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- Feb 1, 2006
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Hi all,
The majority of this site is USA focused but I occasionally get asked about what practice in Canada is like. The general impression being that we must be starving up here in universal health care land.
Well, I escaped residency for 2 weeks using some of my accrued vacation time to do a 2 week anesthesia locum in a major peripheral hospital.
Here is a breakdown of my 10 weekdays and 1 Saturday call.
The billing data is all straight FFS billings. No special locum rate or deals, this is what everyone else in that province is billing the government. Single insurer, no uninsured, no billing agent required to track different insurance companies, submit codes and 2 weeks later get your direct deposit.
From the list you can also see you need to know your billing codes backwards and forwards. 2.5 mg labetolol IV during a total hip = "controlled hypotension" = extra $150. 15 mcg Fentanyl in that spinal = extra $75, ect.
After nearly 13 years of post secondary education and hellish hours in residency it sure is nice to see the end in site. It was also nice to finally get some true independence. It sure is a different feeling though when "the buck stops with you", I'm returning to residency with a renewed motivation to improve some weak areas (upper extremity regional) and a desire to hit the books so these 2 weeks were great for the pocket book, mental health, and my board exam studying.
Monday (Orthopedics)
66 F - Total Hip
- Spinal w narcotics, controlled hypotension. ($682)
73 M - Rotator cuff
- GA ($283)
3rd Rotator cuff canceled as not NPO so I picked up 2 emergencies (Damn, let him go without a "consult" so no $s for me)
30 F - Diagnostic Laproscopy
- GA ($252)
60 F - cystoscopy, double J insertion
- GA ($220)
Total time: 07:45 16:00
Total billings: $1436
Tuesday (Urology)
56 F (MALIGNANT HYPERTHERMIA +++ family history) - Cystoscopy
- IV sedation. Went apnic with very little sedation, much more difficult mask ventilation than expected, no air entry with oral airway, desaturated to 60s before I could place LMA which resolved the obstruction. ($126)
78 M (severe CAD with 2 MI this year stented x 3, currently stable (ish)) - Cystoscopy
- Low dose hypobaric spinal with narcotic ($229)
65 M (Ankylosing spondylities w old C2-3 fracture with partial quadraparesis) - Circumcision
- LMA GA ($157)
66 M - cystoscopy
- IV sedation/MAC ($110)
76 M - cystoscopy
- IV sedation/MAC ($110)
78 M - cystoscopy
- IV sedation/MAC ($110)
75 M - cystoscopy
- IV sedation/MAC ($110)
39 M - cystoscopy
- IV sedation/MAC ($110)
69 M - TURP
- Spinal w narcotics ($308)
Total time: 07:45 15:40
Total billings: $1370
Wednesday (Gynecology)
40 F Laproscopic tubal ligation
- GA ETT ($173)
42 F Endometrial ablation
- GA Mask ventilation ($141)
31 F Diagnostic laproscopy
- GA ETT ($173)
26 F Laproscopic tubal ligation
- GA ETT ($173)
37 F Vaginal hysterectomy
- GA LMA ($204)
36 F Vaginal hysterectomy
- GA LMA ($204)
29 F D&C w laproscopic tubal ligation
- GA ETT ($157)
19 F D&C
- GA Mask ventilation ($110)
Total time: 07:45 16:10
Total billings: $1335
Thusday (General Surgery)
75 F (51 100kg (BMI 41, severe GERD, colon obstruction 2nd to bowel CA with feculent material coming from NG tube) - Coloscopy with colonic stenting
- GA RSI ETT ($346.50)
57 F (54 120 kg (BMI 45), severe GERD, remote CABG x 4, old inferior MI, stable angina <4 mets) - Laparotomy, TAH-USO + staging (for ovarian Ca)
- Thorasic epidural, arterial line, GA RSI ETT, RIJ CVC ($1114.07)
Total time: 07:45 17:55
Total billings: $1460
Friday (Orthopedics)
76 F Revision total knee replacement
- GA ETT, Controlled hypotension ($661.50)
37 yo F Knee arthroscopy w debridement
- GA LMA ($189)
82 F Removal hardware clavicle
- GA LMA ($157.5)
71 M (stable CAD, Afib, DMII) Total hip replacement
- Pt refused spinal. Arterial line, GA ETT, controlled hypotension ($551)
Total time: 07:45 17:05
Total billings: $1559.25
Saturday (On call) (35% premium during day, 50% after 5pm)
Acute pain service visits 8 on PCA, 2 epidural ($526.02)
54 M (mentally handicapped, POD 9 loop ileostomy) Major consult for possible intubation on surgical floor.
- Evaluated, stabilized (NG placed suctioned 900cc fluid from stomach with resolution of respiratory distress, transferred to ICU, agreed with ICU no current indication for intubation) ($131.5)
66 M Cystoscopy, ureteroscopy, Laser+basket for stones
- GA LMA ($403.99)
72 M Bilateral biopsy for presumptive temporal arteritis
- Local + sedation ($346.5)
54 M (mentally handicapped, POD 9 loop ileostomy crashed returning from CT scan suspect pancreatitis) Intubation and resuscitation in ICU
- RSI intubation in ICU ($141.75)
67 F (afib, metallic MVR (off coumadin x 5 days), 53 110kg, angina <4 mets, severe GERD) closed reduction with percutaneous pinning wrist
- arterial line, GA RSI ETT ($565.55)
30 F labour epidural during am then C/S after midnight
- labour epidural + C/S ($637.88)
86 F (afib, severe MR, LVEF 39%, old inferior MI per ECHO, moderate pulmonary hypertension, oxygen dependent in hospital) Bipolar hip replacement for hip fracture
- arterial line, spinal with fentanyl, controlled hypotension (BP post spinal 150-170 systolic, labetalol decreased BP to 120 systolic) ($1021.94)
75 F Major consultation for pre-operative assessment ($131.5)
57 F (recent stable L1 spinal fracture in brace, new bimalleolar ankle fracture) ORIF bimalleolar ankle fracture
- GA LMA ($519.75)
Total time: 07:45 Saturday 01:50 Sunday
Total billings: $4294
Monday (Urology)
82 M cystoscopy, bil retrograde pyelogram
- IV sedation/MAC ($157.5)
39 F cystoscopy bladder dilatation
- GA Mask ($110.25)
67 F cystoscopy, ureteral stent
- GA - Mask ($126)
65 M scrotal exploration excision spermatocoele
- GA - LMA ($157.5)
40 F (severe GERD) - cystoscopy bladder dilatation
- GA ETT - RSI ($110.25)
54 M (Quadriplegic, afib, CAD, DMII) cystoscopy
- canceled 2nd INR 3.5 = limited consult ($131.5)
84 M cystoscopy fulgeration
- GA Mask ($220.5)
33 F cystoscopy bladder dilatation
- GA Mask (good scare here too. While emerging from mask GA, at 0.3 MAC some secretions probably hit her cords and she went into laryngospasm. Peep did not work, couple cc's propofol did not work, 10mg Sux worked. She only hit 88%. ($110.25)
68 M cystoscopy bladder dilatation
- GA Mask ($189)
33 F cystoscopy bladder dilatation
- GA Mask ($189)
Total time: 07:45 16:50
Total billings: $1501.75
Tuesday (ENT until 12:30 when last 2 cases canceled due to lack of beds so I took over 2 nightmare patients in Urology to let an old staff guy go home early and let me bill a little more for the day) *** Here's another billing tip, never let a canceled patient leave without seeing them and writing a note/consult. The T&A I did paid $126, one T&A that was canceled that I saw before the nurses let them go = $131.5 for a consult. Unfortunately the nurses let the 2nd canceled case leave before I could see them.
4 M PE tubes
- GA Mask (no IV) ($110.25)
8 M tympanoplasty with patch
- GA Mask (no IV) ($126)
8 F T&A
- GA ETT ($220.5)
14 M T&A
- GA ETT ($126)
10 M T&A
- canceled 2nd lack of beds = limited consult ($131.5)
55 F FESS
- GA ETT ($220.5)
49 F (51, 100kg, BMI=41, COPD/Asthma with 4 admissions this year alone (still smoking), CAD, DMII, GERD) - cystoscopy, retrograde pyelogram
- IV sedation/MAC (her lungs scared me more than her GERD and they have no proseal LMAs so did her with Propofol/Ketamine to keep her breathing and maintaining some tone without instrumenting her airway) ($157.5)
67 M (59, 98kg, BMI=35, afib, moderate AS (AVA=0.8), EF 39%, CAD prior inferior MI with recent angio = 70% RCA, Pacemaker dependent, GERD) bilateral spermatocoele
- GA ETT, arterial line pre-induction ($307.25)
Total time: 07:45 15:40
Total billings: $1399
Wednesday (Ortho)
57 F Total knee replacement
- (refused spinal) GA ETT, Femoral block post ($401.75)
41 F Knee arthroscopy
- GA - LMA ($126)
42 M Knee arthroscopy
- GA - LMA ($126)
61 M (CAD w MI 2004, 6, 106kg, OSA on home CPAP (not known to surgeon), Wolf-Parkinson-White with 4-5 episodes SVT/month) Carpel tunnel
- MAC (no narcotics, defib in room) originally booked for sedation but OSA history nixed that. ($126)
68 F Total knee replacement
- (refused spinal) GA ETT, Femoral block post ($401.75)
48 M Cardioversion for recurrent afib (emergency case added on)
- IV sedation ($126)
Total time: 07:45 16:00
Total billings: $1307
Thursday (Ortho)
88 M Total knee replacement
- Spinal + intrathecal opioids ($356.43)
44 F (51, 100kg, severe GERD) - Knee arthroscopy
- GA ETT - RSI ($157.5)
50 F (54, 106kg, severe GERD) - Knee arthroscopy
- GA ETT - RSI ($157.5)
43 M (58, 100kg, OSA not on home CPAP) - Knee arthroscopy
- Spinal ($157.5)
86 F (54, 100kg, remote MI, HTN, hypothyroid) Total knee replacement
- Spinal + intrathecal opioids ($450)
Total time: 07:45 15:55
Total billings: $1278
Friday (Gynecology)
33 F Excision vulvar lesion
- GA Mask ($189)
42 F (53, 105kg, severe PONV) - Endometrial ablation
- GA Mask ventilation on TIVA ($157.5)
42 F (54, 102 kg) Hysteroscopy + D&C
- GA Mask ventilation ($126)
37 F (51, 87 kg) - Endometrial ablation
- GA Mask ventilation ($141.75)
41 F (54, 82 kg) - Abdominal hysterectomy
- GA ETT. (Difficult intubation, grade II-III with laryngeal pressure despite initial positioning into sniffing position with 3 pillow ramp. 1st look medical student. 2nd look me unable to pass ETT w stylet. Came out, bagged, success with 3rd look using bougie. Rest of case marginal oxygenation. Ran full differential, then when passed NG into stomach to get idea of stomach contents suctioned 75-100cc gastric fluid = suspected aspiration. Got sat up to 95% on FiO2 50%, 97% on FiO2 100% by end of case so extubated awake in OR went to floor on overnight O2 sat monitoring.) ($252)
45 F (51, 83 kg, Hiatus hernia with severe reflux she was having regurgitation when she lay flat on the OR table) - Endometrial ablation
- GA RSI ETT (also challenging intubation. Grade II-III with laryngeal pressure despite initial positioning into sniffing position with 3 pillow ramp. Success on 1st look with ETT w stylet) ($153)
30 F (52, 86 kg) Vaginal hysterectomy
- GA ETT. ($189)
Total time: 08:00 16:05
Total billings: $1228.5
Total billings for 10 weekdays = $13,876.5
Billings for 1 Saturday call = $4294.88
Grand total billings for 2 week locum = $18,171
So assuming a 42 week working year (10 weeks off) my estimated earnings would be $381,591 base on these 2 weeks of billings (which were nothing spectacular and only 1 day on call). My malpractice cost is ~$3000/yr. I have universal healthcare. I have a great public school system. The Cdn dollar is close to par with the US. Sure my taxes are higher (top marginal tax rate 46% but if you toss in the "freebies" such as healthcare and schooling, the difference out of pocket for a family of 4 is not that great. I'm not putting down the USA at all, just giving a direct example that before making broad statements such as "MD's are starving up in Canuckistan" you need to have some real #'s.
Hope you found this interesting.
P.S. It's interesting to think that the entire population of Canada is the same as the number of non-insured/under-insured Americans. It blows my mind to essentially think that every single patient I see every day would be uninsured and I would get paid nothing.
The majority of this site is USA focused but I occasionally get asked about what practice in Canada is like. The general impression being that we must be starving up here in universal health care land.
Well, I escaped residency for 2 weeks using some of my accrued vacation time to do a 2 week anesthesia locum in a major peripheral hospital.
Here is a breakdown of my 10 weekdays and 1 Saturday call.
The billing data is all straight FFS billings. No special locum rate or deals, this is what everyone else in that province is billing the government. Single insurer, no uninsured, no billing agent required to track different insurance companies, submit codes and 2 weeks later get your direct deposit.
From the list you can also see you need to know your billing codes backwards and forwards. 2.5 mg labetolol IV during a total hip = "controlled hypotension" = extra $150. 15 mcg Fentanyl in that spinal = extra $75, ect.
After nearly 13 years of post secondary education and hellish hours in residency it sure is nice to see the end in site. It was also nice to finally get some true independence. It sure is a different feeling though when "the buck stops with you", I'm returning to residency with a renewed motivation to improve some weak areas (upper extremity regional) and a desire to hit the books so these 2 weeks were great for the pocket book, mental health, and my board exam studying.
Monday (Orthopedics)
66 F - Total Hip
- Spinal w narcotics, controlled hypotension. ($682)
73 M - Rotator cuff
- GA ($283)
3rd Rotator cuff canceled as not NPO so I picked up 2 emergencies (Damn, let him go without a "consult" so no $s for me)
30 F - Diagnostic Laproscopy
- GA ($252)
60 F - cystoscopy, double J insertion
- GA ($220)
Total time: 07:45 16:00
Total billings: $1436
Tuesday (Urology)
56 F (MALIGNANT HYPERTHERMIA +++ family history) - Cystoscopy
- IV sedation. Went apnic with very little sedation, much more difficult mask ventilation than expected, no air entry with oral airway, desaturated to 60s before I could place LMA which resolved the obstruction. ($126)
78 M (severe CAD with 2 MI this year stented x 3, currently stable (ish)) - Cystoscopy
- Low dose hypobaric spinal with narcotic ($229)
65 M (Ankylosing spondylities w old C2-3 fracture with partial quadraparesis) - Circumcision
- LMA GA ($157)
66 M - cystoscopy
- IV sedation/MAC ($110)
76 M - cystoscopy
- IV sedation/MAC ($110)
78 M - cystoscopy
- IV sedation/MAC ($110)
75 M - cystoscopy
- IV sedation/MAC ($110)
39 M - cystoscopy
- IV sedation/MAC ($110)
69 M - TURP
- Spinal w narcotics ($308)
Total time: 07:45 15:40
Total billings: $1370
Wednesday (Gynecology)
40 F Laproscopic tubal ligation
- GA ETT ($173)
42 F Endometrial ablation
- GA Mask ventilation ($141)
31 F Diagnostic laproscopy
- GA ETT ($173)
26 F Laproscopic tubal ligation
- GA ETT ($173)
37 F Vaginal hysterectomy
- GA LMA ($204)
36 F Vaginal hysterectomy
- GA LMA ($204)
29 F D&C w laproscopic tubal ligation
- GA ETT ($157)
19 F D&C
- GA Mask ventilation ($110)
Total time: 07:45 16:10
Total billings: $1335
Thusday (General Surgery)
75 F (51 100kg (BMI 41, severe GERD, colon obstruction 2nd to bowel CA with feculent material coming from NG tube) - Coloscopy with colonic stenting
- GA RSI ETT ($346.50)
57 F (54 120 kg (BMI 45), severe GERD, remote CABG x 4, old inferior MI, stable angina <4 mets) - Laparotomy, TAH-USO + staging (for ovarian Ca)
- Thorasic epidural, arterial line, GA RSI ETT, RIJ CVC ($1114.07)
Total time: 07:45 17:55
Total billings: $1460
Friday (Orthopedics)
76 F Revision total knee replacement
- GA ETT, Controlled hypotension ($661.50)
37 yo F Knee arthroscopy w debridement
- GA LMA ($189)
82 F Removal hardware clavicle
- GA LMA ($157.5)
71 M (stable CAD, Afib, DMII) Total hip replacement
- Pt refused spinal. Arterial line, GA ETT, controlled hypotension ($551)
Total time: 07:45 17:05
Total billings: $1559.25
Saturday (On call) (35% premium during day, 50% after 5pm)
Acute pain service visits 8 on PCA, 2 epidural ($526.02)
54 M (mentally handicapped, POD 9 loop ileostomy) Major consult for possible intubation on surgical floor.
- Evaluated, stabilized (NG placed suctioned 900cc fluid from stomach with resolution of respiratory distress, transferred to ICU, agreed with ICU no current indication for intubation) ($131.5)
66 M Cystoscopy, ureteroscopy, Laser+basket for stones
- GA LMA ($403.99)
72 M Bilateral biopsy for presumptive temporal arteritis
- Local + sedation ($346.5)
54 M (mentally handicapped, POD 9 loop ileostomy crashed returning from CT scan suspect pancreatitis) Intubation and resuscitation in ICU
- RSI intubation in ICU ($141.75)
67 F (afib, metallic MVR (off coumadin x 5 days), 53 110kg, angina <4 mets, severe GERD) closed reduction with percutaneous pinning wrist
- arterial line, GA RSI ETT ($565.55)
30 F labour epidural during am then C/S after midnight
- labour epidural + C/S ($637.88)
86 F (afib, severe MR, LVEF 39%, old inferior MI per ECHO, moderate pulmonary hypertension, oxygen dependent in hospital) Bipolar hip replacement for hip fracture
- arterial line, spinal with fentanyl, controlled hypotension (BP post spinal 150-170 systolic, labetalol decreased BP to 120 systolic) ($1021.94)
75 F Major consultation for pre-operative assessment ($131.5)
57 F (recent stable L1 spinal fracture in brace, new bimalleolar ankle fracture) ORIF bimalleolar ankle fracture
- GA LMA ($519.75)
Total time: 07:45 Saturday 01:50 Sunday
Total billings: $4294
Monday (Urology)
82 M cystoscopy, bil retrograde pyelogram
- IV sedation/MAC ($157.5)
39 F cystoscopy bladder dilatation
- GA Mask ($110.25)
67 F cystoscopy, ureteral stent
- GA - Mask ($126)
65 M scrotal exploration excision spermatocoele
- GA - LMA ($157.5)
40 F (severe GERD) - cystoscopy bladder dilatation
- GA ETT - RSI ($110.25)
54 M (Quadriplegic, afib, CAD, DMII) cystoscopy
- canceled 2nd INR 3.5 = limited consult ($131.5)
84 M cystoscopy fulgeration
- GA Mask ($220.5)
33 F cystoscopy bladder dilatation
- GA Mask (good scare here too. While emerging from mask GA, at 0.3 MAC some secretions probably hit her cords and she went into laryngospasm. Peep did not work, couple cc's propofol did not work, 10mg Sux worked. She only hit 88%. ($110.25)
68 M cystoscopy bladder dilatation
- GA Mask ($189)
33 F cystoscopy bladder dilatation
- GA Mask ($189)
Total time: 07:45 16:50
Total billings: $1501.75
Tuesday (ENT until 12:30 when last 2 cases canceled due to lack of beds so I took over 2 nightmare patients in Urology to let an old staff guy go home early and let me bill a little more for the day) *** Here's another billing tip, never let a canceled patient leave without seeing them and writing a note/consult. The T&A I did paid $126, one T&A that was canceled that I saw before the nurses let them go = $131.5 for a consult. Unfortunately the nurses let the 2nd canceled case leave before I could see them.
4 M PE tubes
- GA Mask (no IV) ($110.25)
8 M tympanoplasty with patch
- GA Mask (no IV) ($126)
8 F T&A
- GA ETT ($220.5)
14 M T&A
- GA ETT ($126)
10 M T&A
- canceled 2nd lack of beds = limited consult ($131.5)
55 F FESS
- GA ETT ($220.5)
49 F (51, 100kg, BMI=41, COPD/Asthma with 4 admissions this year alone (still smoking), CAD, DMII, GERD) - cystoscopy, retrograde pyelogram
- IV sedation/MAC (her lungs scared me more than her GERD and they have no proseal LMAs so did her with Propofol/Ketamine to keep her breathing and maintaining some tone without instrumenting her airway) ($157.5)
67 M (59, 98kg, BMI=35, afib, moderate AS (AVA=0.8), EF 39%, CAD prior inferior MI with recent angio = 70% RCA, Pacemaker dependent, GERD) bilateral spermatocoele
- GA ETT, arterial line pre-induction ($307.25)
Total time: 07:45 15:40
Total billings: $1399
Wednesday (Ortho)
57 F Total knee replacement
- (refused spinal) GA ETT, Femoral block post ($401.75)
41 F Knee arthroscopy
- GA - LMA ($126)
42 M Knee arthroscopy
- GA - LMA ($126)
61 M (CAD w MI 2004, 6, 106kg, OSA on home CPAP (not known to surgeon), Wolf-Parkinson-White with 4-5 episodes SVT/month) Carpel tunnel
- MAC (no narcotics, defib in room) originally booked for sedation but OSA history nixed that. ($126)
68 F Total knee replacement
- (refused spinal) GA ETT, Femoral block post ($401.75)
48 M Cardioversion for recurrent afib (emergency case added on)
- IV sedation ($126)
Total time: 07:45 16:00
Total billings: $1307
Thursday (Ortho)
88 M Total knee replacement
- Spinal + intrathecal opioids ($356.43)
44 F (51, 100kg, severe GERD) - Knee arthroscopy
- GA ETT - RSI ($157.5)
50 F (54, 106kg, severe GERD) - Knee arthroscopy
- GA ETT - RSI ($157.5)
43 M (58, 100kg, OSA not on home CPAP) - Knee arthroscopy
- Spinal ($157.5)
86 F (54, 100kg, remote MI, HTN, hypothyroid) Total knee replacement
- Spinal + intrathecal opioids ($450)
Total time: 07:45 15:55
Total billings: $1278
Friday (Gynecology)
33 F Excision vulvar lesion
- GA Mask ($189)
42 F (53, 105kg, severe PONV) - Endometrial ablation
- GA Mask ventilation on TIVA ($157.5)
42 F (54, 102 kg) Hysteroscopy + D&C
- GA Mask ventilation ($126)
37 F (51, 87 kg) - Endometrial ablation
- GA Mask ventilation ($141.75)
41 F (54, 82 kg) - Abdominal hysterectomy
- GA ETT. (Difficult intubation, grade II-III with laryngeal pressure despite initial positioning into sniffing position with 3 pillow ramp. 1st look medical student. 2nd look me unable to pass ETT w stylet. Came out, bagged, success with 3rd look using bougie. Rest of case marginal oxygenation. Ran full differential, then when passed NG into stomach to get idea of stomach contents suctioned 75-100cc gastric fluid = suspected aspiration. Got sat up to 95% on FiO2 50%, 97% on FiO2 100% by end of case so extubated awake in OR went to floor on overnight O2 sat monitoring.) ($252)
45 F (51, 83 kg, Hiatus hernia with severe reflux she was having regurgitation when she lay flat on the OR table) - Endometrial ablation
- GA RSI ETT (also challenging intubation. Grade II-III with laryngeal pressure despite initial positioning into sniffing position with 3 pillow ramp. Success on 1st look with ETT w stylet) ($153)
30 F (52, 86 kg) Vaginal hysterectomy
- GA ETT. ($189)
Total time: 08:00 16:05
Total billings: $1228.5
Total billings for 10 weekdays = $13,876.5
Billings for 1 Saturday call = $4294.88
Grand total billings for 2 week locum = $18,171
So assuming a 42 week working year (10 weeks off) my estimated earnings would be $381,591 base on these 2 weeks of billings (which were nothing spectacular and only 1 day on call). My malpractice cost is ~$3000/yr. I have universal healthcare. I have a great public school system. The Cdn dollar is close to par with the US. Sure my taxes are higher (top marginal tax rate 46% but if you toss in the "freebies" such as healthcare and schooling, the difference out of pocket for a family of 4 is not that great. I'm not putting down the USA at all, just giving a direct example that before making broad statements such as "MD's are starving up in Canuckistan" you need to have some real #'s.
Hope you found this interesting.
P.S. It's interesting to think that the entire population of Canada is the same as the number of non-insured/under-insured Americans. It blows my mind to essentially think that every single patient I see every day would be uninsured and I would get paid nothing.