Monday March 31, 2008
Show me the Money!
On this week's show we're saying out loud what is perhaps the dirtiest word in medicine: Money.
In many quarters the prevailing belief is that a good doctor is, by definition, one who does not care too much about how much money they make. Think too much about the bottom line and you're suspected of caring more about being well-heeled, than healing.
Well this week we're taking the doctors' side on this one. We look at just how much it costs to keep up a family practice and about how docs find ways to make ends meet, stuck as they are between fixed costs and a fixed fee-for-service system that rewards them more for volume of patients than time taken to deliver quality care.
We talk to some doctors who moonlight in cosmetic procedures to bolster their bottom lines. And we talk to a doctor who volunteers in a clinic for the uninsured in downtown Toronto.
Don't miss the show. And we'll hope you also enjoy this story of Dr. Howard Petroff, a team doctor for the Toronto Raptors, who does it more for the perqs, than the pesos.
Previous Comments (13)
I have been told that there was some discussion about electronic medical records on the show and that they were not justified. I can't find the program to listen to it. I have used an EMR for the past 11 years and have a strong commitment to it. It does not save time at a patient visit but it certain can improve the quality of care and there are other aspects of care and record keeping that are definitely improved. To comment intelligently I need to know what Tom Falloon said.Gordon E. Riddle, March 31, 2008 4:48 PM
Your segment on how doctors struggle to make a living. I'm almost in tears. The operative word, no pun intended,being "almost". They claim to have to see 50 to 60 patients a week just to make expenses yet claim on a "bad" daythey see as many as 7 to 8 patients an hour. It looks as if they should perhaps work at least 4, maybe 5 day's a week to make a living. Wow.They complain about 45 to 140 thousand dollar equipment.Tears here.As a small,operation wise, again no pun intended, rancher my expenses last year was 100,000. My gross 220,000. My Tractors cost over 100,000 each.I work 365 days a year.O , we need a lot more than just tractors to run our operation. I'm not crying yet. If I was I could get 1 of your underpaid doctors to ckeck my tear ducts. Really, if these people don,t like going broke, try ranching. They could still play doctor looking after 300 animals that just love to br tended to.Bill Glassford, April 1, 2008 9:26 AM
Cool subject, gave a lot of insight. The remaining post of this comment is directed at Bill who posted below. Bill, a major segment missing in this broadcast was the work, time and money it takes in being a doctor. To become a fully licensed family physician is at least 8 years (if you go to McMaster, with only 3 years of undergrad). However, the more common path all over Canada, it takes a family physician 10 years to become a fully licensed family physician. This, piled on with the average debt of a doctor at ~$150,000, and then opening a practice, with more added debt. The physician gave you a quote only on overhead expenses. What about interest payments? What about payments on the principal? The physician is probably 30 by this time as well. With still, no house, no car, nothing. Sure you may have those same expenses, however, the physician accumulates, and has no chance to pay it off, by the time he or she is in his or hers mid 30's. That's just to start. And let's be frank, your still paying for medical care, EXPERT medical care. A family physician grosses approximately 200,000 in Ontario, with 100,000 in overhead. And taxes deducted? Making 50,000 a year? At the age of 30-35. With no real possible way of a raise if staying on their own doing the same work? Most are pushed to join practices. Have you considered that for your farm? Giving up your land to others and sharing the profits. You should be empathetic first to understand the other side, before you "almost" tear. The treatment family physicians receive from the general public like you is despicable.Mike Djaba, April 1, 2008 4:55 PM
Over $100,000 to convert to EMR? Hasn't anyone heard of open-source?
Also, if family doctors are feeling pressured when seeing patients with complex problems, perhaps it might be wise to have such patients seen by internal medicine specialists instead!Ed, April 1, 2008 5:49 PM
Having listened today to my interview with Brian I realize that my answer to Brian's question regarding the cost effectiveness of EMR (electronic medical records)may suggest that I am not a fan of EMR. If one only looks at cost effectiveness, as was the context of the interview, then one can challenge the benefit of implementing EMR. However, when it comes to quality and comprehensiveness of care then EMR is the only way to go. In actuality I believe EMR is the way of the future. A well designed EMR system is an effective and efficient tool that greatly assists the GP and their staff, consultants and allied care givers to offer comprehensive care. EMR also ensures that the medical record is always legable when many traditional paper charts are not. The cost however will continue to be a hurdle unless ministries of health offer more assistance for all GPs.Tom Faloon, April 1, 2008 11:59 PM
I have worked as a medical assistant for both family doctors and specialists. I can tell you that as a rule, the family doctors I have known work very hard and under very demanding circumstances with minimal financial rewards relative to doctors who specialize. I like to compare them to the "foot soldiers" in a war -- they are the ones who are right down there in the trenches doing the hard, dirty work while the "generals" stand back and survey the scene when the battle is over. Family doctors often have in their practice numerous patients with very complex medical histories who require a considerable amount of time at each appointment in order for the doctor to do a decent job for the patient. This creates the inevitable backlog for the other patients yet to be seen who are sitting in the waiting room, not always so "patiently". I don't pretend to know the financial details of each doctor's take home salary, but I do believe that the good ones work darn hard for their money and deserve every bit of it.Barbara , April 2, 2008 9:25 PM
Ed, I think that you're missing a couple of points about the care of complex patients. First, I think that the number of general internists is in decline, as most in internal medicine are choosing to specialize in to specific disciplines, such as cardiology, GI, resp, etc. The other thing is that not all specialists follow patients along chronically. Some do (like me; I specialize in Parkinson's and similar conditions), but others see patients, give advice and guidance, and that's it. Family physicians are on their own frequently. As well, while the system is short of GP's, it is short of a host of other specialties as well, so it isn't quite as easy as it sounds.
As for open-source, while the software is free, I think the bigger issue is service and support (which isn't). I enjoy tinkering with software, but most of my colleagues would never be DIY types with open-source EMR software. They would be still be on the hook for getting said software professionally installed and supported.Chris, April 2, 2008 11:11 PM
Chris, your points are noted. I guess it's more wishful thinking than a concrete solution when it comes to extending internal medicine to more of a focus on chronic/complex patients. And certainly the shortage of generalists isn't helping.
As for open-source EMR, I'm pretty sure that even taking into account installation and maintenance costs, the final price tag would still be a lot lower than the exorbitant fees quoted in the show, and the amount of support available from fellow users who might be more tech-savvy is certainly significant.Ed, April 3, 2008 10:18 PM
Thanks Brian for your interesting programs over the past seasons; you are doing a great job. As to that nasty little subject of 'money', I believe that for many doctors it may not be very enticing to get into debt for decades on end. The $35.- per hour the government pays doesn't seem very much, and should perhaps be increased. Although, I am dead-set against private health care,I also believe that the patient should pay at least a token payment to doctors or hospitals for each visit they make. $5 or $10 perhaps, and strictly monitored. That might keep the attention-seekers and those with "maladies imaginaries" away from scarce resources. I mention this, because some years ago I was in the emergency department of a Toronto Hospital to be examined for a blood clot in my lower leg. (It turned out that I did have one.) In the waiting area, however, there was a middle-aged woman, who--it must be said in all fairness--had waited longer than I had, but she had got her self brought in by ambulance, and was, given supper. After eating her supper, she stood up and walked out on her own steam declaring that she had waited long enough and no longer wanted to be looked after. Who do you think is going to pay for the cost she caused the system? (I, by the way, had come to the hospital by bus, and paid for my own supper.)Andy Ross, April 4, 2008 9:52 PM
Everyone wants to have a caring, compassionate and knowledgeable physician who will take time to explain and diagnose.
The thorny issue of compensation seems to rankle the public.
The students who are chosen to enter medical school are chosen on the basis of their ability to assimilate, retain, process and apply large quantities of information. They need to be able to work under pressure.
Those that enter medicine are certainly not the only ones that have this ability to learn, as there are many other professions including skilled workers who have the same capacity.
Physicians, and the others outlined hone their skills starting early in their schooling, much like professional athletes who practice and apply their skills from early childhood.
The public does not envy/decry the exorbitant fees earned by professional athletes. The income earned by professional athletes are many multiples of those earned by physicians. Yet the public derides income when comes to physician compensation, despite the fact that it is a small fraction of that earned by athletes, and one that comes with 50-60 hours of work per week for many of us.
The question that the public needs to resolve is
"What is the value that physicians bring to themselves and society?" "What is the value of the physician teasing out the real problem when a patient presents with complaints?" "What is the value of a timely diagnosis and treatment which prevents dire negative outcomes such as death or significant debility?"
Is the value similar to the hard physicial work and instability of farming as per one of the comments?
Society has to resolve this issue.
In the meantime, the numbers of physicians available to provide medical care are diminishing and many have gone to other countries. This exodus is largely due to the attitudes of the public and the policies and punitive measures instituted by the various governments which have ruled this province over the past twenty years.Dr. T. Weinberger, April 6, 2008 9:01 AM
This is crazy. I am quitting clinical medicine and taking a job with a drug company. I will make more, and be supplied with benefits and a pension.
Thanks for helping me make my decision!
AlAlain Campbell MD, April 7, 2008 6:03 PM
This is seriously ridiculousjarome higgins, May 23, 2008 4:39 PM
Dr.Goldman, first thank you for a great eye opening show. On the subject of money/funding. How did it come about that hospitals have become dependant on "charity"? We, the constantly abused, Canadian taxpayers are already paying $ 55 billion dollars into our health care system every year. Still, some of our dihonest politicians, and even some media, are constantly telling us that we have "free" health care here in Canada. They are perpetuating this big lie to make us believe that we have achieved some kind of "medical utopia" in Canada. Our hospitals are supposed to be fully funded already, yes by us the Canadian tax payers. Why are hospitals constantly asking for "donations"? Are hospitals some type of "charities"? What is especially obscene about our hospitals' asking for "donations" is the way they try to get those "donations" from their former patient/victims. What about those patient/victims the hospitals hurt, injured or killed by medical errors etc.? Are those hospitals going to send "donations" to their patient/victims?, or are they going to continue to cover up and lie about those tragedies caused by them, the hospitals? Signed, Mark Mager, of London (our medical "Mecca"), Ontario.Mark Mager, May 28, 2008 1:20 PM