EM salary and Obama's plan

[tabula0rasa]

I don't completely understand what Obama's healthcare reform will consist of, but I imagine that he would try to change the way physicians are paid. As I understand, there are arguments that the current way in which physicians are paid is inefficient because its pay-per-procedure and thus it incentivize physicians to perform more costly procedures, even if its not the best for their patient. However, since many/most ER physicians are paid by the hour, they don't have that problem (or am I wrong?). So, is it safe to say that ER physicians will take less of a hit than other specialties if a plan abolishing pay-per-procedure goes into effect?

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[allendo]

I don't completely understand what Obama's healthcare reform will consist of, but I imagine that he would try to change the way physicians are paid. As I understand, there are arguments that the current way in which physicians are paid is inefficient because its pay-per-procedure and thus it incentivize physicians to perform more costly procedures, even if its not the best for their patient. However, since many/most ER physicians are paid by the hour, they don't have that problem (or am I wrong?). So, is it safe to say that ER physicians will take less of a hit than other specialties if a plan abolishing pay-per-procedure goes into effect?

I think we all will take a hit. On the ACEP website their is a emergency access act or something like that where they are trying to get a 10% pay increase for emergency physicians since we are the safety net.

 

[MikeyLu2010]

dont forget medical legal medicine..where physicians order all these things to cover their own *****..

 

[quideam]

Three words: Massive Tort Reform

 

[GeneralVeers]

Three words: Massive Tort Reform

Not going to happen. Our salaries are going to be cut (in terms of medicare reimbursement) and the trial lawyers will continue to chip away at our hard-won gains on tort reform.

Anyone want to go to New Zealand with me?

 

[docB]

I don't completely understand what Obama's healthcare reform will consist of, but I imagine that he would try to change the way physicians are paid. As I understand, there are arguments that the current way in which physicians are paid is inefficient because its pay-per-procedure and thus it incentivize physicians to perform more costly procedures, even if its not the best for their patient. However, since many/most ER physicians are paid by the hour, they don't have that problem (or am I wrong?). So, is it safe to say that ER physicians will take less of a hit than other specialties if a plan abolishing pay-per-procedure goes into effect?

Yes. You are wrong. Which is ok because you have a misperception which is very common among med students and residents.

EPs are not really paid by the hour. We get paid by patients. In some groups of EPs the money that comes in from patient billing is divided up based on hours worked. In other groups it's divided based on work load (aka RVUs), billing, collections, phases of the moon, etc.

If the amount of money paid to docs for services rendered drops there will be less money to pay docs. Even if your share of the money is based on hours worked you will be dividing a smaller pot.

 

[quideam]

Anyone want to go to New Zealand with me?

It's certainly beautiful... but you would definitely get paid a lot less there. Sure it's worth the kayaking?

 

[Old_Mil]

Three words: Massive Tort Reform

No chance. Not with a democratic president and a democratic congress. These guys in the pockets of trial lawyers. Heck, half of them are lawyers.

http://en.wikipedia.org/wiki/Saskatchewan_Doctors'_Strike

An interesting piece on the 1962 doctor's strike that failed in Saskatchewan. Perhaps someone with more knowledge of Canadian history can tell me if this is true or not, but I remember an old school physician telling me that during this time (when Canada nationalized health care), they actually banned physicians from emigrating from the country...?

 

[Speed Racer]

Not going to happen. Our salaries are going to be cut (in terms of medicare reimbursement) and the trial lawyers will continue to chip away at our hard-won gains on tort reform.

Anyone want to go to New Zealand with me?

I have heard that Canadian Physicians are actually paid quite well.

 

[GeneralVeers]

I have heard that Canadian Physicians are actually paid quite well.

The salary in Canada is Capped at 430K (which is 300K USD). That is why orthopedic surgeons only work 6 months of the year, hit their cap, and then go on vacation.

The average EP in Canada makes 165K (which is abou 120K USD).

Bear in mind, that 60% of that gets taxed back by the Federal and Provincial governments.

 

[quideam]

Yeah, but they also have minimal med school debt... I would take a lower salary with no debt over a slightly higher salary adn 140K+ in debt any day - at least this way you have freedom. And besides, if you end up working in academia in a big city (NY, LA, SF, etc) you're not looking at a salary much higher than 180K, if that... so what's the difference?

 

[WilcoWorld]

Well, it's a good thing that so many people on this forum list "Mountain Man" as their dream job...

 

[Jeff698]

If any of us were being honest, we'd have to admit we have no idea what will happen to our salaries in the future. This is just as true with Obama as president as it would have been with McCain.

The current system we have is clearly unsustainable. Something is going to change. No president has the ability to change it into exactly what he wants. There are far too many very powerful interest groups who will be able to torpedo it if they hate it. Ask Hillary about it.

Now for my guess: I think Obama wants to pass something that makes an attempt at fixing the problem more than he wants his dream system. He seems to understand that he needs all the main interest groups involved. I anticipate much horse trading.

Still, I have no clue what will actually happen. In this, I'm in the same boat as everyone else from Obama down to the pre-meds still in college.

Take care,
Jeff

 

[Future Doc B]

The salary in Canada is Capped at 430K (which is 300K USD). That is why orthopedic surgeons only work 6 months of the year, hit their cap, and then go on vacation.

The average EP in Canada makes 165K (which is abou 120K USD).

Bear in mind, that 60% of that gets taxed back by the Federal and Provincial governments.

I've been trying to figure out if you really pay 60% back to the Canadian government. If you're interested in helping me and others satisfy our curiosity, follow the link below and tell me what the difference in take-home pay is between the US and Canada. I'd be interested to know if it is drastically different.

http://www.ey.com/GLOBAL/content.nsf/Canada/Tax_-_Calculators_-_2007_Personal_Tax

 

[GeneralVeers]

I've been trying to figure out if you really pay 60% back to the Canadian government. If you're interested in helping me and others satisfy our curiosity, follow the link below and tell me what the difference in take-home pay is between the US and Canada. I'd be interested to know if it is drastically different.

http://www.ey.com/GLOBAL/content.nsf/Canada/Tax_-_Calculators_-_2007_Personal_Tax

I've actually calculated it before. I'll use Ontario, the most populous province as an example.

The top income tax is actually lower at 29%.
The sales tax is 15%
Provincial income tax is 11%
Pension plan 4.95%

Total is 50%

In other provinces like Newfieland the provincial income tax is 20% with sales taxes above 15%, putting it well over 60%.

 

[Speed Racer]

It seems simplistic but I believe the most likely scenario is to expand the income requirements for medicaid coverage to include the 35 million person "gap" of uninsured. And just tax the rest of us to pay for it.

As some one who works with a high percentage of medicaid patients, I submit that it has the potential to be an unmitigated disaster. But who cares! The government spends money that is not theirs only to hand it over to people (and by people I also mean corporations) who did not earn it. And so so the "have's" ease their collective guilty conscience.

 

[GeneralVeers]

It seems simplistic but I believe the most likely scenario is to expand the income requirements for medicaid coverage to include the 35 million person "gap" of uninsured. And just tax the rest of us to pay for it.

Not quite so simple. It would cost a fortune, and it wouldn't do anytihng to address the real problem: the impending collapse of the Medicare system. If the projections are correct, just paying the Medicare expenses for the elderly at the present rate will consume most of the budget and bankrupt the country. Costs all across the system need to be controlled. Enrolling 35 million more people will do nothing but make the crisis more imminent.

 

[southerndoc]

I've actually calculated it before. I'll use Ontario, the most populous province as an example.

The top income tax is actually lower at 29%.
The sales tax is 15%
Provincial income tax is 11%
Pension plan 4.95%

Total is 50%

In other provinces like Newfieland the provincial income tax is 20% with sales taxes above 15%, putting it well over 60%.

You can't really include sales tax in comparing income taxes. It's deceiving. Yes, they will still pay more money in taxes in Canada, but you can't say they pay 60% of their income in taxes because some people may save instead of spending, and therefore may not be hit with that huge sales tax. Many areas of the US have 8-9% sales tax, so it's not that much more when you consider that we're probably paying more than 5% of our spenditures as health insurance, medications, and other healthcare expenditures.

However, I do agree with you that Canadians pay more tax than Americans.

 

[niranjan162]

Not quite so simple. It would cost a fortune, and it wouldn't do anytihng to address the real problem: the impending collapse of the Medicare system. If the projections are correct, just paying the Medicare expenses for the elderly at the present rate will consume most of the budget and bankrupt the country. Costs all across the system need to be controlled. Enrolling 35 million more people will do nothing but make the crisis more imminent.

wait the government tries to fix problems? I thought they just throw money at it until the next term comes around.

 

[KYTNOH]

I doubt we'll see salaries decrease that much in the short term. History has shown time and time again that cuts in reimbursement by Medicare does not decrease net income. Providers have always increased services in response to cuts in reimbursement. I'm not sure reimbursements will be cut either. There has been a strong majority in Congress that has resisted reflex SGR payment cuts the last few years.

The more concerning issue is the total Obama package that seems to be gaining momentum. Long-term I am concerned that we're going to be entering a 1960s-1970s era economy with extraordinarily high marginal rates, big government, increased inflation to pay for our irresponsible social programs, and anemic economic growth. Under such a system I don't see anyone in the top 10% of earners increasing their take home pay for the next decade. Most any gains will be eaten up by wealth transfer to the lower income brackets.

Our best hope is that the Republicans sweep into Congress in the 2010 mid-terms. Unilateral party rule is not good for the country. It wasn't good in the 60s, the late 70s, or in the early 2000s. It isn't good now.

 

[GeneralVeers]

I doubt we'll see salaries decrease that much in the short term. History has shown time and time again that cuts in reimbursement by Medicare does not decrease net income. Providers have always increased services in response to cuts in reimbursement. I'm not sure reimbursements will be cut either. There has been a strong majority in Congress that has resisted reflex SGR payment cuts the last few years.

The more concerning issue is the total Obama package that seems to be gaining momentum. Long-term I am concerned that we're going to be entering a 1960s-1970s era economy with extraordinarily high marginal rates, big government, increased inflation to pay for our irresponsible social programs, and anemic economic growth. Under such a system I don't see anyone in the top 10% of earners increasing their take home pay for the next decade. Most any gains will be eaten up by wealth transfer to the lower income brackets.

Our best hope is that the Republicans sweep into Congress in the 2010 mid-terms. Unilateral party rule is not good for the country. It wasn't good in the 60s, the late 70s, or in the early 2000s. It isn't good now.

One only has to look at "progressive" California to see the future of this country. The state with the most generous social programs, environmental laws, and highest taxes, is also the one with the worst budget problems and crushing infrastructure problems.

 

[trisomy55]

Canadian docs do better than you might think. In BC, Emergency Physicians make $268,000 ($210,000 US as of today) as salary now for 14.5 8 hour shifts per month. They do even better than this in Alberta, Manitoba, and Ontario. Not sure about the other provinces.


Tax rate in BC for that income is 36.7%, before any deductions.
http://www.ey.com/GLOBAL/content.nsf/Canada/Tax_-_Calculators_-_2009_Personal_Tax

And, of course, that includes free healthcare.

 

[KYTNOH]

I saw this bumper sticker recently:

 

[JaggerPlate]

I saw this bumper sticker recently:

HA. Amazing.

 

[WakeMedHeel]

The current system we have is unsustainable. We cannot continue to spend 16% of GDP on healthcare and expect our economy to sustain itself.

The major problem is that health care is supply sensitive. It doesn't follow the normal the economic principles of supply and demand. If you have 100 ICU beds in a region, you're going to use 100 ICU beds, even if you don't need those beds.

We spend too much on expensive after care than we do on preventative medicine. This is a function of having a reimbursement system that has significant financial rewards for specialists who perform procedures, but doesn't reimburse primary care docs fairly.

Our hospitals spend too much competing for Ortho, Cardiac, and Oncology patients because that's where the high margins are. Why does a city like Indianapolis, with 1.2 million people, need 5 brand spanking new cardiac centers?

It all boils down to the fact, that there is no or very little incentive for better health care outcomes, only for performing more procedures and churning high margin patients. This is what we have repeaped by allowing large corporations to determine what is best for shareholders rather than allowing physicians to determine what is best for patients.

Who knows what'll happen to are salaries...my guess, is that the physicians lobbies will fight hard against any real health care reform, because why would you bite the hand that feeds you.

 

[J.J.]

Stating the obvious, I think the biggest single improvement we could make to address healthcare is TORT reform. Allowing physicians to make decisions about the care we provide in a logical way without the fear of consequences, would substantially decrease medical cost across the country. I'm sure many of you feel the same way, however as someone else mentioned, drastic changes in TORT are unlikely to occur. On the contrary, I do have some hope now that they've finally asked for physician involvement in the medical reformation process.

As for EM, I feel we are big spenders. We see every patient at their very worst and feel we are forced to pursue a substantial and expensive w/u due to the fear of a missed dx. These missed dx are often found through rather expensive studies. This problem has gotten worse since the ER has become the catch-all for every sniffle and sneeze across the country.

I'm not sure we could ever change it now, but allowing the ER to function as a true ER could also drastically reduce health care cost. A clinic attached to every ER, similar to a fast trac, that's run by FPs who get paid more than they would in the community would be a substantial relief to every ER. Let the FP's address the sniffling, sneezing, coughing aching, stuffy-head and fever. This can't be a new idea!

Also, we have to begin making people more accountable. The belief that because I'm poor and have no ambition, I should get a free ride is absolutely ridiculous. That may sound heartless, but forcing those who receive gov't. monies to be accountable should not be a strange idea. If you receive money, you should be forced to take drug tests, provide proof that you are at least searching for a job and, or providing a minimal amount of public service.

Don't even get me started on criminals. Can we make jail something more than a nice hotel stay!

End Rant on America's problems... where's my coffee!

 

[GeneralVeers]

The current system we have is unsustainable. We cannot continue to spend 16% of GDP on healthcare and expect our economy to sustain itself.

The major problem is that health care is supply sensitive. It doesn't follow the normal the economic principles of supply and demand. If you have 100 ICU beds in a region, you're going to use 100 ICU beds, even if you don't need those beds.

We spend too much on expensive after care than we do on preventative medicine. This is a function of having a reimbursement system that has significant financial rewards for specialists who perform procedures, but doesn't reimburse primary care docs fairly.

Our hospitals spend too much competing for Ortho, Cardiac, and Oncology patients because that's where the high margins are. Why does a city like Indianapolis, with 1.2 million people, need 5 brand spanking new cardiac centers?

It all boils down to the fact, that there is no or very little incentive for better health care outcomes, only for performing more procedures and churning high margin patients. This is what we have repeaped by allowing large corporations to determine what is best for shareholders rather than allowing physicians to determine what is best for patients.

Who knows what'll happen to are salaries...my guess, is that the physicians lobbies will fight hard against any real health care reform, because why would you bite the hand that feeds you.

The 90-year old on dialysis with white-out of his right lung who was septic and in respiratory failure, who I just intubated because family "Just wants him to recover and be himself again" proves your point.

 

[WakeMedHeel]

The 90-year old on dialysis with white-out of his right lung who was septic and in respiratory failure, who I just intubated because family "Just wants him to recover and be himself again" proves your point.

Don't get me started on that one...

 

[coldweatherblue]

Anyone want to go to New Zealand with me?

off-topic but seriously is it fairly straight-forward to become licensed in New Zealand if you're a board-certified U.S. MD?

surfing, snowboarding, backpacking galore, good crowd... I love the United States and will probably never leave but at least New Zealand would give me something to fantasize about when I read the daily news..

 

[GeneralVeers]

off-topic but seriously is it fairly straight-forward to become licensed in New Zealand if you're a board-certified U.S. MD?

surfing, snowboarding, backpacking galore, good crowd... I love the United States and will probably never leave but at least New Zealand would give me something to fantasize about when I read the daily news..

I came to the U.S. in order to have the life and opportunity I couldn't get in Canada. Seems the Democrats are determined to spread European/Canadian mediocrity to us as well. Why can't anyone see the value and good things in this country that have made it the best country in the world?

 

[DrQuinn]

Stating the obvious, I think the biggest single improvement we could make to address healthcare is TORT reform. Allowing physicians to make decisions about the care we provide in a logical way without the fear of consequences, would substantially decrease medical cost across the country. I'm sure many of you feel the same way, however as someone else mentioned, drastic changes in TORT are unlikely to occur. On the contrary, I do have some hope now that they've finally asked for physician involvement in the medical reformation process.

As for EM, I feel we are big spenders. We see every patient at their very worst and feel we are forced to pursue a substantial and expensive w/u due to the fear of a missed dx. These missed dx are often found through rather expensive studies. This problem has gotten worse since the ER has become the catch-all for every sniffle and sneeze across the country.

I tend not to be involved in these conversations as there are many great opinions out there. And I believe years ago I shared your opinion above. Howeve,r now that I am 2.7 years out of residency, I do not necessarily feel that by changing tort reform it will help decrease costs. I mean, think about it:

Do you think DC'ing that 40 year old with weird chest pain instead of a 23 hour obs is really covering your butt? Or would you do the same to your 40 year old uncle, to make sure he isn't the 1-5% that we find positive findings for?

Do you think you're doing the CT scan to look for that appendicitis you really think is there, or are you doing it to just "cover your butt?"

I tell my patients, "hey listen, your kid looks great, didn't have a seizure, isn't vomiting, didn't pass out.... etc.... I don't think we need to do a CT scan, plus, its extra radiation. How about if things get worse, you just come right back and we do the CT scan?" I have only had ONE parent deny this and request the CT scan.

Same thing with CT scans of the abdomen, etc. I think in residency I was paranoid about lawsuits, but I just sit down and talk with my pateints and honestly I have cut down on my test ordering by about 30-40%. If there were tort reforms (I am in a very physician freindly state by the way), I don't think I would practice any differently.

Q

 

[niranjan162]

I tend not to be involved in these conversations as there are many great opinions out there. And I believe years ago I shared your opinion above. Howeve,r now that I am 2.7 years out of residency, I do not necessarily feel that by changing tort reform it will help decrease costs. I mean, think about it:

Do you think DC'ing that 40 year old with weird chest pain instead of a 23 hour obs is really covering your butt? Or would you do the same to your 40 year old uncle, to make sure he isn't the 1-5% that we find positive findings for?

Do you think you're doing the CT scan to look for that appendicitis you really think is there, or are you doing it to just "cover your butt?"

I tell my patients, "hey listen, your kid looks great, didn't have a seizure, isn't vomiting, didn't pass out.... etc.... I don't think we need to do a CT scan, plus, its extra radiation. How about if things get worse, you just come right back and we do the CT scan?" I have only had ONE parent deny this and request the CT scan.

Same thing with CT scans of the abdomen, etc. I think in residency I was paranoid about lawsuits, but I just sit down and talk with my pateints and honestly I have cut down on my test ordering by about 30-40%. If there were tort reforms (I am in a very physician freindly state by the way), I don't think I would practice any differently.

Q

do you think tort reform would result in less time doing paperwork?

 

[southerndoc]

do you think tort reform would result in less time doing paperwork?

No, the Joint Commission would fill any void left by less paperwork due to tort reform.

 

[J.J.]

I tend not to be involved in these conversations as there are many great opinions out there. And I believe years ago I shared your opinion above. Howeve,r now that I am 2.7 years out of residency, I do not necessarily feel that by changing tort reform it will help decrease costs. I mean, think about it:
Q

While I can appreciate your point, I believe that your practice as an attending is totally dependent upon what population you serve. I do countless studies on a weekly basis that I know for a fact are going to be negative. Believe me, it's not because I want to. The majority of the time it's done to protect the license of the attending physician.

I believe in physical exam findings and common sense, and in suburban America, I think a physician could practice safe, cost effective medicine, much the way you describe, however in the majority of training institutions located in urban America, the practice of EM is totally different. You do expensive studies on everyone with hopes of avoiding that frivolous lawsuit. Don't get me wrong, I think there is valuable training in obtaining negative studies, especially when you count on a PE as much as I do.

Also, let us not forget, the torture of a lawsuit is not the monetary loss you could potentially experience (hell you're insured), it's the time requirements and anxiety of the entire process. IMO, It's "easier" to get the expensive study.

I don't believe that TORT reform will fix everything, however multiple small changes in a large system such as healthcare could have extraordinary impacts on the system as a whole, and fundamentally TORT reform is about physicians practicing evidence based, cost effective medicine w/o worrying about the bad outcomes that sometime happen regardless of what we do. Medicine is far from perfect and we should not be expected to practice, cost effective, evidence based medicine in an environment that expects perfection.

 

[DrQuinn]

While I can appreciate your point, I believe that your practice as an attending is totally dependent upon what population you serve.

I believe in physical exam findings and common sense, and in suburban America, I think a physician could practice safe, cost effective medicine, much the way you describe, however in the majority of training institutions located in urban America, the practice of EM is totally different. You do expensive studies on everyone with hopes of avoiding that frivolous lawsuit.

Disagree again. I was in academic practice in Wash, DC, for 2.5 years before I came to the utopia of EM. DC is one fo the worst places to practice medicine, especially Emergency Medicine. Similar to the Philadelphia area. 3 year statue of limitations but no cap on any damages. Very physician unfriendly jury.

But I still practiced the same way there I do now.

It is a bit easier when you are an attending and under your own license than as a resident. I know in my residency I did feel we practiced very conservative "CYA" medicine, but yet again this was somewhat attending dependent.

I used to be very angry about the whole med mal issue, but having done some expert review, as well as being a med mal defense paralegal for 8+ years, I do believe that if you just practice good medicine, have good communication with the patient and their family, and "just do what's right," then you will be okay. That being said, I only have 2.7 years experience outside of residency and I have not gotten "burned" yet as far as I can tell. (I am waiting for my staute of limititations to be up in DC!).

Q

 

[NoRegrets]

Could it be possible that Obama's plan makes it easier for EM docs? I have heard many complain about not getting paid for services by their low socioeconomic non-insured patients. If these 46 million patients were insured... then could this particular problem would be reduced?

 

[GeneralVeers]

Could it be possible that Obama's plan makes it easier for EM docs? I have heard many complain about not getting paid for services by their low socioeconomic non-insured patients. If these 46 million patients were insured... then could this particular problem would be reduced?

The current system is unsustainable because it costs so much. Do you seriously think any "reform" efforts would result in a higher pay for EPs?

 

[NoRegrets]

The current system is unsustainable because it costs so much. Do you seriously think any "reform" efforts would result in a higher pay for EPs?

Not necessarily higher pay... just easier to get reimbursed for these particular patients. Can you respond again more directly to my point?

 

[GeneralVeers]

Not necessarily higher pay... just easier to get reimbursed for these particular patients. Can you respond again more directly to my point?

Sure it could be easier. If the majority of patients were signed up to a public health plan (like Canada) and government directly reimbursed all of us then yes, it might be "easier". But if the government is paying $0.50 on the dollar for each patient, is easier really a good thing? Additionally on a whim they can cut your per-patient reimbursement without your agreement, and there is nothing you can do.

 

[NoRegrets]

Sure it could be easier. If the majority of patients were signed up to a public health plan (like Canada) and government directly reimbursed all of us then yes, it might be "easier". But if the government is paying $0.50 on the dollar for each patient, is easier really a good thing? Additionally on a whim they can cut your per-patient reimbursement without your agreement, and there is nothing you can do.

True. It will be interesting to see what happens.

 

[novastorm]

To be honest the best indicator that I can tell (as of now) where health care is going would be to take a look at the 700 million that H.R. 1 put in the hands of the NIH to go though medicine and more or less find out what is worth doing (they still have till Nov. 1 to really decide). Then take a look at S. 438 (of the 111th congress just in case anyone needs help with that). This was introduced by Senator Whitehouse in Rhode Island. The bill is currently in committee (Finance). It looks great on the surface talking about states allowing their medical board to set "best practices" and set medicare payments differentially on how close people stick to them (seems logical and they allow exceptions) However there is a blanket clause allowing the health and human services secretary to unilaterally set "best practices". I would keep my eye on this bill if I were you.

 

[igottaquestion]

right now, aren't insurance companies setting limits to medical care by establishing "best practices" for their profit? wouldn't the government be more inclined to define "best practices" in terms of cost-effectiveness rather than profitability?

 

[MedDeac]

As for EM, I feel we are big spenders. We see every patient at their very worst and feel we are forced to pursue a substantial and expensive w/u due to the fear of a missed dx. These missed dx are often found through rather expensive studies. This problem has gotten worse since the ER has become the catch-all for every sniffle and sneeze across the country.

The system has forced us to change from just 'emergency centers' into the treatment and diagnostic centers for the hospital. we see the large uninsured population but also we get the transfers from primary care provider clinics, specialty clinics which used to be direct admissions. why? because we are more equipped to rapidly diagnose, treat, and triage into the medical centers. And quite frankly primary providers send patients to us for our opinions now more than ever. specialties accept patients in transfer not to necessarily see and admit them but to let the EMP's see and evaluate them, to get appropriate studies and make diagnoses. The problem with this is there is no financial support for this new role.

 

[WakeMedHeel]

The system has forced us to change from just 'emergency centers' into the treatment and diagnostic centers for the hospital. we see the large uninsured population but also we get the transfers from primary care provider clinics, specialty clinics which used to be direct admissions. why? because we are more equipped to rapidly diagnose, treat, and triage into the medical centers. And quite frankly primary providers send patients to us for our opinions now more than ever. specialties accept patients in transfer not to necessarily see and admit them but to let the EMP's see and evaluate them, to get appropriate studies and make diagnoses. The problem with this is there is no financial support for this new role.

Dude...don't let the medicine guys here this.

Seriously though, I think this is highly region, hospital system, and even primary care group dependent. Some hospital systems have a very good direct admission process. Others, its just easier to send them to the ED. It's all about financial incentives.

And there are primary care groups that never send us patient and there are clueless groups that send asymptomatic hypertension for admissions/opinions all the time. I can't tell you how many times I've had a conversation that goes something like this:

PCP or even worse, clinic nurse: "Hey, we're sending a guy with elevated BP...180/100"

Me: "Any symptoms..."

PCP: "No"

Me: "Headache...blurry vision...numbness...tingling "

PCP: "No"

Me: "Can you just sit them in a quite room and recheck their BP in 15 minutes?"

PCP: "No...that's not our policy."

Me: Long sigh...."Okay, well, we're going to check their BP again and when it's below 180 I'm going to discharge him without any new meds because it's not my job to manage chronic asymptomatic hypertension...and then I'm going to send him to your clinic..."

And cycle continues...

 

[leviathan]

The salary in Canada is Capped at 430K (which is 300K USD).

WHAT?! Are you making that up on the spot, and if not, who told you this? If you look at common lucrative specialties like ophto or derm, many of these physicians are billing millions of dollars every year. By the way, 430k is about 340K US, and that is only because of the current economic situation.

The average EP in Canada makes 165K (which is abou 120K USD).

165K? GV, where are you getting these numbers? The average EP makes about the same as Americans, about $250k. This can be a lot higher in rural areas, and a bit lower in major urban centres. You can't just compare the two currencies either. It is better to look at how far that $250k will get you based on costs of living in either country.

Bear in mind, that 60% of that gets taxed back by the Federal and Provincial governments.

I think someone else already posted how wrong that is. It is in the 30ish percent range for an EP's income.

 

[GeneralVeers]

WHAT?! Are you making that up on the spot, and if not, who told you this? If you look at common lucrative specialties like ophto or derm, many of these physicians are billing millions of dollars every year. By the way, 430k is about 340K US, and that is only because of the current economic situation.

A pulmonologist at my hospital (who fled Canada) told me. I just looked it up, and it looks like Ontario lifted the salary cap in 2006.

165K? GV, where are you getting these numbers? The average EP makes about the same as Americans, about $250k. This can be a lot higher in rural areas, and a bit lower in major urban centres. You can't just compare the two currencies either. It is better to look at how far that $250k will get you based on costs of living in either country.

I don't believe for a second that it's 250K. Show me your data. I'm basing the $165K on recruiting ads I've seen for Vancouver and other cities. I don't really care about pay in rural areas. Show me what an EP will make working in Calagary, Vancouver, or Southern Ontario.

 

[wrx04silver]

This makes me laugh. Seems a reality check is in order. As a previous poster mentioned, the ED is not where complex diagnosis is made, unless you consider ordering a CT, BNP, troponin, and cardiology consult on every patient with a flipped T wave diagnosing. Stick to what your good at, and leave the diagnosing and managing of complex patients to the inpatient physicians and surgeons.

 

[GeneralVeers]

This makes me laugh. Seems a reality check is in order. As a previous poster mentioned, the ED is not where complex diagnosis is made, unless you consider ordering a CT, BNP, troponin, and cardiology consult on every patient with a flipped T wave diagnosing. Stick to what your good at, and leave the diagnosing and managing of complex patients to the inpatient physicians and surgeons.

Let me guess, you're one of these brainiac surgeons or inpatient physicians? The ones who send their patient to me because it's after 5 PM and you're too "busy" to take care of them? The ones who tell patients to "go to the ER" for even the most minor medical complaint that 3rd year medical student should be able to handle?

Please, come in at 3 AM and stand at the bedside of your patient and "diagnose" them with me. Only then will your statement have any validity.

 

[leviathan]

A pulmonologist at my hospital (who fled Canada) told me. I just looked it up, and it looks like Ontario lifted the salary cap in 2006.

Fair enough. I've never heard of that in Ontario either, but things can certainly be different over there.

I don't believe for a second that it's 250K. Show me your data. I'm basing the $165K on recruiting ads I've seen for Vancouver and other cities.

http://www.cg-ins.com/news/?p=1637
"The average salary for an ER doctor at St. Paul's is $268,000, and they typically work 14 shifts per month." - This is the hospital in the downtown core of Vancouver. You couldn't get more urban than that.

Even family physicians in Vancouver can make 165K. If you search for Vancouver locums, you will find positions there offering $125/hour or $1000/day minimums, and that is after overhead/split.

So no I don't think Obamacare is going to be so bad for you guys, if it's done right. You forget that Canada isn't a socialist health care system, it is a single-payer publically funded health care system. There is a difference. Physicians still incorporate and run businesses and work privately and choose to practice medicine how it pleases them. They just bill from one source and don't deal with the hassle of insurance companies and denied claims and ridiculous malpractice fees.

 

[GeneralVeers]

So no I don't think Obamacare is going to be so bad for you guys, if it's done right. You forget that Canada isn't a socialist health care system, it is a single-payer publically funded health care system. There is a difference. Physicians still incorporate and run businesses and work privately and choose to practice medicine how it pleases them. They just bill from one source and don't deal with the hassle of insurance companies and denied claims and ridiculous malpractice fees.

I'm remembering Canada from 1997-2000 when my family moved here (mainly because my father, a Physician at the time could make 3X the salary in the U.S.). Obviously things have changed.

Still, in Canada they frequently have discussions about the sustainability (or lack thereof) of their system, and the rationing and waiting periods required to make it work.