challenging accepted thinking | offering solutions
My 14 year old spent her summer furiously clicking on her MacBook. Two years later, her first novel, The Last Pages, is ready for pre-order on Amazon.com. She has a contract for book 2, and has a 3rd well under way.
Young adult novels command a huge chunk of the publishing market right now. If you know of any YA readers, tell them to check out The Last Pages by Lara Whatley!
Toronto doctor smacks down U.S. Senate question on Canadian waitlist deaths | National Post.
I appreciate Dr. Martin’s quick wit in deflecting a question with an attack on the questioner.
Nice move.
The Toronto Star gushed about Dr. Martin being best suited to represent the values of the Canadian health care system. Apparently, the Huffington Post said she just became Canada’s newest hero.
Debates like this make change almost impossible. They entrench discussion into a debate about Canadian distinctiveness compared with our southern neighbour, completely missing the point.
We need to debate what’s best for patients.
If our system was as great as Martin says, don’t you think someone – anyone – would have copied it?
No, ideological devotion blinds Dr. Martin, the media, and most of the rest of us to the need for change in our beloved Medicare.
A colleague said, “Salaried clinicians: we only care about the patients; patient care. You guys; you always think about billing. We only think about patients.”
Salaried physicians and nurses claim moral purity.
At least until their shift ends.
Go ask them: salaried workers insist they provide better care because their concern is unadulterated by money. Just don’t ask whether their purity is influenced by the attention they give to the clock.
To make more money on fee for service you need to work MORE. You need to see more patients, perform more procedures, and somehow do more work. You have to help more people.
To make more money on salary you need to work LESS. Your earnings per hour of work increase if you spend more time not working (breaks, lunch, clean-up, etc.). Your earnings per unit of effort rise if you expend less effort; in other words, work less.
Salaried workers – ask them to skip a break, stay late, or come in to work for free…or even just forgo overtime.
Fee for service workers – ask them to do something they cannot bill for.
Salaried workers occasionally work without pay to see patients by staying late or shortening their coffee or meal breaks. Those who do so routinely are pitied by their peers for working any harder than necessary or for not being skilled enough to take their full break times.
Fee for service providers continually provide care for free because so many necessary things are unbillable. Dozens of times each shift providers are asked to do necessary things for which they cannot bill.
What about guys who bill for work they didn’t do? That’s called fraud; you must report it. People lose their licence and could face criminal charges or jail time. You cannot dismiss fee for service with hand-waving about fraud.
Don’t fee for service workers cut corners? Don’t they leave out patient education, thorough physical exam, note taking, etc., etc., etc.? Without question, FFS workers face the temptation to shorten clinical encounters just as salaried workers face the temptation to lengthen them by doing things that do not add value for patients to avoid burning energy seeing new patients.
We should compare payment using criteria that add value for patients: patient satisfaction scores, patient wait times, clinical quality indicators. We should not invent arbitrary measures of quality (e.g., long charts) that often add no value to patients.
Moral corruption exists everywhere: in both salaried and fee for service settings. People determined to get paid for doing less than necessary will succeed regardless of the remuneration model.
Let’s focus on outcomes. Judging others’ motives gets us nowhere.