At least my daughter will never go South for what? To be pushed around
by $$$ sign? She always says "I did not become a doctor to get rich"
Nowadays keeping busy during her off shift at refugee clinic here.
Thankfully MANY Canadian doctors have the same outlook. Many who have
gone south for the dollar come back appreciating the fact there is
more to doctoring than money, and here in Canada they don't have to
chase patients for payment and fight with HMOs tooth and nail.
On 2/26/2016 11:16 PM, firstname.lastname@example.org wrote:
My PCP is a "doctor" -- in much the same way that I'm an "engineer".
Neither of us wants to deal with the messy "business side" of our
I think this is something you can pick up on if you are observant.
E.g., I have friends who recount how their doctor made them
come back for a second appointment (instead of addressing
TWO problems in a single visit). I bring a laundry list of
questions, issues, etc. and my MD is very happy to address
all of them in a single visit.
At the same time, he's aware of how the billing system works and
you wouldn't be surprised to hear him say: "You're better off
going to XYZ to have that addressed because *we* would bill you $$$"
This is unfortunate as it just adds to the delivery cost
(i.e., the fact that he has to KNOW those things; or, that
there are two different prices for the same service provided
in two different ways/providers)
Some years back I saw a documentary on health care in France - where
doctors are on salary and make house calls.
The doctor and wife they featured were not getting rich by any means,
but they lived at a very high standard (nice car, nice house, restaurant
meals when they felt the urge...and so-forth....)..... The bottom line
per that couple was that they thought they had a really good life and
medical school was 100% worthwhile to the guy.
Over the long-haul I have no way of knowing. I know of only one who
went directly back to Canada since we've returned to the family farm (15
yr now) and that was a specific family hardship case. The others leave
for "greener pastures" within the States at least initially; East and
West coasts are primary target areas of course; anywhere but "flyover
W/ the changes in US medical practices, many are becoming more
frustrated but that's not restricted to the Canadian imports; it's
pretty universal throughout.
The reductions in Medicare/Medicaid pay schedules has forced several of
the rural hospitals into closure so we have several multi-county areas
now with no emergency response facilities at all...the local is hanging
on but it's "iffy" even though while still small by city standards at
least are one of the higher-populated counties with a regional retail
hub from the surrounding area as far as into SE CO, far NE NM, and the
OK and TX panhandles.
From discussions with my MD and other medical professionals (connections at
one of the local hospitals), this seems to be the case.
On the one hand, you can say its sour grapes as now pressures are being
brought to bear (that hadn't previously) on how they practice medicine. The
semi-god-like reverence for doctors has faded significantly over the course
of a single career; I'm not sure that's easy to accept.
OTOH, there may now be too much of a move to "bean counting". E.g.,
the new coding system breaks things down into such fine detail
that i wouldn't be surprised if some of the codes are only "applied"
ONCE, in a year, NATIONWIDE:
"eye injury; left; fall; trip; child's roller skate; while texting"
OToOH, my peeks inside medical practices suggest they are long overdue for
rethinking. Do you REALLY need all those bodies to deliver healthcare?
How do places with fewer staff "manage to cope"?
I think we have ~10 hospitals. But, only one "trauma center". The
area covered is pretty large -- most hospitals have (and use on a
regular basis) helipads to airlift patients in.
There's also a bit of "book cooking" that happens, esp with INS
involvement. E.g., a truck full of "illegals" that crashes
will have them all treated at a local facility; but, INS won't
assume CUSTODY of them until afterwards (leaving the hospital
trying to get payment from the "patients" -- which will soon
Of course, hospitals can play that game, as well: advertising
to more affluent Mexicans that they should come up, have their
baby delivered here (US citizen!) and get in a few days of shopping
before going back across the border...
On 2/25/2016 10:48 AM, email@example.com wrote:
And they don't want to run a deficit. So, that suggests they
just omit expenses when they approach their budgetary limits.
I.e., how do you budget for an unknown "consumption" pattern?
Unless they only "sell" so much "product" and then close up
In theory, that is true in our "nonprofit" AND "for profit"
institutions. Waste cuts into profit. Or, cause your
costs to be higher than another facility -- that can end
up driving YOUR reimbursement rate ("Hospital A is willing
to accept $X for this procedure. Take it or BEAT it!")
That, of course, would depend on the local market. If there are
a surplus of "health care professionals", then there is downward
pressure on at least *some* wages.
Are patients going to complain that Dr. Bob's phlebotomist is
"a bad shot" while Dr. Tim's is "always spot on"? Are they
going to just pick up and move to a different/new practice?
Do they even have that choice? (why would a practitioner
want MORE patients than he can already handle -- "quotas"?)
OK, that's a difference. Here, the anti-big-government folks
fight any attempt to create registries and INFORM consumers
(ANY type of consumer!)
I assume a doctor can't up and move to a different province and
hang his shingle anew? Here, that's entirely possible! Walk away
from your past performance/problems... (unless you're jailed!)
We've supposedly got LOTS of checks and balances -- ambulance chasing
attorneys being the biggest "check". But, they don't seem to work.
Too many ways to game the system.
My PCP has a stake in the other organizations to which he refers
me: for XRays, Lab work, etc. Should he be prohibited from
making those investments? Should he be prevented from directing me
to one of those providers -- perhaps to an inferior provider?
And there is one of the BIG differences between Canada and the USA
We are what yiu folks call a "socialist" country.
We demand our government do things Americans won't let their
government even think about.
It does happen occaisionally -but each province has it's own medical
association - and to practice you need to be a member.
If you have been disciplined by one, generally all the others will
find that out. Some get away with it for a little while - - -
That;s probably true.
OTOH, I always thought that the little "scooter" (power chairs)
would be dog slow, etc. Had to repair one for a non-profit.
Took it for a test drive and nearly ran folks over with it!
Apparently, they come in different "speed grades". The chair I
had repaired would do 6MPH! Makes me wonder how folks can
navigate INDOORS without punching holes through walls...
A good bit of thinking re: those sorts of "issues" went into choosing
this place. House layout, weather, size of yard, bathroom layouts, etc.
And, I've been subtly scheduling the larger "maintenance" issues
(new roof, paint job, felling trees, etc.) with an eye towards
"how long can I postpone these things yet still be able to
tackle them myself -- so the *next* iteration will be well past
the point where I *must* hire it out".
+1 The brim is the problem. When I was a FF we used the newer style helmet
which didn't have much of a front brim but the face shield would pivot up
and one could still see. The problem was with the SCBA. couldn't see much
peripherally. Now thermal imaging cameras work wonders.
I was 68 and one day walking down the stairs, my left leg kept
bending, collapsing, and I had to hold on to the railing with my right
hand to avoid falling to the left. I made my way down the whole
flight of stairs like this, and then I rested at the bottom for a
Then I was fine, and 8 months later, it hasn't shown up again.
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