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Many countries with universal healthcare still pay by the act. In Canada, doctors are mostly independent service providers that bill the government directly. Th

Many countries with universal healthcare still pay by the act. In Canada, doctors are mostly independent service providers that bill the government directly. This can lead to two problems: a) they don’t do a whole lot of medical acts because it already pays so well that they can afford to slack off (e.g., work 3-4 days a week, see very little patients), or b) do a lot of unnecessary acts because it goes directly into their pockets.

belval 5y ago
Yep and it's a pretty big issue actually as it creates a lot of abuse in the system, doctors mostly interested in smaller "easier" acts that they are known to pay well, doctors getting referrals from a clinic outside of their administrative region (those pay more), and of course radiologists working 2-3 days a week because their acts are even better remunerated. Add on top that by being independent, doctors will have their own company and be subjected to a much lower tax rate than a "normal" person earning 400k$/year.
rectang 5y ago
It's clear why performing unnecessary medical acts is problematic, but what is the issue if doctors being paid by the act work 3-4 days a week? Isn't this just piece work and you can add more doctors?
- klyrs 5y ago
  Yeah, that sounds ideal to me. I hate seeing stressed out, rushed medical professionals. In part, that's selfish -- they aren't doing their best work. But also, they set a terrible example to their patients by ignoring the impact of overwork on their own physical and mental health. Less overwork results in better care, and more jobs. I'm all for it.
- dasudasu 5y ago
  Because the supply of medical doctors in most countries including Canada is heavily constrained. People are wary of opening the flood gates because it is expected that the quality of care would drop (not necessarily a good argument). Meanwhile, there is a huge access issue with long wait times at the ER or for seeing specialists. A large proportion of the population has no family doctor.
- dahfizz 5y ago
  The median wait time to see a specialist in canada is 78 days[1]. Yes, in theory you could "just add more doctors". But there is clearly already less doctors than there needs to be. Policy that encourages doctors to work less exacerbates this issue. You can't just say "add more doctors" as if that helps anything. Shortages exist for a reason, and analyzing and fixing the system which creates the shortage is the only way to resolve the shortage. You can't just tell poor people to "make more money" and solve poverty in the blink of an eye. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292524/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292524/
  - vanviegen 5y ago
    > You can't just say "add more doctors" as if that helps anything. Why wouldn't it? There are more than enough people who would want to become a doctor, and would be capable. Especially if the work/life balance would be better. At least in my part of the world, it seems that the system is rigged to keep the number of docters artificially low.
    - dahfizz 5y ago
      > Why wouldn't it? I explained in my comment: There is a shortage of doctors. Unless you know 50,000 people with medical degrees searching for a job, you are going to have to fix the situation that created the shortage rather than just wishing more doctors would appear. This is what dasudasu was doing. They identified a cause of the shortage (doctors are encouraged to work 60% of a work week) and your response was "so what, more doctors will just appear". More doctors have not been appearing.
      - vanviegen 5y ago
        No, what I said is that there appears to be a structural problem causing a lack of docters, which we need to fix, as it causes high work pressure (and rather high earnings). I don't think doctors working 60+ hour weeks is the type of solution to the shortage we should aim work.
deleted 5y ago
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belval 5y ago

Yep and it's a pretty big issue actually as it creates a lot of abuse in the system, doctors mostly interested in smaller "easier" acts that they are known to pay well, doctors getting referrals from a clinic outside of their administrative region (those pay more), and of course radiologists working 2-3 days a week because their acts are even better remunerated. Add on top that by being independent, doctors will have their own company and be subjected to a much lower tax rate than a "normal" person earning 400k$/year.

rectang 5y ago

It's clear why performing unnecessary medical acts is problematic, but what is the issue if doctors being paid by the act work 3-4 days a week? Isn't this just piece work and you can add more doctors?

klyrs 5y ago
Yeah, that sounds ideal to me. I hate seeing stressed out, rushed medical professionals. In part, that's selfish -- they aren't doing their best work. But also, they set a terrible example to their patients by ignoring the impact of overwork on their own physical and mental health. Less overwork results in better care, and more jobs. I'm all for it.
dasudasu 5y ago
Because the supply of medical doctors in most countries including Canada is heavily constrained. People are wary of opening the flood gates because it is expected that the quality of care would drop (not necessarily a good argument). Meanwhile, there is a huge access issue with long wait times at the ER or for seeing specialists. A large proportion of the population has no family doctor.
dahfizz 5y ago
The median wait time to see a specialist in canada is 78 days[1]. Yes, in theory you could "just add more doctors". But there is clearly already less doctors than there needs to be. Policy that encourages doctors to work less exacerbates this issue. You can't just say "add more doctors" as if that helps anything. Shortages exist for a reason, and analyzing and fixing the system which creates the shortage is the only way to resolve the shortage. You can't just tell poor people to "make more money" and solve poverty in the blink of an eye. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292524/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292524/
- vanviegen 5y ago
  > You can't just say "add more doctors" as if that helps anything. Why wouldn't it? There are more than enough people who would want to become a doctor, and would be capable. Especially if the work/life balance would be better. At least in my part of the world, it seems that the system is rigged to keep the number of docters artificially low.
  - dahfizz 5y ago
    > Why wouldn't it? I explained in my comment: There is a shortage of doctors. Unless you know 50,000 people with medical degrees searching for a job, you are going to have to fix the situation that created the shortage rather than just wishing more doctors would appear. This is what dasudasu was doing. They identified a cause of the shortage (doctors are encouraged to work 60% of a work week) and your response was "so what, more doctors will just appear". More doctors have not been appearing.
    - vanviegen 5y ago
      No, what I said is that there appears to be a structural problem causing a lack of docters, which we need to fix, as it causes high work pressure (and rather high earnings). I don't think doctors working 60+ hour weeks is the type of solution to the shortage we should aim work.

deleted 5y ago

[deleted]