After 10-15 years of university, new doctors have spent most of their lives feeling inferior to MDs in authority. Students often feel undermined but learn to make teachers look good without being obsequious. Nuanced flattery is a survival skill.
New doctors have spent 12,000 hours in training but continue to hone their skills for the first 5 years of practice. Graduates often take as many years to shed their deference of older doctors. Many never do.
Dr. Nadia Alam, a new doctor, wrote:
however, i’m curious. what do you say to those [older] docs who insist that “things are so much better than they used to be when every family doc was fee-for-service?” or, “i get paid a lot more now than i ever did before — i daren’t complain!” or, “i remember a decade ago when there were 20% fewer docs and we were paid 300% less than what we are now. we have made enormous gains. we should be grateful for our privileged position.”
i’ve only been in practice 5 years. i admit, i don’t know the entire history of medical politics in ontario. and i too hear the talk of pendulum swings etc etc. i’m still furious at the government’s bullying tactics. if the government were to negotiate fairly on equal grounds, i would not be as pissed off or disappointed by them as i am. but i also get frustrated at the complacency i see among fellow colleagues when i try to bring up healthcare reform — i almost feel as if i’m being patted on the head like a fussy child: “there, there, give it a few years and you’ll come around.”
I discussed this with a mid-career physician.
He nodded and agreed things were bad for new doctors. “But they can still bill fee for service,“ he said. “That’s what I had to do.”
I mentioned that the A007 has barely changed for 10 years at $33 per visit. Inflation made A007 largely irrelevant as fee for service (FFS) got left behind to primary care reform. Premier Wynne axed the reforms. To suggest new grads could return to bill 10 year old fees that were woefully out of date 10 years ago is heartless and cruel.
“There just isn’t enough money in the system,” he said. “We have to cut somewhere.“
Even if FFS was a viable option, a mid-career MD should have enough sense to see the panic new grads face at digging out of $200k of debt using $33 per patient. On top of this, older doctors have never experienced unilateral legislated cuts like these. Despite attempts at analogy, this is unprecedented. If older doctors cannot manage outrage on behalf of new grads, maybe they should choose empathic silence?
Society defines itself by how it treats its most vulnerable.
Premier Wynne attacked new graduates. She attacks those who cannot fight back. If we will not decry the Liberal barrage on new graduates, older doctors might be better off keeping quiet.
photo credit: fhs.mcmaster.ca
I think the pain is more widespread than “new vs old” can express. From what I understand, new grads won’t be able to join FHO’s/FHt’s for now. And won’t get the rostering bonuses. This will make it tough, especially the way they were trained. But a lot of older docs never entered these agreements and are still slugging it out FFS and they are in the same boat.
I guess at least they have established some sort of practice, and can keep it going, albeit not very profitably. Whereas a new grad would be loathe to invest capital in an A007 factory.
It seemed there was a brief window of opportunity to make some money. Some got it, many didn’t.
Now we have two-tier medicine both on the provider end, and for the lottery winning patients who are in FHT’s.
I think the government closing these is the ultimate breach of Universality. They should be called out on it. Personally I think they are ultimately too expensive, but hey, if they say they are good, and will pay for this luxury practice for “some” Ontarians, then they should open it right up… and take Medicare to the brink.
Great comments again!
You are right: many missed the window and it’s hard for seasoned docs to slug it through on FFS, too. As you say, at least they have an established group of patients (hopefully). I was just making the point that the cuts disproportionately impact new grads.
I loved your last line: “…and take Medicare to the brink.” We need to be especially careful about making sure the government owns the collapse it created.
Thanks again for taking time to read and comment!
Best
Shawn
Although I did not have a large student debt, when I opened my own office in 1977 I had to buy $100,000 worth of equipment. Add inflation and we both started with a similar amount of debt. It took me 10 years to get fully booked and I borrowed all that money.
I have watched Healthcare for many years and seen the infighting among physicians for the limited health dollar pie. In 2012 the specialties with the highest overheads had their fees slashed in an agreement that most of the other members of the OMA voted for. Their billings were high but many other physicians did not understand the concept of high overhead. The medical students and residents voted overwhelmingly for this agreement even if at the time they had no experience running a private office http://healthydebate.ca/opinions/is-the-oma-an-appropriate-vehicle-for-negotiating-doctors-fees .
The government has used the divide and conquer tactic for years and those in practice have seen themselves getting raises less than inflation. The fee structure should never have become an inter-generational or inter-specialty issue. Had we stuck together in the past the government would not have got such a stranglehold on our ability to bill fairly. (Fairly is a relative term to be discussed at another time).
Now is not the time for Ontario physicians to fight among ourselves again. The current fee problem should lie at the feet of the politicians who over promised, under delivered and now under fund Health Care.
As always, thank you so much for taking time to read and comment, Gerry!
Your call to unity should be followed by all. When times are tough, it’s more important than ever.
Thanks again!
Shawn
“The current fee problem should lie at the feet of the politicians who over promised, under delivered and now under fund Health Care.”
Yes, yes, yes! Gerry, you nailed it.
Thanks for commenting, Syed! I agree!
I wonder…is it really true that older doctors have never experienced unilateral legislated cuts like these. I think it is really important to study the history of what happened to the medical profession in Ontario in the period of 1990 – 2004. I look on the OMA website for such archived information like previous contracts, vote results etc and find NOTHING. Maybe there were not “cuts like these”, but there were clawbacks…there were billing caps. Were these agreed to by the profession in a contract or were these legislated? Dunno…the information is NOWHERE. Laborious internet searches turn up little of the past…
There is also a history of the young being ‘eaten’ as is being played out right now with the treatment of new family practice grads and highly qualified new surgeons being under and unemployed.
Those 15 years were the darkest of ages for the medical profession in Ontario. The table was set for that in 1986. The dark days have returned and they are here to stay for the next 10-20 years unless the profession, and the OMA, stand up and start challenging the chains that bind us in legislation through the courts.
Really great comments, Paul!
The current cuts stand out because of the way they were done and because they targeted new grads especially. As for dark days, I agree. We have had many years of very dark days in the past.
I met with a family physician this morning who needs to recruit an associate to cover a retiring physician. She mentioned that the recruiters tell her that new grads are looking at fellowships or moving out of province. I do not blame them!
Physicians run small businesses. They purchase or lease offices, renovate them, sub-let, hire staff, maintain licences, etc. Then, they work to provide great care to people they’ve known for years. There is no incentive for doctors to short-change their patients! Who speaks for these small businesses? Who advocates for the services they provide? No one pays closer attention to efficiency and service than a small business owner who works in her own shop.
I think many of us are looking forward to the council meeting next weekend. Unless doctors see convincing evidence that the concerns of small business owners get taken seriously, OMA members will revolt.
Thanks again!
Best
Shawn