3 ms·

This is just a prioritization problem. We have more doctors per capita than we did 20 years ago, they just don't pay them properly to be family doctors.

by soperj 3y ago

hesdeadjim 3y ago
My father was a GP who ran and taught a residency program for the speciality. In the 80s and 90s the program was extremely competitive, but by the 00’s they struggled to fill a class. Med students caught on, why work your ass off in the most thankless field of medicine to make 200-300k when you could be a cardiologist and make $1mm reading X-rays?
- ActionHank 3y ago
  It also takes ages to see any specialists, so it's not like there is a glut of cardiologists running around.
  - deleted 3y ago
    [deleted]
  - bryanlarsen 3y ago
    The bottleneck is the residency programs. The cardiology residencies are massively oversubscribed, whereas the GP residencies get the dregs.
- cybercity 3y ago
  Every few weeks they do a walk-in (or crawl-in) for those who are not insured. It's not a thankless job but it sure as hell doesn't pay the bills.
  - soperj 3y ago
    Who's not insured?
- beaeglebeached 3y ago
  'Market' failure. Something is interfering with supply and demand.
ActionHank 3y ago
Another side effect is that when you do get one they are so packed with patients that you have to wait months for a low priority appointment or see the doctor after hours.
stewx 3y ago
From 2000-2022, Canada's average age increased from 36.8 to 41. Older population consumes more health services. https://www.statista.com/statistics/444844/canada-median-age-of-resident-population/ https://www.statista.com/statistics/444844/canada-median-age...
ttul 3y ago
BC changed its primary care billing model dramatically in 2023 to address the problem. The new model pays doctors based on a combination of their patient load and the complexity of their cases. The typical family doctor pay rises as a result from C$250K to C$385K - in line with what many specialists earn. As a result, doctors are moving to BC from other provinces and countries and, as an anecdote, my small community now has 3x as many doctors as it had before. Money works.
loceng 3y ago
You may be right that this is a prioritization problem, in that the priority is allowing incompetent/bad bureaucrats and unelected administrators as a central-single point of failure to make decisions - rather than allowing the free market decide, allowing the general population decide - so then the most efficient providers while providing an acceptable quality of care gain momentum, can hire more staff, etc. But this is not a "just don't pay them properly" issue because in Canada free market competitive forces don't economically suffocate out the bad-incompetent doctors and administrators, and also then don't fuel-reward the good-best doctors and administrators. How do I know this? 10+ years of hell trying to navigate the Ontario medical system, the prior 10+ years being harmed by that Ontario system - where I have had to spend $600k+ getting medical treatment outside of Canada, with the next surgery coming in in Europe to add another 60k EUR to medical expenses - of which I would have to find a lawyer who specializes in suing OHIP, spend another $200k+ and years of time, to try to get compensated for any of the expenses; stress, time, and money that isn't available to initiate that. Anyone defending the current system has no leg to stand on: there's absolutely zero oversight and accountability. Example? I recently actually became a "rostered" patient with a general-family physician, rostered meaning that instead of going to a walk-in clinic and waiting many many hours to briefly discuss 1 thing - I can book an appointment instead. Of the 3 phone calls I had with this "family" physician so far, of which I had a file with them for years and recently had see multiple of his assistants (PAs: physician assistants), he hadn't even for a moment reviewed my file, nor on the 2nd and 3rd call did he even review the previous call notes with me - to even know what page he should be on; and no, not a new physician, he's been practicing for 25+ years. This also is part of a planned destruction-erasure of Canadian culture and weakening of the population strategy. In part via weaponized immigration + weaponized international student visas + irrational-illogical highly harmful "carbon tax" on all Canadian products and services - rather than say specifically on products coming from China - which arguably the majority are but Trudeau is toeing the CCP line, our intelligence agency CSIS having multiple whistle blowers [one who even came publicly forward to add credibility] stated that Trudeau and 11+ MPs had help of CCP to get elected for at least the last 2 elections; and more tactics they deployed. Chart showing the West reducing its CO2 emissions vs. China's skyrocketing: https://ourworldindata.org/explorers/co2?facet=none&Gas+or+Warming=CO%E2%82%82&Accounting=Territorial&Fuel+or+Land+Use+Change=All+fossil+emissions&Count=Per+country&Relative+to+world+total=false&country=CHN~IND~GBR~USA~CAN~FRA~DEU https://ourworldindata.org/explorers/co2?facet=none&Gas+or+W... Ignorance is bliss, and if the depths of your understanding is only what's discussed as acceptable to pop culture - which is heavily crafted by what narratives state-funded media like CBC floods the landscape with - then you'll miss the foundational points, because they don't want you to know the fundamentals, don't want you critically thinking through - they want you regurgitating-parroting.
alephnerd 3y ago
Canadian Medicare is also largely based on the NHS system back in the UK, which is also buckling for similar reasons. Both the Canadian and British Single Payer system are holdovers from the post-war Old Labour era, specifically, the vision of Clement Attlee in the UK and Tommy Douglas in Canada. I think a lot of people forget that Canada was basically Britain-lite until the 70s and 80s (hell, Newfoundland was under direct British rule until 1945), when Americanization became more prominent in the younger post-war generation. Most of the Canadian leadership until the 1980s studied in the UK, were born in the UK, or were the children of immigrants from the UK. And specifically blue collar Labour Party leaning parts of Scotland. As such, a lot of the policies and legislation passed in Canada before the 80s or 90s tends to have a significant amount of British influence in it. Australia's is similar as well, but they moved towards a public-private model in the late 1990s after their economy almost collapsed in the early 1990s.

This is just a prioritization problem. We have more doctors per capita than we did 20 years ago, they just don't pay them properly to be family doctors.

by soperj 3y ago

This is just a prioritization problem. We have more doctors per capita than we did 20 years ago, they just don't pay them properly to be family doctors.

hesdeadjim 3y ago

My father was a GP who ran and taught a residency program for the speciality. In the 80s and 90s the program was extremely competitive, but by the 00’s they struggled to fill a class. Med students caught on, why work your ass off in the most thankless field of medicine to make 200-300k when you could be a cardiologist and make $1mm reading X-rays?

ActionHank 3y ago
It also takes ages to see any specialists, so it's not like there is a glut of cardiologists running around.
- deleted 3y ago
  [deleted]
- bryanlarsen 3y ago
  The bottleneck is the residency programs. The cardiology residencies are massively oversubscribed, whereas the GP residencies get the dregs.
cybercity 3y ago
Every few weeks they do a walk-in (or crawl-in) for those who are not insured. It's not a thankless job but it sure as hell doesn't pay the bills.
- soperj 3y ago
  Who's not insured?
beaeglebeached 3y ago
'Market' failure. Something is interfering with supply and demand.

ActionHank 3y ago

Another side effect is that when you do get one they are so packed with patients that you have to wait months for a low priority appointment or see the doctor after hours.

stewx 3y ago

From 2000-2022, Canada's average age increased from 36.8 to 41. Older population consumes more health services. https://www.statista.com/statistics/444844/canada-median-age-of-resident-population/ https://www.statista.com/statistics/444844/canada-median-age...

ttul 3y ago

BC changed its primary care billing model dramatically in 2023 to address the problem. The new model pays doctors based on a combination of their patient load and the complexity of their cases. The typical family doctor pay rises as a result from C$250K to C$385K - in line with what many specialists earn. As a result, doctors are moving to BC from other provinces and countries and, as an anecdote, my small community now has 3x as many doctors as it had before. Money works.

loceng 3y ago

You may be right that this is a prioritization problem, in that the priority is allowing incompetent/bad bureaucrats and unelected administrators as a central-single point of failure to make decisions - rather than allowing the free market decide, allowing the general population decide - so then the most efficient providers while providing an acceptable quality of care gain momentum, can hire more staff, etc. But this is not a "just don't pay them properly" issue because in Canada free market competitive forces don't economically suffocate out the bad-incompetent doctors and administrators, and also then don't fuel-reward the good-best doctors and administrators. How do I know this? 10+ years of hell trying to navigate the Ontario medical system, the prior 10+ years being harmed by that Ontario system - where I have had to spend $600k+ getting medical treatment outside of Canada, with the next surgery coming in in Europe to add another 60k EUR to medical expenses - of which I would have to find a lawyer who specializes in suing OHIP, spend another $200k+ and years of time, to try to get compensated for any of the expenses; stress, time, and money that isn't available to initiate that. Anyone defending the current system has no leg to stand on: there's absolutely zero oversight and accountability. Example? I recently actually became a "rostered" patient with a general-family physician, rostered meaning that instead of going to a walk-in clinic and waiting many many hours to briefly discuss 1 thing - I can book an appointment instead. Of the 3 phone calls I had with this "family" physician so far, of which I had a file with them for years and recently had see multiple of his assistants (PAs: physician assistants), he hadn't even for a moment reviewed my file, nor on the 2nd and 3rd call did he even review the previous call notes with me - to even know what page he should be on; and no, not a new physician, he's been practicing for 25+ years. This also is part of a planned destruction-erasure of Canadian culture and weakening of the population strategy. In part via weaponized immigration + weaponized international student visas + irrational-illogical highly harmful "carbon tax" on all Canadian products and services - rather than say specifically on products coming from China - which arguably the majority are but Trudeau is toeing the CCP line, our intelligence agency CSIS having multiple whistle blowers [one who even came publicly forward to add credibility] stated that Trudeau and 11+ MPs had help of CCP to get elected for at least the last 2 elections; and more tactics they deployed. Chart showing the West reducing its CO2 emissions vs. China's skyrocketing: https://ourworldindata.org/explorers/co2?facet=none&Gas+or+Warming=CO%E2%82%82&Accounting=Territorial&Fuel+or+Land+Use+Change=All+fossil+emissions&Count=Per+country&Relative+to+world+total=false&country=CHN~IND~GBR~USA~CAN~FRA~DEU https://ourworldindata.org/explorers/co2?facet=none&Gas+or+W... Ignorance is bliss, and if the depths of your understanding is only what's discussed as acceptable to pop culture - which is heavily crafted by what narratives state-funded media like CBC floods the landscape with - then you'll miss the foundational points, because they don't want you to know the fundamentals, don't want you critically thinking through - they want you regurgitating-parroting.

alephnerd 3y ago

Canadian Medicare is also largely based on the NHS system back in the UK, which is also buckling for similar reasons. Both the Canadian and British Single Payer system are holdovers from the post-war Old Labour era, specifically, the vision of Clement Attlee in the UK and Tommy Douglas in Canada. I think a lot of people forget that Canada was basically Britain-lite until the 70s and 80s (hell, Newfoundland was under direct British rule until 1945), when Americanization became more prominent in the younger post-war generation. Most of the Canadian leadership until the 1980s studied in the UK, were born in the UK, or were the children of immigrants from the UK. And specifically blue collar Labour Party leaning parts of Scotland. As such, a lot of the policies and legislation passed in Canada before the 80s or 90s tends to have a significant amount of British influence in it. Australia's is similar as well, but they moved towards a public-private model in the late 1990s after their economy almost collapsed in the early 1990s.