Grass Isn't Always Greener

Discussion in 'Anesthesiology' started by Ronin786, Aug 31, 2017.

  1. Ronin786

    Ronin786 ASA Member

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    Meet the nurse who will soon perform surgery on patients alone

    I know it's in the UK, but anybody who doesn't think that nurses/midlevels really want to replace doctors should open their eyes. All the perks and none of the work.
     
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  3. Lecithin5

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  4. bashwell

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    That's because the UK's NHS is in a downward spiral right now:
    -Heaps of junior physicians on strike in the past year or two.
    -Heaps of junior physicians utterly demoralised by recent events.
    -Heaps of junior physicians fleeing the UK.
    -Other nations in the former Commonwealth such as Australia having to curb the flow of disgruntled UK physicians from coming to their shores.
    -NHS considering hiring GPs from India to help.
    -UK campaigns to bring back GPs to the UK because so many have left including attempts to paint things in a more positive light.
    -There are even heated debates over whether or not to privatise the NHS in the hopes of saving the NHS from purported eventual collapse.
    -Etc.
     
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  5. Psai

    Psai Account on Hold
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    They want to do plastic surgery and rounds but they still call it advanced practice nursing lmao
     
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  6. turnupthegas

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  7. FFP

    FFP Grunt, body, pompous ass, pissant, buzzkill, jaded
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    Advanced plastic nursing.
     
  8. lobelsteve

    lobelsteve SDN Lifetime Donor
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    Read the article, loved the comments. Same as nurses in US. Don't know what they don't know. Dangerous.
     
  9. IlDestriero

    IlDestriero Ether Man
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    I just got sent this as well.
    The cancer is spreading, and those morons are seeding the tumors themselves.
    We'll catch up soon enough.


    --
    Il Destriero
     
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  10. FFP

    FFP Grunt, body, pompous ass, pissant, buzzkill, jaded
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    It's already in the VA (independent midlevels posing as doctors). Just not among proceduralists.
     
  11. FFP

    FFP Grunt, body, pompous ass, pissant, buzzkill, jaded
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    What's the pinnacle of plastic surgery? In goes a nurse and out comes a "doctor".
     
    #10 FFP, Aug 31, 2017
    Last edited: Sep 1, 2017
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  12. acidbase1

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    This will be the US x 1000 when we go single payer. Nobody wants to go through 8 years of hell to make 150k
     
  13. caligas

    caligas ASA Member

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    True, but I think single payer is the only likely solution from a purely economic viewpoint
     
  14. Mad Jack

    Mad Jack Critically Caring
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    [​IMG]
    Or we could just focus on where the real problem is: unnecessary administrative positions.
     
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  15. TorMed

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    In Ontario we have single payer and anesthesiologists make around 400k typically. If you have single payer in the US you'll need each state to be a separate payer so they have to pay competitively. In Canada every provincial Ministry of Health is a separate payer with their own payment schedule


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  17. Mad Jack

    Mad Jack Critically Caring
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    Wouldn't work in America because there is such a huge spread of income inequality between states.
     
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  18. caligas

    caligas ASA Member

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    We should, but it might not fix the system from a cost standpoint
     
  19. Mad Jack

    Mad Jack Critically Caring
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    It might actually go quite a ways
    Medicine’s Top Earners Are Not the M.D.s

    Labor is roughly half of health care spending, with management costing three times more than physician salaries overall (while physician fees amount to 14.8% of spending, only about a third of that goes to their salaries, the rest goes to paying for offices, the hospital's cut, etc).

    Where does all the health care money go? | Academy Health

    A further 8% could be saved by cutting administrative overhead. Basically you could save $500 billion per year or more with some simple changes and administrative elimination.
     
    #17 Mad Jack, Sep 1, 2017
    Last edited: Sep 1, 2017
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  20. pgg

    pgg Laugh at me, will they?
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    Might as well ask the lawyers what they think of tort reform for all the good it'll do.

    Hospital administration is the self licking-est ice cream cone in the history of the world.
     
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  21. doctalaughs

    doctalaughs Member

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    Not to mention the cost of medical education and legal liability in the US. We can move to Canada's system once they fix these issues (ie never). Not to mention retraining a generation of doctors to stop practicing defensive medicine.


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  22. Mad Jack

    Mad Jack Critically Caring
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    And the legal liability will never go away, even in a socialized system. Politicians are mostly ex-lawyers, and the legal industry has lobbying power that puts physicians to shame. Combine that with the fact that malpractice is largely regulated at the state level, and you're basically in a situation where if we end up socialized we'll have all the downsides of socialized medicine with all the liability of the current system. Hooray.
     
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  23. dr doze

    dr doze To be able to forget means to sanity
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    I wouldn't take that bet. There are situations that sovereign immunity is granted when the state is on the hook.


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  24. Mad Jack

    Mad Jack Critically Caring
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    Such systems, as implemented in the US VA system, would be the most likely framework. That would obliterate the medical malpractice industry and the public would be easy to sell on not backing a world in which doctors don't face consequences for harming their loved ones (or so the ads would say). Lobbying is a powerful thing, literally the most powerful force in the country. We would undoubtedly lose.
     
  25. dr doze

    dr doze To be able to forget means to sanity
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    Lots of states have significant caps for damages in malpractice cases regarding decisions made in the Emergency Room., I think that Jackson memorial in Miami has significant limitations in liability for much of what they do. Ohio has limited immunity for their state institutions, probably more examples out there.

    Go to single payor, greatly expand the use of midlevels, shave on the training experience of doc trainees, cut costs wherever possible with associated drop in quality of care, is it really so hard to envision that the medical liability game may change radically if the the above were to occur? If not, we might be at the dawn of a golden age for the ambulance chasers.
     
    #23 dr doze, Sep 3, 2017
    Last edited: Sep 3, 2017
  26. Mad Jack

    Mad Jack Critically Caring
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    Taxes — the average Canadian family’s largest expense

    Yeah, but between the tax rates and the low exchange rate Canadian anesthesiologists really fall behind, particularly in investment potential.
     
  27. Blitz2006

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    Not really.

    Remember in Canada healthcare is free, so that's 20k savings on average/year (for a family of 4). And education is much cheaper (the most expensive medical school is Univ. of Toronto, which is 20k/year). So if you have 3 kids and have to send them to medical school...you're not dumping of upwards of 300k/kid/M.D

    But yes, taxes are higher and COL is also overall higher (but again, that is variable, Edmonton is much cheaper than SF, etc.)

    And the stress levels practicing in Canada is far <<< than US. You can't put a price on that. I know for a fact that in Ontario, the highest malpractice fees are OBGYN and Neurosurg (75k/year). Much lower than the ridiculous numbers I hear, here in NY.

    So making 400k/year in Canada isn't so bad. And because the reimbursement rates are pretty much fixed throughout the country, there's less variability in geographic differences in pay. I know personally pain docs that hit 750k in Canada...
     
    #25 Blitz2006, Sep 5, 2017
    Last edited: Sep 5, 2017
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  28. nimbus

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    You are overstating the stress of practicing in the US. Doubt it's any different.
     
  29. Blitz2006

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    Its very different. Much less paper work, much less litigation, billing/coding is much more straightforward. 0 phone calls with insurance companies, no prior-auths, etc.

    I'm not saying Canada is perfect, but there are upsides...
     
  30. nimbus

    nimbus Member

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    Our paperwork consists of preop and postop note, anesthesia record, and preop and pacu orders. Billing/coding is looking up a CPT code on abeoCoder, but most of the common procedures are committed to memory.
    By the time the patients reach us, all the authorizations are done. They don't authorize surgery without anesthesia. I don't know of any anesthesiologists personally calling an insurance company, maybe our billers do. As for litigation, I don't want to jinx myself but it hasn't been an issue.

    Is it much different in Canada?
     
  31. Blitz2006

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    I'm not an anesthesiologist, so I don't know is the honest answer. I do know that litigation is definitely lower in Canada for all specialties.

    I was commenting in general as physicians, particularly in the pp setting (ie. Pain Management) with regards to stress.



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    #29 Blitz2006, Sep 5, 2017
    Last edited: Sep 5, 2017
  32. nimbus

    nimbus Member

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    Pain is another game entirely but I think the day to day practice of anesthesia is very similar in both countries and many others.
     
    #30 nimbus, Sep 5, 2017
    Last edited: Sep 5, 2017
  33. Mad Jack

    Mad Jack Critically Caring
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    Given that not everyone has kids or pays for their education (or sees their kids go to medical school, for that matter), that whole point is kind of null for many. So I'm looking at the health care cost savings- which, for a wealthy individual, don't add up to a savings. The average family in the top 10% of earners (of which physicians are certainly a part) in Canada pays almost $38,000 per year toward health insurance via taxes. So then we look at malpractice, which is highly specialty dependent. A policy in the specialty I hope to match to runs around $2,000/year in my state. So then we're looking at higher tax burdens and a lower exchange rate, so you've got to make up for that in wages. Psychiatry certainly doesn't- average wages in Canada are the same or substantially less than in the US.

    Let's compare a FP in Quebec earning 350k versus a FP in California making 300k in an employed position that provides insurance (both on the higher side for their area, both in high tax regions). Both come out making about 195k after tax, but those Canadian dollars amount to 0.81 USD each, so you're really getting 158k USD worth of pay out of your 350k CDN pretax. The US physician will have to pay a portion of their costs (we'll say they are a Kaiser employee, so their cost is, on the high end, $4,500). That leaves the US doc ahead 190.5k. Then on any money you spend, you've got to pay sales tax- in Quebec, you're looking at 14.975% versus California's 7.25%. Own a house? That's 3.4% of the home value in tax per year in Quebec versus 1.16% in the Los Angeles area. All of that adds up to Canadian docs being way behind unless you're in a high paying specialty, particularly if you're looking to save up and have the option of early retirement.
     
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  34. Blitz2006

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    Well stated, can you send me the link on the percentage of taxes per income bracket that goes towards healthcare? I didn't know these stats. Did not realize it was as high as 38k for top 10%.

    I disagree with your statement on Psychiatrists earning the same or substantially less than in the U.S. Psychiatrists in Canada average 320k-350k/year. In the States, you can only hit 300-350k if you are in smalltown America or 400-500k if you hustle in NYC/LA with a cash-only practice. But these are outliers. The median pay in psych is roughly 250-275k in the U.S.

    A caveat in your Quebec vs. Cali argument is that homes in Quebec are much cheaper than Cali...even if you do MTL vs. SF. So yes, while taxes are lower in Cali, your mortage payments/down payment will be a lot less in Quebec for a lot more house.
     
  35. Mad Jack

    Mad Jack Critically Caring
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    How Much "Free" Health Care Really Costs Canadians
    Article discussing how "free" their care is.
    https://www.fraserinstitute.org/sites/default/files/health-care-in-canada-costs-typical-canadian-family-more-than-11000.pdf
    Some stats from which the article was derived.
    2017 Personal tax calculator - EY - Canada
    Canadian income tax calculator
    Paycheckcity.com
    Paycheck calculator, I used CA filing status, married, 4 exemptions.
    Canada VAT Rates – Ad Valorem
    Canadian VAT and sales tax rates.
    Statistics Canada: Property taxes
    Canadian property tax stats.
    Paying too much? Comparing property tax rates for L.A. County cities
    Article on property taxes in LA county.
    http://www.boe.ca.gov/pdf/boe95.pdf
    Tax rates in California. As a correction, the sales tax rate in Los Angeles County is 9.25%.
     
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  36. Mad Jack

    Mad Jack Critically Caring
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    Also, per CIHI's official report (and they pay the vast majority of psychiatrists in Canada directly, so these are accurate numbers), the average psychiatrist salary in Canada is $259,000 as of the most recent report in 2015. The closest thing we've got in the US is the Medscape Compensation Report, which has a very large sample size and tends to be fairly accurate, which estimates psychiatrist salaries to be an average of $235,000. Basically, you're still making more after the exchange rate in the United States. One interesting thing to note, however, is that psychiatrists actually make more in the desirable area of California- an average of $252,000.

    https://secure.cihi.ca/free_products/Summary_Report_2015_EN.pdf
    Medscape: Medscape Access
     
  37. Twiggidy

    Twiggidy ASA Member

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    I stand by this post. A very large problem that our generation and future generations of physicians will face in this country is the growing cost of medical education, the growing cost of living, and mostly stagnant wages. The generation before us had it better which is why they'll be able to retire easier.
     
  38. Mad Jack

    Mad Jack Critically Caring
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    Really depends on the field. Primary care and psych have gone waaaaaay up in the last fifteen years, much faster than expected. Anesthesia, well... You guys have gotten boned left and right. Medical education is a one-time expense, so if you're taking more than a 13k a year pay cut for it for the rest of your life, you're not coming out ahead (and possibly even much less than that, if you've got less debt). Now, if you intend to pay for your kids' education, well... That's another story I guess. Cost of living though... Well it all depends. Basically if you're having kids, Canada can be a big boon.
    Does it cost more to live in Canada or the U.S.? Depends if you have kids
    But then again, you've got to live in Canada.
     
  39. Twiggidy

    Twiggidy ASA Member

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    "If you live a healthy and active lifestyle and don't plan on having children, the U.S. is potentially the place for you. "

    Truth
     
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  40. Blitz2006

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    Fair points. Remember in Psychiatry, large proportion of psychiatrists (70%) work less than 40 hrs/week. So while the median in Canada is $260k, if you worked a full 40 hours, the median would be easily over 300k, guestimating 320ish. But anyways, that also applies here in the U.S, with the "real" median being probably 275k assuming a "normal" amount of Psychiatrists worked 40 hrs/week.

    But thats beside the point. I think you made some valid points on showing U.S might be better in the big picture, but I just think its narrower than what people think. A lot of people here think "socialized" medicine for doctors mean "terrible pay". While yes, it is much tougher in Canada to be making millions:

    http://nypost.com/2014/04/13/citys-hospital-specialists-are-raking-in-millions-of-dollars/

    For the vast majority of physicians in the U.S, Canada isn't a bad alternative when up north there are Ophthalmologists easily clearing 600k, Pediatricians making 300k, etc.
     
  41. FFP

    FFP Grunt, body, pompous ass, pissant, buzzkill, jaded
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    I imagine working in Canada like working for the VA, just maybe with a better pay. Most VA anesthesiologists seem happy.
     
  42. Blitz2006

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  43. nimbus

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    I'm pretty sure 15 ER docs at my hospital cleared $400k. And the weather is a lot better than Winnipeg. I don't think pay in either country is meaningfully different.
     
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  44. Blitz2006

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    Fair enough. My point is that docs in socialized healthcare do alright. That's all.

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  45. FFP

    FFP Grunt, body, pompous ass, pissant, buzzkill, jaded
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    Not everywhere. See Germany, the UK etc.
     
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  46. Blitz2006

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    Agreed. But countries like Oz and Canada have it figured out.

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  47. Mad Jack

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    That 15 ER docs made 400k when many ER docs here would scoff at such a number says a lot.
     
  48. Mad Jack

    Mad Jack Critically Caring
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    Those are literally the only two countries where docs do okay in a socialized system.
     
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  49. Blitz2006

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    Here in the Northeast the average ER doc salary is around 250k, + or - 20k.

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  50. Mad Jack

    Mad Jack Critically Caring
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    Medscape: Medscape Access

    Maybe in NYC it's that low, but in the northeast as a whole, it's substantially higher. Basically every EM doc I've ever talked with about salary has been pulling 350-400k outside of academics (and I live in the northeast).
     
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  51. Blitz2006

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    Yeah don't come to NYC if you want $, lol

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  52. AdmiralChz

    AdmiralChz ASA Member

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    Hard to agree more! The UK is so bad they have semi-regular doctor strikes!
     
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