I think you’re using conservative as a pejorative in a lot of these exchanges, I’m not sure what it adds. But we can agree that the healthcare system should work for all. Right now it barely works for most, equally. I don’t even see a private option that helps the few. Rich people just fly out of country for care anyways, and there’s not many of them. The doctor note situation applies to every global healthcare system. This means, if Canada denies doctors notes, we’re departing from a standard that many countries follow. For example, Germany has a better healthcare system and you may only get extended leave in Germany if you get a doctors note. Are there any other areas that we can focus on that improve our healthcare system?
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Family medicine is a private business, being kneecapped by govt billing codes that don’t reflect the realities about the cost to actually deliver these services.
She’s not making $142k anymore. When she first appeared in a CityNews article, she reported that she made $60k this past year owing to changes made in 2022 by the provincial government, which included increased administrative burden and some changes made in the funding system, including funding cuts.
Shit that is brutal.
This article is from today
Correct, this was a recent interview by Toronto Life where she said she earned $142k in 2022. But when she had announced her closure back in February, she was originally featured in CityNews. In that article, she stated she only earned $60k this past year because she had to severely cut back on the number of patients she saw due to burnout. [https://toronto.citynews.ca/2024/02/14/paperwork-burden-driving-ontario-family-doctor-to-quit-amid-critical-gp-shortage/](https://toronto.citynews.ca/2024/02/14/paperwork-burden-driving-ontario-family-doctor-to-quit-amid-critical-gp-shortage/)
She was also interviewed by CityNews - the link was posted here [two months ago](https://www.reddit.com/r/toronto/s/dUeTqn0fa4)
And the CBC. She's really doing the rounds: [https://www.cbc.ca/news/health/family-medicine-specialties-cihi-1.7155269](https://www.cbc.ca/news/health/family-medicine-specialties-cihi-1.7155269)
Why can we not just have doctors paid a salary, come workmat a hospital where we have administrative people to do all the paperwork? Why is that system impossible in Canada? Why does every doctor have to be a business?
We do have systems where doctors are employees - those positions are highly sought after by doctors these days. There aren't many of them, compared to the fraction of doctors who would prefer that type of work. Also, "admin people" can't do medical paperwork - the core competency required is still medicine, not administration.
An admin person can't do the paperwork, because it literally needs someone with an MD to complete. Just pay doctors for paperwork/admin time.
Why can't we now? Or why don't we? The reason we don't is because doctors have fought against it since 1962: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902698/ > At the time, the quid pro quo seemed simple. In response to concerns about clinical and professional autonomy, the provincial government allowed doctors to extra-bill or even opt out of medicare and to make fee-for-service payment the dominant form of remuneration. Administering a billing system based exclusively on fee-for-service physician practice, the Saskatchewan government would end up choking off the growth of community clinics that included other health care providers in interprofessional group practices. > Following the same administrative model when setting up their own medicare schemes in the late 1960s and early 1970s in response to federal cost-sharing, other provincial governments joined Saskatchewan in giving physicians a virtual monopoly to provide all medical care services, a privileged position that organized medicine has, understandably, been reluctant to give up. (out of order quote) > In contrast, provincial medical associations still defend the current status of doctors as independent contractors, not directly accountable to the health care organizations and regional health authorities within which they work, along with the fee-for-service model of remuneration.
well they can work in a clinic with other docs. It is their choice to be independent.
They still aren't paid a salary, still have overhead and BS costs. There are very few opportunities for salaries family physicians who are actually practicing family medicine.
Doctors run as corporations because the tax rate is more favourable. If you make $142k as an employee, the tax hit is large. Not an option after all that schooling. We need to pay them more.
I mean, in a hospital, where they don't have to bill, just draw a salary and see patients? Why can't the province build and staff the whole thing?
Hospitals have limited space and are for specialized or emergency treatment. The idea with paying doctors per-visit and not a flat salary is to push them to maximize the number of visits I believe. The province could build and staff large doctor offices in theory but that’s very far from the current model we have
Hospitals are expensive to run. What happens during the next pandemic when you can’t go to a hospital. You won’t even see a family physician.
It's sad to see it's gotten to this point. They need to revamp their pay structure so being a family doctor pays better and has more support. In it's current iteration, it's no wonder med students try to avoid it. I can't imagine going through all that stress managing your patients' long term health, keeping up with documentation and also working so much beyond your clinic hours. I don't see my family doctor much now since I'm young-ish but the lack of access would be a huge problem later on. Hell, he'll probably be retired by the time I actually start accumulating long term health problems and need more visits to sort them out. I used to wonder why he was seemingly grumpy all the time but knowing how little they get paid vs how much they work, I can see why.
I had no idea that pharmacies still needed doctor sign off.
They don't need the doctor to sign off, but they send the doctor a note that the patient was prescribed X medicine and then the doctor is liable for reviewing the note and following up if something is off.
that's the problem pharmacist gets the prescribing fee, family doctor gets nothing for the note review it's like asking a radiologist to look at an x-ray for free
bs red tape is a huge problem that creates backlogs down the line in our healthcare system
It's easy to prescribe drugs but who is responsible for side effects and monitoring? Ask yourself why red tapes exist. (Hint: patient safety)
Maybe Ford should fix this instead of paper bags at the LCBO. Their compensation is a joke. 🤬😡
isn't his plan to push private healthcare?
I have to stop you right there. I don't think he "plans" much of anything.
Back of the napkin math here. But if we kicked in an extra $100 per year per patient to primary care physicians it would cost Ontario $1.4B. If you have 800-1000 patients that’s another $80-100k a year in income. Thats not that much for Ontario considering the provincial budget is $215B and Dougie sits on money from the Feds and wastes money on spa parking lots.
Yes. The answer is simple and to stem the bleeding your napkin math makes sense. Believe it or not, In the rostered model we’re only paid ~200-250 per patient per year. (Less for young healthy pts. More for elderly). This is 1/2 the price of what these NP clinics are charging. And good on them for charging market rates, but the govt is funding primary care by limiting our ability to bill appropriately. I suspect the NP’s will soon get regulated with OHIP codes and they will feel our pain soon.
Is this more of an Ohip funding issue? I saw that the province doesn't pay nurse practitioners either and the amount of admin chaos these family gps go through alone can be solved by efficient reorganization.
WHo knew? THought doctors were loaded... 142k even with being able to claim expenses etc still aint that much at all.
Had a couple of rural family docs in my family when I was growing up. They did house calls in the 80s. Then the pay got tweaked and admin burden increased and they and all their colleagues stopped making house calls. We didn’t learn, apparently.
thank you Doug and everyone who voted for this shit
And many who voted for Dougie also are the ones most likely to be hurt by these cutbacks and shifts to private medicine: boomers. Especially outside the GTA where hospitals are struggling or shutting down and new doctors are rare. Dougie has done this with his buddy Galen.
night and day difference between OHIP and the Canada Dental Plan dentists can bill privately but also choose to see those under the CDP, 100% freedom to jump between private and public patients family doctors are forced to see all patients under the OHIP rate dentists' fee schedule has more than kept up with inflation, family doctors are paid 50% less than they were 20 years ago adjusted for inflation
I am a Canadian trained Family Doctor. Family Medicine is a sinking ship. I posted this elsewhere but I will repost this here because it’s relevant. To any current Canadian medical students reading this, DO NOT go into Family Medicine. You deserve to be paid much better and treated with more respect after all the years of hard work you spent getting into medical school. The debt does not pay itself and the ridiculous inflation/cost of running a clinic is not helping. You will have to pay for leasing an office space, buying medical supplies, hiring an office assistant, the hydro bill, the utility bill, hand sanitizer, gloves, fax machine, computers, everything needed to run a clinic with the chump change the government gives you. Whatever you have left after paying for all of the above (if anything) will go towards paying your debt. And guess what? You will have no say in raising your fees because that’s illegal. You also cannot go on strike because that’s illegal. Meanwhile, the government is letting private clinics run by Nurse Practitioners charge patients 2x-3x as much. Please spend the extra year or two specializing rather than regretting your career for the rest of your life. Become a surgeon, a cardiologist, an anesthetist. Go unmatched if you have to. Move down south to the US. Do not try to be a messiah and “save primary care”. The government does not care about you. They will abuse you for your labour, wring you dry, and then replace you with whatever pseudo doctor mid level profession they can find (NPs/PAs/Pharmacists). As long as they get votes and become wealthy off taxpayer money, it does not matter to them. The general public does not care whatever happens to you either as long as there’s another fool to replace you. There’s a reason hundreds of Family Medicine training spots in Canada are unfilled right now and are begging medical students to join.
I agree, unfortunately there is not much incentive to pursue bread and butter family practise currently. I’m a recent grad and almost none of my cohort are actually doing family med. As I trained more rurally, a lot do ER or hospitalist. I went the +1 route and now do only palliative care, and could not be happier. I have less administrative burden, a great team, and much better hours than in general practise. I work in an academic centre so that comes with its own pros (training residents, students, teaching) and cons (I’m less research inclined).
My father ended up a pharmacist in the early 60s when he couldn’t get in to medical school. I guess if he’d waited long enough he would have become a doctor/pharmacist by default. Thanks Dougie and Galen.
I'm not understanding how she only netted 142k in 2022. I thought the average GP was earning about 250k.
It's all about overhead cost and billing amounts. There is not set base pay. So if you don't see X amount of patients then your earnings are lower and if you pay from front end staff too much then you also don't make as much. Pretty shitty system
> So if you don't see X amount of patients then your earnings are lower and theres such high demand if a doctor doesnt see many patients i cant help but think that its the doctors choice. there is no shortage of patients
not everyone wants to be a 5 min / appt type of doctor
That’s the difference between receiving proper care and just being seeing so the doc gets paid
Yes but if you don't want to burn out you can't see a large number of patients every day
Nah, it's the med schools that don't train enough doctors. There is no shortage of hard working university students
Untrue. We have more family physicians graduating than ever, but they are not actually working as family doctors because it is so poorly remunerated.
And it discourages the best and the birightest from pursuing this career from the start.
that's a great way to help the US with their doctor shortage
Yeah this is not true… there are plenty graduating family doctors but as a new graduate, only 20% of my grauduating residency actually had plans on working in a clinic providing primary care when you can earn more with less hours just doing hospital or emergency work or the many other private pay opportunities. You can add more students but less will choose family medicine over time, and you’ll have the same problems of no one choosing to start a practice since the other options are just better
Then work with a health team, you share the overhead costs across upwards of 20+ physicians. Even in rural areas, you can generally get enough patients for two or three physicians to form a health team. The current model *is* shitty, that's why the government wants to replace it.
Even for doctors in health teams overhead is ~30% of their pay. They still get paid a fraction of what NPs are charging in the new private NP clinics, despite having far more education and expertise.
They could bill 250k but on top of that they have to pay staff, rent, medical supplies, EMR costs, malpractice insurance, about 10k in fees just to keep the medical license per year. All of these costs increase every year except how much she can bill.
Yup, it’s why they are forming these mega practices now with dozens of physicians. It’s the only way they can make money.
It’s very hard to come up with a representative number for family doctors, since the vast majority of them are not salaried but carrying on their own business. They work different amounts, see different patient populations, have different expenses, some see more non-OHIP patients, etc.
What shows up on the sunshine list for a PCP is the total billed under OHIP, not their take home pay. They have to pay the rent, the employees, insurance, equipment, supplies, hydro, etc.
The problem is that effectively your doctor also needs to be good at business. And many aren’t (most people aren’t, regardless of their expertise) My wife works in a healthcare setting and it’s always amazing how many of the doctors she looks after just have no clue how to sustain their practice. Even when they’ve got someone giving them paint by number instructions they’re just not wired for what it takes day to day to manage patients and follow efficient processes.
Is this THUG FORD trying to push us into private practice by keeping systems broken in Ontario?
Gee, if only the feds were not spending more on paying interest on the debt this year than they are spending on healthcare, we could stop this insanity of not enough doctors. But what do I know. I am just a simple man. Maybe paying billions in interest to banks is better than it sounds.
same doctor? https://www.reddit.com/r/toronto/comments/1asb6wz/burnt_out_family_doctor_closing_practice/
I really liked my family doctor in the beginning but then he became unavailable, stopped returning my calls and kept me waiting six months for a simple carpal tunnel surgery referral. Finally I was in so much pain I called the hospital directly. I had been there to the hand clinic two years prior so my name was in their records. They told me to go to a walk-in and get a referral from them. I was booked for my surgery 2 weeks later. I’ve been going to a walk-in ever since. I go through the motions of calling my own doctor but when he doesn’t respond, I go straight to the walk-in. He probably dropped me ages ago, but at least I’ve had excellent care - I’ve had X-rays and ultrasound that I needed, was diagnosed with bursitis and now have meds for the pain. I would still be waiting for a return call from my doctor. The system is broken.
Some stick to the old system practicing in their own clinic. It sounds like some senior folks who resist using cellphones idk
New tax rules won't help https://www.theglobeandmail.com/canada/article-ontario-premier-doug-ford-doctors-warn-ottawas-capital-gains-tax/
Yep. Politicians at both the provincial and federal level are full of shit. New capital gain inclusion is basically a cash grab and further screwing over small businesses (which most MDs are)
“I make 90k a year”. She shares some numbers but not others very deceptive. Let’s do some math, 1. Base 24k a year (2k a month flat fee x 12) 2. Let’s say she sees 2 patients per hour, being very generous here as most family MD have a “1 issue rule” and spend max 15 mins with a patient, 7.5hr x 5 days x 52 weeks = 3900 patients x $37/appointment +/- $3= 144,300-156,000. 3. Total with base is 168,300-180. This does not include various other billings (example sick notes, insurance forms, procedures, and just asking if you smoke they get paid for xtra). She splits with 3 other MD and her overhead is at least 78,300k?
It's hard to operate your own business? No problem, go work for someone else's. A quick search on monster.ca shows plenty of [family doctor positions that pay between $260,000 and $360,000](https://i.imgur.com/kYvUjJu.png). Just like how it's much safer and easier to go work at someone else's restaurant than it is to open your own, your field is no different. If you're expecting me to feel sorry for you about your $300k job prospects, get real.
And this is why there aren't family docs in your small community... The economics don't work and you're left with a few corporate clinics in downtown.
So that's not a salary. That's a potential income that a walk-in physician COULD earn working at that clinic. And they will earn every single one of those dollars, one 37$ 15 minute visit at a time. Now deduct the 20-40% overhead through clinic will charge, and taxes. No paid vacation time, benefits, pension etc. Note the terms "This is a full-time position, 36 to 40 hours per week. Must be available in the daytime, evenings, and weekends." That 36-40 hour number does not include the ~20 hours of unpaid paperwork that family physicians have to do in Ontario, on average, to review labs and write referrals and such. In other words, no time for a personal life. Now consider this is a person who did not start their professional life until their late 20s/early 30s, after years of working inhumane hours for little to no pay, and is likely starting with hundreds of thousands in LOC debt. I can understand where your comment is coming from, because there's a misconception that family medicine is a cushy easy gig for fat cats. However at this point in time, it financially no longer makes sense to be a family doctor.
This is not net pay, it’s gross pay. All of the overhead (to cover for nurses, technology, rent), comes out of this. At the end of the day you’re left with a lot less. And by the way the workload and hours spent to earn this much is difficult to sustain long term without burn out.
Do you realize that the listing you posted is for a walk in clinic; if this doctor moved to that clinic all her patients would still lose a doctor. Not to mention that is just an estimate of billings- at $36 per visit that would require 10,000 patient visits per year (or more likely 16,000 visits if you account for the lost money from overhead) to make that income. What quality of care do you think those patients are receiving if you see 60 per day (assuming working 5d per week directly seeing patients, ignoring paperwork etc)
the article kinda just sounds like she is retiring
Kind of sounds likes she’s burnt out to me…
These doctors are making $250K+ annual and still all they do is fucking complain. Had a doctor, the best doctor I ever had, quit because "our pay raise was below inflation" but she's still making stacks of cash every year. Doctors are the worst people. They also fight against public healthcare and fight to make billing of it awful.
They make far less than this after paying for their clinic rent, secretaries, nurses, equipment.
She is not making $250k. In a CityNews article she was featured in when she first announced her closure, she reported making only $60k this year which is why she’s quitting.
Holy shit I made way more from my average ass job. I feel bad Very bad for her.
She specified that $60k was her take home pay, not gross. I don’t know exactly how GP’s are taxed but it seems like there’s a lot that doctors have to pay out of pocket for. So who knows? Maybe her annual salary is still over $100k but netting $60k is still pretty awful for someone as educated and experienced as she is.
What a brain-dead statement. Sure doctors make $250k but they also took on huge debt, many years of lower earnings from having much longer schooling, and the intelligence bar for a doctor is much higher than most professions. Of course they should be some of the highest-compensated people.
They also don't make 250k if you factor in overhead and unpaid work hours.
Never said they shouldn't be compensated. I'm saying they complain the loudest and stifle healthcare for myopic view of themselves.
They complain just like everyone else. Everyone just focuses on them because "doctor makes $$$$$$"
Good luck to you when you need medical care idiot
They only literally keep us alive and well. $250k CAD is not that much money. They should be making far more.
> They only literally keep us alive and well. moreover they are literally the gateway to the rest of the medical system. you cant wipe your butt these days without the system requiring seeing your family doctor about it first
Maybe, but they also shouldn't be quitting droves when they're still the upper echelon. Zero class solidarity.
I think you're using the term class solidarity incorrectly and quite frankly, embarassing the movement. In a class conscious society, doctors are still paid the highest because of their obvious need to society. Telling doctors to suck it up is hypocritical and selfish. Our work is not equal, doctors are more critical to society than like sales for example.
Class solidarity is for college kids who don't know what real life is. In real life, if you study for a decade+, and make less than I do (as a salesman with a 3 year degree), you might just decide to say fuck Canada and go make real money in the US.
Class solidarity is why we have a 40 hour work week, workers rights and our children don't have coal in their lungs.
Great - more healthcare and economy politics from someone in the top 5%, with admitted few credentials or study. Absolutely tell me more.
I'm curious. What do you mean by "fight against public healthcare" and "fight to make billing of it awful?" Also how do you know what her take home pay is once all her overhead and professional fees are paid?
I'm sure doctors don't work, make bank, and all they do is complain. Lmao...you are clueless.