Why are doctors CAPPED? And hockey players ***** about a CAP?

[aquariaguy]

I don't get it. Why do they cap doctors? First of all, we NEED them. Secondly, a lot of the highest paid doctors that are capped DON'T work during the summer months cuz they go away. Thus, they accept less patients, and have less hours because why work more when you will only get X amount of money.

Also, i don't understand how sport players whine/***** about being capped when they do half-ass job at A HOBBY. (ie. vince carter)

Yea, Canada doesn't have enough money for doctors, but why do we give tax write-offs to sport teams?

Someone care to enlighten me?

[Aristophanes]

15,000 MDs in Ontario, 13 active NBA players for the Toronto Raptors.

They generate $ too. Blah, there's too many ways to argue this.

[Kenneth]

Canadian Doctors are far more greedy than NHL players.

If you thought about it with a population of 32 million people; our medical schools could supply thousands of graduates to fill the current "shortage" overnight. But if the Leaf's needed a another Wanye Gretzky do you really think they could find one easily? This from a country which loves our hockey.

It's explain further later; saving this spot though ;) .

[aquariaguy]

Canadian Doctors are far more greedy than NHL players.

If you thought about it with a population of 32 million people; our medical schools could supply thousands of graduates to fill the current "shortage" overnight. But if the Leaf's needed a another Wanye Gretzky do you really think they could find one easily? This from a country which loves our hockey.

It's explain further later; saving this spot though ;) .

Yes we could get thousands............which lack skill. Do you really want to open up the enrollment?

[aquariaguy]

15,000 MDs in Ontario, 13 active NBA players for the Toronto Raptors.

They generate $ too. Blah, there's too many ways to argue this.

Well i'm guessing the Raptors payroll is $60 million? Plus Blue Jays (1 milllion? j/k) Leafs...etc...i'm guessing the argos are poor like the jays? (I don't know anything about them)

Each doctor capped at what..200-400 thousand?

[Montague]

Why not upcap teachers salaries?

Why not the nurses?

Why not the police?

Why not firemen?

Where does it end?

You will end up just handing over your ENTIRE paycheque to the government to pay for all these high paid workers not to mention the free loaders of society.

[UrbanPoet]

Why not upcap teachers salaries?

Why not the nurses?

Why not the police?

Why not firemen?

Where does it end?

You will end up just handing over your ENTIRE paycheque to the government to pay for all these high paid workers not to mention the free loaders of society.

I believe teachers should get paid more since they are teaching 50 kid classes now...
And all the extra work they gotta mark.... etc.

[eelfliw]

That's the diff between public & private sector. If we had a 2-tier health system where the other tier is privately funded, then governments can't place caps on that tier.

On the other hand, if we had a publicly funded monopolistic pro hockey league, then I can see salary caps being introduced. Imagine not having to pay to watch live NHL games?

[Master]

Canadian Doctors are far more greedy than NHL players.

.

That's a big accusation you are making. Doctors in Canada specifically in Ontario have NOT gone on strike. They have committed to provide care to patients regardless of the state of pay negotiation with the government. Their pay have not caught up with rate of inflation over the past 10 years. Do you how much a family doctor make to see you? Approx $17 a visit in Newfoundland approx $27 a visit in ontario. Contrary to popular beliefs, they do not get fees for a referal to a specialist or writing a prescription.

Doctors in university affiliated hospital do not get a stipend for teaching residents/interns/medical students. It's all done for free. Yes, you can churn out thousands of doctors from medical school, or even better, just import them from China/India/Indonesia. The standard of care will suffer. The practice of medicine and the standard of care is different in every country. The same applies to lowering the requirements to medical school entrance in order to solve the shortage of MDs in this country. You create lower quality doctors and this health care.

At this point of time, Ontario doctors have been working without a valid contract with the goverment. It has been like this since mid-last year.
And yes, I can assure you that many excellent doctors are leaving Ontario and moving to Alberta or USA.

[Master]

The cap on doctors is not really a big issue because most doctors do NOT cap anyway. The problem I have is the pay discrepancy between a family doctor and specialist. As the government is trying to promote primary care reform, it will only make sense to encourage more students going into family medicine. They are making family doctors pay so low that students are choosing to specialise.

We hear about not having enough family doctors much more than not having enough specialist. Stupid Mcguinty govt...

I'm paying more taxes this year due to health care premium. If I don't see an improvement in health care by next election, I'm voting Mcguinty out!


I don't get it. Why do they cap doctors? First of all, we NEED them. Secondly, a lot of the highest paid doctors that are capped DON'T work during the summer months cuz they go away. Thus, they accept less patients, and have less hours because why work more when you will only get X amount of money.

[afong56]

the health care premium will only get ontario back to pre-harris 'common sense' revolution funding levels, if that.

when you combine the per capita strips, and the the massive deficit that the tories saddled ontarians with, then the premium can only do so much.

it is going to be a demographic reality that our province will have to spend more and more on health care, as the baby boomers age. the majority of them haven't even reached retirement age yet, and unfortunately, unless they start living better, healthier lifestyles, my generation (and i'm guessing yours too) will have to pay for that.

anyone being reasonable can see that mcguinty cannot be blamed for that.

so, being completely realistic, one should see some improvement, but not a dramatic one.

[Master]

That's exactly what I mean. With the health care premium, if I don't see an improvement by next election, I'm voting Mcguinty out. I want to see my tax dollar going into action. There's a question whether the 100% of the premium will go into health care. I want to see that audit as well.

I can almost guess that there will be no improvement. In fact, it's going to be worse in the health care system. Doctors are leaving the province because of lack of contract. The waiting list that the govt are talking about is going to be even LONGER!

[blue_xii]

The same applies to lowering the requirements to medical school entrance in order to solve the shortage of MDs in this country. You create lower quality doctors and this health care.



You don't need to lower med school requirements, there are many candidates that more than qualify under current requirements but aren't accepted due to lack of space. A guy with a 3.7 GPA gets accepted because he was a student council president over a guy with a 3.8 GPA who wasn't into organized extra-curricular's doesn’t make a better doctor. If anything, opening up med school spots will lead to inferior dentists!

[aquariaguy]

You don't need to lower med school requirements, there are many candidates that more than qualify under current requirements but aren't accepted due to lack of space. A guy with a 3.7 GPA gets accepted because he was a student council president over a guy with a 3.8 GPA who wasn't into organized extra-curricular's doesn’t make a better doctor. If anything, opening up med school spots will lead to inferior dentists!

I would choose the 3.7 guy too. That shows the 3.8 guy has no volunteer activites and shows he spent his whole life studying.

[Montague]

'm guessing the argos are poor like the jays?
Do NOT even mention the Argos payroll or any CFL team in this thread.

Outside of maybe one or two players most are not making alot of money.

PLUS you have to figure their careers in the sport is likely no more than five years.

Probably many auto workers make more money that the VAST majority of players in the CFL.

Many have to get other jobs in the offseason to supplement their income.

[Master]

You don't need to lower med school requirements, there are many candidates that more than qualify under current requirements but aren't accepted due to lack of space. A guy with a 3.7 GPA gets accepted because he was a student council president over a guy with a 3.8 GPA who wasn't into organized extra-curricular's doesn’t make a better doctor. If anything, opening up med school spots will lead to inferior dentists!

I hope you are not implying that students choose dentistry because they can't get into med school.

Medical school admission not only looks at GPA, MCAT, extra-curricular's activity but also the personal statement and most importantly the interview. I have personally seen students who scores 3.8 - 3.9 GPA and yet get denied into med schools because of personality, motivation, or simply lack of common sense when dealing with issues. Some people simply panicked when faced with an ethical problem during the interview. These are only some of many factors that comprise the interview process.

Now, if you tell me to choose 50% of all interviewees intead of 10% of all interviewees, I will have to make do with inferior candidates. The interviewers are diplomatic about rejecting candidates. They can't say "Sorry, you suck". They write a nice letter saying that although you are a strong candidate but you are not the ones that they are looking for.

[ronny1980]

hippocratic oath

enough said.

[gman]

I don't get it. Why do they cap doctors? First of all, we NEED them. Secondly, a lot of the highest paid doctors that are capped DON'T work during the summer months cuz they go away. Thus, they accept less patients, and have less hours because why work more when you will only get X amount of money.


First, they did not want to be capped and nobody does.

Second, a lot of doctors were burned out when there was no cap. They worked much longer hours because of the extra money. They didn't take holiday. Although we need them, it is not healthy for them either (IMO). My family doctor used to stay 12 hours per day in his office 6.5 days per week. I don't know when he could see his family or his own kids. Now, he works 12 hours per day and 4.5 days per week. I think it is more reasonable.

The problem is NOT how long our existing doctors work because most of them do work longer than a normal joe. The problem is we do not have enough doctors.


Also, i don't understand how sport players whine/***** about being capped when they do half-ass job at A HOBBY. (ie. vince carter)


Are you saying the doctors did not whine? Are you saying you will not whine if your salary is capped? Are you saying you never do half-ass job in your life but earning a full pay?


Yea, Canada doesn't have enough money for doctors, but why do we give tax write-offs to sport teams?

Someone care to enlighten me?

Because in short sight version, paying doctors is an expense. Having a sport teams in the city generates more revenue in terms of hotel, parking, restaurant, bars, etc. That is if you give up 1 million and you can earn 2 millions back, net profit = $1 million (I said if). If you give up nothing and no sport team, net profit = $0. THink about how much tax break GM got for having its factory in Oshawa.

[aquariaguy]

I never said doctors want to be capped. I'm asking WHY they are capped. Its not fair, they shouldn't be. This is why their is a shortage, because a lot of them won't take new patients cuz whats the point? If i'm a doctor, i wouldn't take on more people since i'm not making any more money..why bother?

And i don't know what you mean by accusing me of saying doctors won't whine? I'm saying they DO whine, and they should be, since they are being CAPPED. They are more useful to us than sport players are, in my opinion. Yea, they bring in revenue and stuff but thats all. They can't do ****. I'm talking about the sport players whining. Why whine if you're making 10 million a year? Even if you only play for 5 years, thats quite a bit.

Did I say its bad having a sports team? I said, why do the players have to whine when their making waaay more money than doctors will ever make. I think you have to read the post again.

GM is different. They will be providing jobs LONG TERM. So people will get employed, and people will make money.

I don't think you understand what i'm trying to say. I'm trying to say that sport players whine so much about being capped, but in one year, they make more than anyone will ever make sometimes. It's not our fault they choose to flunk school and only play hockey for a life or basketball etc...

I think you should read the post again, because it seems like you're accusing me of stuff i didn't say?

First, they did not want to be capped and nobody does.

Second, a lot of doctors were burned out when there was no cap. They worked much longer hours because of the extra money. They didn't take holiday. Although we need them, it is not healthy for them either (IMO). My family doctor used to stay 12 hours per day in his office 6.5 days per week. I don't know when he could see his family or his own kids. Now, he works 12 hours per day and 4.5 days per week. I think it is more reasonable.

The problem is NOT how long our existing doctors work because most of them do work longer than a normal joe. The problem is we do not have enough doctors.

Are you saying the doctors did not whine? Are you saying you will not whine if your salary is capped? Are you saying you never do half-ass job in your life but earning a full pay?

Because in short sight version, paying doctors is an expense. Having a sport teams in the city generates more revenue in terms of hotel, parking, restaurant, bars, etc. That is if you give up 1 million and you can earn 2 millions back, net profit = $1 million (I said if). If you give up nothing and no sport team, net profit = $0. THink about how much tax break GM got for having its factory in Oshawa.

[gman]

First, I am not accusing you anything.

I never said doctors want to be capped. I'm asking WHY they are capped. Its not fair, they shouldn't be. This is why their is a shortage, because a lot of them won't take new patients cuz whats the point? If i'm a doctor, i wouldn't take on more people since i'm not making any more money..why bother?


IMO, they have enough work load to cover in order to give reasonable service to the existing patients. Again, IMO, if they get more patients, in order to earn more than exsiting cap, that means they will spend less time per patient OR to increase their working hours which I think it is already too much.

This is not the solution of the problem. The solution should be:

1. people does not get sick as often.
2. more doctors.

By the way, doctor is not capped the same way as the proposed sport player cap. Doctor is capped by a fixed amount and each patient visit is a fixed amount of money. In order to go over the cap amount (if the cap is not there), they will need to have more patient visit. i.e. work more. They can't ask to increase the amount of money they should get per patient visit.

The player cap is not capped the same way. They can't say I want to earn more money this year, I want to play 5 games more.

If you think the doctors can take 5% more patient visits, just raise the cap 5% instead of get rid of the cap.


And i don't know what you mean by accusing me of saying doctors won't whine? I'm saying they DO whine, and they should be, since they are being CAPPED. They are more useful to us than sport players are, in my opinion. Yea, they bring in revenue and stuff but thats all. They can't do ****. I'm talking about the sport players whining. Why whine if you're making 10 million a year? Even if you only play for 5 years, thats quite a bit.


The boss of the doctors is government. We pay their salary because we pay tax.
The boss of sport players are team owners. They deal with them, not the public. It is up to the owner and the players to decide what is the best.
Yes, sport players earns a lot relatively to most people. Doctors also earns a lot relatively to some people. I also earn a lot relatively to some people. You can always ask "why whine if you making 10 million? 1 million? $500,000? $250,000? $100,000?" If I think I should earn 1 million and you only give me half, I will whine. Will you?


Did I say its bad having a sports team? I said, why do the players have to whine when their making waaay more money than doctors will ever make. I think you have to read the post again.


Can I change that to "why do the doctors have to whine when they are making way more money than McDonalds worker will ever make (cap or not)"? If you can answer this question, you can answer your own question.


GM is different. They will be providing jobs LONG TERM. So people will get employed, and people will make money.


Same as a sport team. They will provide job LONG TERM directly and indirectly. So people will get employed and people will make money. By the way, GM's tax break is also LONG TERM. Do you wonder why the residential property tax rate is so high in Oshawa?


I don't think you understand what i'm trying to say. I'm trying to say that sport players whine so much about being capped, but in one year, they make more than anyone will ever make sometimes. It's not our fault they choose to flunk school and only play hockey for a life or basketball etc...

I think you should read the post again, because it seems like you're accusing me of stuff i didn't say?

Why does it matter to you about their salary being capped? You don't pay them, right? I say they whine as much as any people. You think they should not whine because they earn too much. I think doctor should not whine because they also earn a lot. Some people thinks I should not whine because I earn more than they are.

[Kai Viti]

You don't need to lower med school requirements, there are many candidates that more than qualify under current requirements but aren't accepted due to lack of space. A guy with a 3.7 GPA gets accepted because he was a student council president over a guy with a 3.8 GPA who wasn't into organized extra-curricular's doesn’t make a better doctor. If anything, opening up med school spots will lead to inferior dentists!

That's very true that a lot of people who don't get admitted into med school, choose dentistry. However, skill-set is a little different; a little more manual dexterity required. Guess they can always apply to med school after their DDS (or BDS, depending on which country you graduate from) and eventually become top neurosurgeons.

In a lot of countries, dentists make more than doctors, but also have highest suicide rate of various professions.

How does one get govt funding to do a study into this? ;) My thesis is that gases in patients with halitosis drive dentists to suicide!

[charger]

Walk in clinics are the reason doctors are capped. My dad is a doctor, and when he ran his practice, on a day of family practice he could see about 50 people.


On a walk in day he would see 200+ people.

The medical system charges the same for a visit, whtehr that visit is 45 minutes or 30 seconds. And with the walk in it could be 30 seconds.

They have a graduated system. I don't know exactly what the cap is but I think after you see 50 people the price goes down to $20 per patient until it reaches 75 and then it goes down to $10 per patient up to 100. Then every patient from then on is not billed at all.

The thing about running a doctors office, about half of the income goes to over head, (staffing, office rental, other expenses.)

As for the hockey players, everyone involved are being greedy bastards. I have no sympathy for the player. If they fired them all and replaced them I would not shed a tear.

[Master]

First, they did not want to be capped and nobody does.

Second, a lot of doctors were burned out when there was no cap. They worked much longer hours because of the extra money. They didn't take holiday. Although we need them, it is not healthy for them either (IMO). My family doctor used to stay 12 hours per day in his office 6.5 days per week. I don't know when he could see his family or his own kids. Now, he works 12 hours per day and 4.5 days per week. I think it is more reasonable.

The problem is NOT how long our existing doctors work because most of them do work longer than a normal joe. The problem is we do not have enough doctors.



Most MDs are inherently hard-workers. That's how they did well in school and finally went to meds school in the first place. The amount of time spent in schools and training result in trememdous amount of debt. MDs start off with careers later than most profession and therefore need to work hard in order to be survive.

I strongly believe that the govt needs to encourage more students getting into family medicine more.

[blue_xii]

I hope you are not implying that students choose dentistry because they can't get into med school.



I'm implying some people chose dentistry as a backup, not all. I hope yuo're not implying that becasue there are X spots for doctors in medical schools that means there are X qualified candidates and allowing more will significantly decrease quality. I'm saying there are a lot of qualified people that dont get accepted that would make very good doctors.

[Master]

I'm implying some people chose dentistry as a backup, not all. I hope yuo're not implying that becasue there are X spots for doctors in medical schools that means there are X qualified candidates and allowing more will significantly decrease quality. I'm saying there are a lot of qualified people that dont get accepted that would make very good doctors.

I believe most dentists chose their profession because they like dentistry. And only a very small minority goes into dentistry because they can't get into meds school. Therefore, increasing meds school entrance would not result in an increase of less deserved dentistry students.

I'm not just implying but stressing that if you significantly increase med school entrance, you will decrease quality of doctors produced. I have already given an example earlier that as an interviewer, I will have to allow students with lesser caliber to enter med school if there are more spots available. In fact, I will HAVE to allow 100% entrance if 100 students apply to 100 spots in the class. You don't think that's going to reduce quality of students?

There are more to just get more med student. There are not enough clinical professors to teach a significant increase in students because the govt doesn't pay prof for teaching. There are not enough residency/internship training spots for them once they graduates because the govt doesn't want to pay their salary as residents/interns. There is no private funding in the system. The govt has to sponsor everything...and they are currently not doing that.

[HammerJoe]

I don't get it. Why do they cap doctors? First of all, we NEED them. Secondly, a lot of the highest paid doctors that are capped DON'T work during the summer months cuz they go away. Thus, they accept less patients, and have less hours because why work more when you will only get X amount of money.

Also, i don't understand how sport players whine/***** about being capped when they do half-ass job at A HOBBY. (ie. vince carter)

Yea, Canada doesn't have enough money for doctors, but why do we give tax write-offs to sport teams?

Someone care to enlighten me?


I am not familiar with the issue but I believe the reason there is a cap for doctors is because they are paid with TAXMONEY while hockey players not.

It makes a world of difference.

[gman]

Most MDs are inherently hard-workers. That's how they did well in school and finally went to meds school in the first place. The amount of time spent in schools and training result in trememdous amount of debt. MDs start off with careers later than most profession and therefore need to work hard in order to be survive.

I strongly believe that the govt needs to encourage more students getting into family medicine more.

Then, they can expand the cap to get them 5%, 10% or 20% more of workload. The last thing I want is to decrease the time my doctor wants to see me. After they implemented the cap, my family doctor spend more time per visit with me than before.

[webdoctors]

if I wanted to be a doctor I could be, a hockey player? nope, dont have the talent.

besides the demand/supply issue of hockey players vs. docs, its a free country, so any private job can't have caps, I'd be pissed if da gov capped my job too. Gov jobs tho are not private sector, public sector so gov has right to say what they wanna pay someone. If someone doesnt like it, they can work at another institution.

[Master]

Then, they can expand the cap to get them 5%, 10% or 20% more of workload. The last thing I want is to decrease the time my doctor wants to see me. After they implemented the cap, my family doctor spend more time per visit with me than before.

You are probably an outlier. The cap has made many doctors go on vacation when they cap so that they won't see patients at a discount. Then the patients will have to go to walk-in clinic or emergency room for treatment. The wait in emergency is 6-8 hours for stuffs that can be dealt with family doctor.

Find another doctor if your doctor is not spending enough time with you. Now, if we have a lot more family doctors in ontario, then switching doctor won't be a problem, will it?

I don't think the cap will result in longer consultation time. There isn't an incentive for family MDs to retain you as a patient. So what if you leave? Your MDs is seeing you for a mere $17 after the cap. My accountant charges me $150/hr. Why would a MD see you for $17X4 (15 minutes consultation) = $68/hr unless your MD is just in for a chat?

[Master]

if I wanted to be a doctor I could be, a hockey player? nope, dont have the talent.

besides the demand/supply issue of hockey players vs. docs, its a free country, so any private job can't have caps, I'd be pissed if da gov capped my job too. Gov jobs tho are not private sector, public sector so gov has right to say what they wanna pay someone. If someone doesnt like it, they can work at another institution.

You are absolutely right. Doctors get paid by the govt (public sector) so govt can implement salary cap. Only problem is that doctors can't go private in Canada if they don't like their employer (govt). So, the end result is, doctors leaving Canada for the USA. The most brilliant ones leave first because USA hospital wants competitiveness and the best for themselves. I guess we can keep enrolling students to fill the positions.

[EchoAngel911]

all i would like to say is that farmers should be the highest paid people.

with no farmers, there would be no food. If no food, then no people.

[espeed]

Bottom line is that specialists get paid way too much compared to family docs.

Family doc: $25 per visit, spends 15-30 minutes, getting into social history, family history, physical exam etc etc.

Specialist: >$50 per consultation, spends like 5 minutes, then books for surgery and gets another >$600.

Radiologist: $100+ per film read, takes like less than 5 minutes?

Plastic surgeon: 1.5-2 hours for breast reduction, gets his residents to do all the **** work, pops in for 1 minute just so he can say he was there, and then walks out again, and he gets his pay of $6000.

No wonder family docs are not happy. They work 12 hours a day, 6 days a week most of them, and specialists can afford to work 8 hours a day, 5 days a week and still get paid a heck of a lot more than family docs.

Wouldn't you be?

[Master]

I agree. The govt should encourage more family physicians by giving more incentives to them. The specialists are doing fine already.

The cap only applies to a small group of specialists...and it really doesn't make a lot of difference to family doctors.

What we need is more family doctors!

[gman]

You are probably an outlier. The cap has made many doctors go on vacation when they cap so that they won't see patients at a discount. Then the patients will have to go to walk-in clinic or emergency room for treatment. The wait in emergency is 6-8 hours for stuffs that can be dealt with family doctor.

I don't see how you have disagree with me although it seems you did. As I said, if you think the family doctor can deal with more patients without decreasing the service of the existing volumes, raise the cap.

Some MD may go for vacation a lot but his office can still be opened with another MD serving you. They still need to pay rent, hydro and other costs.


Find another doctor if your doctor is not spending enough time with you. Now, if we have a lot more family doctors in ontario, then switching doctor won't be a problem, will it?


I asked for more doctor instead of removing the cap. Not sure what you disagreed with me here.


I don't think the cap will result in longer consultation time. There isn't an incentive for family MDs to retain you as a patient. So what if you leave? Your MDs is seeing you for a mere $17 after the cap. My accountant charges me $150/hr. Why would a MD see you for $17X4 (15 minutes consultation) = $68/hr unless your MD is just in for a chat?

Of course, it does. At least, mine does. It used to 5 minutes per visit. Now, 15 minutes per visit. And, it is not just for me. The waiting time is as long as before although there are less people waiting now.

[Master]

I don't see how you have disagree with me although it seems you did. As I said, if you think the family doctor can deal with more patients without decreasing the service of the existing volumes, raise the cap.

Some MD may go for vacation a lot but his office can still be opened with another MD serving you. They still need to pay rent, hydro and other costs.

I asked for more doctor instead of removing the cap. Not sure what you disagreed with me here.

Of course, it does. At least, mine does. It used to 5 minutes per visit. Now, 15 minutes per visit. And, it is not just for me. The waiting time is as long as before although there are less people waiting now.

I don't think we disagree with each other very much except for claims that MDs spends more time with patients now because of the cap. I understand yours do and therefore your case is an outlier.

When most MDs go on vacation, they have a hard time finding a temporary replacement simply because there aren't enough family MDs around. Again, I find your case different as well.

[bdckr]

A salary cap doesn't make any sense for doctors.

Keep in mind that a doctor's "salary" isn't a salary the way most people think of it. There's no hourly wage. No benefits. The total money collected is a result of being paid a "fee for service". So each encounter is worth a certain amount of money. The "salary" is the total amount billed to the government for the total number of services. Out of this "salary" comes all expenses: rent, utilities, staff salaries, etc. It's more like doing (more expensive and more skilled) piece work (e.g. envelope stuffing) instead of earning a salary.

I'd be really surprised if someone noticed a difference in service as a result of a salary. I can't find a reference anywhere, but I'm pretty sure that salary caps were first introduced about ten years ago during Bob Rae's provincial government. So unless you're comparing service now to service from the same doctor more than 10 years ago...

No doctor is getting paid more to spend 15 minutes instead of 5 minutes with you. With a few exceptions, visits are paid the same no matter how long it lasts.

So if we look at only the doctors that are affected by the cap (i.e. they would otherwise be seeing more patients, delivering more services, and billing more money) and their options:
1) Work at a discounted rate (after the 1st threshold) or free (after they've reached the cap)
2) Work at a slower rate (taking more time per patient/service) to earn up to the cap (but not over)
3) Work at the same rate, but take more time off/vacation so you don't go over the cap (and save money on utilities and staff salaries even if they don't get a locum/replacement)

I think you're kidding yourself if you think there's any motivation for someone to pick 1 or 2. Doctors working hard before the cap who didn't reach the cap won't have any reason to work harder or be more lazy after the cap.

Raising the cap x% makes no sense, the way that any cap makes no sense. A cap serves as a disincentive to work. A salary cap effectively sets a limit on the amount of work that someone is being paid to do. It is not an incentive to provide better service.

So why are doctor's billings capped?

1) Public relations
Make people believe that greedy doctors are being unscrupulous and overbilling the system. This is the same thing Bob Rae did with his Social Contract "Rae days (http://www.caut.ca/cuasa/salsethistory.html)". Public sector employees were required to take 5 unpaid days off per year. This only works if you think people (civil servants) were wasting time 5 days a year. And a doctor salary cap only works if the service (that's no longer being paid for) was not necessary, or not being done.

2) Cost containment
Setting a hard cap means you know that any one individual will not cost the government more than x dollars. A salary cap is a cost containment procedure for a government that doesn't have enough money. The NDP government under Bob Rae didn't have enough money. They wanted to spend less. So they paid for less service. And they got less service. It's not like you have a cheaper alternative to an ophthalmologist for doing your cataract surgery.

edit: Forgot to address the comment about getting a replacement MD for someone who has reached the cap: This assumes that there is
1) Someone available to do the work
2) He/she has not reached the cap
3) He/she will be busy enough to make it worth keeping the office open to pay for staff salaries and utilities (of course rent is a fixed expense) after splitting the billings.

So let's assume that the cap has helped contain costs by forcing an MD to take time off. Sure, you can save money if a replacement isn't needed. That means that people are happy to wait around until their regular MD comes back, not going to a walk-in clinic or seeing someone else. Voila, money saved. But that doesn't happen.

But if you're saying that hiring a replacement MD is needed, or maybe they go see someone else --- the service is still being delivered and being charged for. Replacement MDs don't bill the government any less. Patients get to see a stranger instead of their regular MD. So what's the advantage of a this?

[gman]

A salary cap doesn't make any sense for doctors.

Keep in mind that a doctor's "salary" isn't a salary the way most people think of it. There's no hourly wage. No benefits. The total money collected is a result of being paid a "fee for service". So each encounter is worth a certain amount of money. The "salary" is the total amount billed to the government for the total number of services. Out of this "salary" comes all expenses: rent, utilities, staff salaries, etc. It's more like doing (more expensive and more skilled) piece work (e.g. envelope stuffing) instead of earning a salary.


Cap makes no sense to any worker. Nobody who is receiving pay wants cap.


I'd be really surprised if someone noticed a difference in service as a result of a salary. I can't find a reference anywhere, but I'm pretty sure that salary caps were first introduced about ten years ago during Bob Rae's provincial government. So unless you're comparing service now to service from the same doctor more than 10 years ago...


Yes, I am comparing the same service from the same doctor since 89.
Back then, the waiting area was bigger than now and people needed to line up outside every time I was there. Patients were 'processed' per patient faster than now. Now, the office is re-decorated. The waiting area is smaller (~25% smaller). Less people waiting but longer time to 'process' one patient. Taking long time with one patient does not necessary mean work a lot more. The doctor can be less stressful. He does not need to rush as much. He could have a bit more time to read my file and write down notes, ask more questions, etc.


No doctor is getting paid more to spend 15 minutes instead of 5 minutes with you. With a few exceptions, visits are paid the same no matter how long it lasts.


I mentioned that.


So if we look at only the doctors that are affected by the cap (i.e. they would otherwise be seeing more patients, delivering more services, and billing more money) and their options:
1) Work at a discounted rate (after the 1st threshold) or free (after they've reached the cap)
2) Work at a slower rate (taking more time per patient/service) to earn up to the cap (but not over)
3) Work at the same rate, but take more time off/vacation so you don't go over the cap (and save money on utilities and staff salaries even if they don't get a locum/replacement)


My doctor goes for (2) because he is supposed to be there in his office hour. He just takes his time to 'process' a patient. He does more proper paper works instead of rush, rush and makes mistake.


I think you're kidding yourself if you think there's any motivation for someone to pick 1 or 2. Doctors working hard before the cap who didn't reach the cap won't have any reason to work harder or be more lazy after the cap.


For (2), the motivation is you can take it easy instead of rushing.


Raising the cap x% makes no sense, the way that any cap makes no sense. A cap serves as a disincentive to work. A salary cap effectively sets a limit on the amount of work that someone is being paid to do. It is not an incentive to provide better service.


If the cap is a hard to reach cap, it is the same as no cap. A cap is to limit some doctor doing crazy thing. If a doctor processing 200 patients per day, there is something wrong.


edit: Forgot to address the comment about getting a replacement MD for someone who has reached the cap: This assumes that there is
1) Someone available to do the work
2) He/she has not reached the cap
3) He/she will be busy enough to make it worth keeping the office open to pay for staff salaries and utilities (of course rent is a fixed expense) after splitting the billings.


It is not replacement MD. It is 2 or more MD in the same office. In other words, they share the office. They can do rotating vacation. They have access to the patient records.


So let's assume that the cap has helped contain costs by forcing an MD to take time off. Sure, you can save money if a replacement isn't needed. That means that people are happy to wait around until their regular MD comes back, not going to a walk-in clinic or seeing someone else. Voila, money saved. But that doesn't happen.

But if you're saying that hiring a replacement MD is needed, or maybe they go see someone else --- the service is still being delivered and being charged for. Replacement MDs don't bill the government any less. Patients get to see a stranger instead of their regular MD. So what's the advantage of a this?

I guess this is moot because I was not saying hiring replacement MD and I was not saying cutting cost. IMO, MD should go for vacation time to time. I saw doctor burned out. Their faces looked worse than the patient sometime.

[Roninvancouver]

the sooner we live in a truly free market where everyone can do what they want; the sooner we get to a non-capitalist utopia.

[findingnemoscar]

Why should NHL players or professional sports players be capped? I totally agree that they should not be capped. The blame for them making millions and millions of dollars lies squarely on us, the consumer. If you are so tired of them whining about being capped, then do something about your convictions. Stop watching NHL hockey whenever it comes back, stop going to games, stop buying NHL merchandise (especially video games), do a total boycott.

Sure you might be only one person, but hey, at least you can stand up at the end of the day and be glad that you didn't contribute to their overpaid salaries.

That's the irony of sports. You hear so many people calling into the FAN 590 whining about players and/or owners making too much money but as soon as the NHL gets back up and running, those same people will run out to a local sports bar, or try to get some leafs tickets... until this happens, i have no problems with the Leafs gouging their fanbase at the ticket office and so forth.

[Master]

Good point from bdckr. I don't like the cap either.


If the cap is a hard to reach cap, it is the same as no cap. A cap is to limit some doctor doing crazy thing. If a doctor processing 200 patients per day, there is something wrong.


I disagree with using fee cap to curb the amount of patient seen. Why not caping the number of patient seen instead? The whole reason for the cap is the govt doesn't want to pay for you to see a physician. You MD is still allowed to see you at a discount. Heck, it will be even better if the govt can make MD see you and 200 others per day for free!

The authority that deals with problems with MDs doing a bad job (perhaps seeing too many patients and becomes negligent) is the medical-legal system.

[rookie]

What about actor's / actresses? They should be capped.

[findingnemoscar]

What about actor's / actresses? They should be capped.
Again, on what basis? Same with sports, if you have a problem with John Doe making 20mil/ flick, stop watching his movies and eventually, the producers will stop paying him the big bucks since he can't earn them a return on their investement.

[bdckr]

Cap makes no sense to any worker. Nobody who is receiving pay wants cap.



Yes, I am comparing the same service from the same doctor since 89.
Back then, the waiting area was bigger than now and people needed to line up outside every time I was there. Patients were 'processed' per patient faster than now. Now, the office is re-decorated. The waiting area is smaller (~25% smaller). Less people waiting but longer time to 'process' one patient. Taking long time with one patient does not necessary mean work a lot more. The doctor can be less stressful. He does not need to rush as much. He could have a bit more time to read my file and write down notes, ask more questions, etc.



I mentioned that.



My doctor goes for (2) because he is supposed to be there in his office hour. He just takes his time to 'process' a patient. He does more proper paper works instead of rush, rush and makes mistake.



For (2), the motivation is you can take it easy instead of rushing.



If the cap is a hard to reach cap, it is the same as no cap. A cap is to limit some doctor doing crazy thing. If a doctor processing 200 patients per day, there is something wrong.



It is not replacement MD. It is 2 or more MD in the same office. In other words, they share the office. They can do rotating vacation. They have access to the patient records.



I guess this is moot because I was not saying hiring replacement MD and I was not saying cutting cost. IMO, MD should go for vacation time to time. I saw doctor burned out. Their faces looked worse than the patient sometime.So you're saying that a salary cap is useful because it encourages an MD to take a vacation or take it easy? That still doesn't make sense.

A lot of my previous post was about why the salary cap was introduced (to answer the original question).

The rest of it is an explanation why a salary cap does not encourage a doctor to take more time with each person.

Doctors work on a fee for service system. You do a particular service, you get paid a particular fee. With few exceptions, it doesn't matter how long you take: you do the service, you get the fee. Again, very much like piece work.

So look at the example of stuffing envelopes: you stuff an envelope, you get paid a certain amount. Doesn't matter how long it takes you to stuff it, you get paid the same amount. What happens if you limit the total amount that the envelope stuffer can make? Do you really think that the limit will motivate the stuffer to take more time per envelope? Or do you think he/she will try to work at the same rate and stop when he/she makes the maximum?

Let's not be disingenuous, here. Someone who isn't close to the salary cap is not affected by it. We're only talking about the people who do enough to bill that much.

Unless your doctor was billing close to the cap, the existence of the cap would not have made a difference. And if he/she was/is billing close to the cap, I can assure you that the cap would only be a motivation to take unpaid time off. If your doctor were getting paid the same maximum amount, do you think he/she would prefer to:
1) do the work slower than before and take more time to get paid that amount, or
2) do the work at the same speed as before and take more time off?

In other words, the cap would not influence your doctor to take more time with you.

A salary cap for doctors makes no sense except for the PR and potential cost containment.

It is not an incentive to take more time and do a better job.

It is a disincentive to work.

If you want to encourage doctors to take a vacation: give them paid vacation time.

With the exception of Bob Rae's Social Contract, nowhere else will you find people trying to justify something so illogical:
You pay at the same rate, but just set a maximum amount that someone can earn. If they weren't reaching that maximum, well, it really makes no difference, does it? And if they were reaching that maximum, then you're forcing someone to take unpaid time off. And you're trying to say that this is a good way to encourage taking vacation? In the real world, that's called a temporary layoff.

Whether your doctor chooses to rush or do a good job has absolutely nothing to do with a salary cap. It has to do with wanting to do a good job.

Remember, people are motivated by more than just money. Fine, your doctor takes more time with you than in 1989. Nothing to do with a salary cap. Why don't you ask him/her why?

[d_jedi]

You are absolutely right. Doctors get paid by the govt (public sector) so govt can implement salary cap. Only problem is that doctors can't go private in Canada if they don't like their employer (govt). So, the end result is, doctors leaving Canada for the USA. The most brilliant ones leave first because USA hospital wants competitiveness and the best for themselves. I guess we can keep enrolling students to fill the positions.

That's incorrect. They can go private.. but if they do, they can't charge the government for any public sector work.

[gman]

That's incorrect. They can go private.. but if they do, they can't charge the government for any public sector work.

I don't think they are allowed to do that. This is the 2-tier system.

[Master]

That's incorrect. They can go private.. but if they do, they can't charge the government for any public sector work.

We will have private health care system then! Most Canadians are afraid of that.

The govt doesn't allow doctors to go private...So there you go!

[bdckr]

That's incorrect. They can go private.. but if they do, they can't charge the government for any public sector work.
I don't think they are allowed to do that. This is the 2-tier system.
Here's (http://www.cmaj.ca/cgi/reprint/164/6/825) an article (pdf)that explains it.

d_jedi is right that you can opt out of the public plan and bill people directly. He's also right that you cannot bill the government for the entire duration that you choose to bill privately.

It's not a two-tier system because a doctor in Ontario can't charge more than the regulated fees set out by the government. So whether you bill the government or bill the patient directly, you can only bill what is laid out in the schedule of fees. Extra-billing is prohibited. So even if your doctor were billing you directly, it would be no more than what he would get from the government, and you would be able to get the money back from the government.

That's why there is no incentive for a doctor in Ontario to opt out. And even if he/she did, it would all be at the same price.

Edit: Some of the other provinces (the table in the article summarizes it) do allow for opted out physicians to bill more.

[d_jedi]

We will have private health care system then! Most Canadians are afraid of that.

The govt doesn't allow doctors to go private...So there you go!

Yes, they do. I'm sure there are better sources for this, but this is the best I can find with a quick google search:

Or rather, it is to prohibit the mixing of private and public funds. Contrary to popular belief, the Canada Health Act does not prevent doctors from charging patients out of pocket, or patients from paying them. But to do so, both parties must "opt out" of medicare altogether: They cannot also claim reimbursement.

The principle -- either you're in or you're out -- is a sound one. If providers are allowed to "extra-bill" for services provided under medicare, the effect is to give those who can pay more first call on public dollars.