Canada Has More Doctors, Making More Money Than Ever

Doctors debate physician-assisted suicide

I dont believe Canada has a problem with the number of physicians, he said. I think we have a substantial problem with the types and, furthermore, the distribution of doctors. Weve got a situation now where there isnt always a good alignment between the training programs [medical schools] and what the market actually needs, he said. I do not believe Canada suffers from an insufficient number of physicians. Changes in pay Doctors earned more last year than ever before. The data show the average physician was paid $328,000 for clinical services last year, from a high of $376,000 in Ontario to a low of $258,000 in Nova Scotia. (Most doctors must pay their overhead including office space and staff wages out of their income.) Across the country, average income was 5-per-cent higher than in the previous year. Increasingly, though, doctors are earning their pay in ways other than the traditional fee-for-service model, in which a doctor sees a patient and bills for his or her time and expertise. So-called alternative-payment methods have skyrocketed in recent years, and last year accounted for 28.7 per cent of the $22-billion provincial and territorial governments paid out to doctors. A decade ago, alternative payments made up just 11 per cent of physician income. Its a big, big shift, and I think for the better, said Scott Wooder, president of the Ontario Medical Association, which negotiates physicians pay with the province. These alternative payments include straight salaries, compensation in which physicians are paid a fixed sum per patient on their roster, and hourly or daily wages. Sometimes remuneration is a blend of fee-for-service and an alternative payment. Ontario doctors have been embracing alternative payments in greater numbers since the 1990s. Almost $3.4-billion, or roughly 35 per cent, of all physician income in Ontario last year was alternative payments. Most were in the form of what is called capitation compensation based on the number of patients on their roster, regardless of how often a patient seeks medical attention. Has service changed?


Canadian Armed Forces Medical Officers Recognized by the College of Family Physicians of Canada

Photograph by: Tijana Martin Tijana Martin , Calgary Herald Thirty years ago, Dr. Srini Chary was at his cancer-stricken wifeas bedside when she died in their home, three years after her diagnosis. Then a budding surgeon, Chary says thatas when he came to understand the value of care at the end of a patientas life, and soon switched his studies to train as a palliative care specialist. On Monday, as Canadaas doctors began a public debate over physician-assisted suicide, the Calgary MD said his experience caring for his wife a and many patients since a means he simply canat consider the thought of helping a suffering patient die. aIf care and well-being is what I train for, Iad like to focus on care and well-being,a Chary said, in an interview. aItas not even a suicide in my mind. Iam killing.a The polarizing issue took centre stage at the Canadian Medical Associationas annual general council meeting, which opened Monday in Calgary, as delegates heard from an expert panel on end-of-life-care. Canada needs better programs that allow patients to die comfortably at home and more palliative care training for young physicians, said panellist Dr. Eric Wasylenko, a Calgary family physician specializing in palliative care. Proper end-of-life care strives to help patients live as well as they can before they die, he said. aMy personal view is it is not within the role of the physician or the practice of medicine to actually deliberately cause someoneas death, even if theyave asked for it,a said Wasylenko, in an interview following the panel discussion. aThe role of physicians and medical care is to support people in their life until their natural death, not to kill them artificially or in advance of their natural death.a The debate has taken on growing urgency in Canada after Quebec introduced contentious right-to-die legislation this year.

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“The health of our men and women in uniform is a top priority for this government and the education and training of our medical officers is pivotal to the ability of Canadian Forces Health Services to deliver healthcare,” said Minister MacKay.”These medical officers represent the finest doctors in Canada, are testament to the high level of care our Canadian Armed Forces members receive at home and abroad and, on behalf of the Government of Canada, I wish to congratulate them.” Captain Scott MacLean, 1 Field Ambulance, Edmonton, is the recipient of the 2012 Murray Stalker award.This award, named in honour of the late Dr. Murray Stalker, first College of Family Physicians of Canada President (1954-1955), recognizes and promotes scholarly activities of family medicine residents.It is awarded to an outstanding family medicine resident who is recognized as a potential future leader in the discipline. Captain MacLean and Captain Jason Lorette, 26 Canadian Forces Health Services Centre, Greenwood, are both the recipients of the Family Medicine Resident Leadership Awards.These awards recognize the leadership abilities of outstanding senior family medicine residents from each of the 17 Canadian family medicine residency programs. Captain Melissa Welsh, 24 Canadian Forces Health Services Centre, Trenton, is the 2012 recipient of the Bob Robertson Award.This award, dedicated to the memory of the late Dr. Bob Robertson, former College of Family Physicians of Canada President (1980-1981), recognizes the individual who achieved the highest standing among family medicine residents in the organization”s certification examination in family medicine. Captain Shawn Benninger is the 2012 recipient of the Award of Excellence.The Award of Excellence recognizes the College of Family Physicians of Canada member who, in the past 12-24 months, has made an outstanding contribution in a specific area pertaining to one or more of the following areas:patient care; community service; hospital or health care institutions; college activities (national or chapter); or teaching, research or other elements of the academic discipline of family medicine.Capt. Benninger is currently serving on board Her Majesty”s Canadian Ship Protecteur. “We are extremely proud of the accomplishments of these medical officers. They will serve their nation and the Canadian Armed Forces well as they progress through their military medical careers,” said Brig.-Gen. Bernier.”The standard of healthcare Canada is able to provide to its men and women in uniform will be enhanced by these talented physicians.They have set the bar high for those doctors who wish to practice medicine in uniform.” Canadian Forces Health Services, with the support of their health care partners, provides full-spectrum care and the highest standard of health care possible to Canada”s military personnel, wherever and whenever they serve. “The morale and well-being of our soldiers, sailors, airmen, and airwomen, is the backbone of operational effectiveness,” said Chief Warrant Officer Pierre Marchand, Canadian Forces Health Services Chief Warrant Officer. “The medical professionals and support staff who make up the Canadian Forces Health Services Branch are a critical aspect of the morale and welfare of our troops serving across the nation and abroad during operations, exercises, and garrison duties.” Notes to editor/news director:For more information on Canadian Forces Health Services, please visit . Health


Why We Have Too Many Medical Specialists: Our System’s An Uncoordinated Mess

Are Canadian medical schools graduating the doctors of yesterday? Study finds 1 in 6 specialists can’t find work

And this is before considering Canadians who have gone to medical schools abroad and then returned to Canada hoping to practice here, or medical graduates from other countries. The numbers of both entering practice here have also increased dramatically over the past decade, and there is considerable pressure, particularly from Canadians who have gone abroad for training (currently about 3,500, with more joining every year) and organizations representing them, to increase numbers even further. It is not that the one in six implies that Canada now has an overall surplus of specialists, any more than the widespread claims of shortage in the mid-1990s meant, then, that we had an overall shortage of physicians. We had then, and we have now, an inability or unwillingness as a country to develop plans and policies designed to train and deploy physicians in a sensible manner. The reports author is correct in noting that there is no quick fix here. The Royal Colleges plan to convene a meeting early next year to discuss a nationally co-ordinated approach to health system work force planning may be a useful start. It is difficult to imagine the recommendations that might emerge from such a meeting being worse than the current uncoordinated mess. At present, policy decisions, or often the lack thereof, are failing to meet the needs of new trainees or of patients. For example, there are no national (and few provincial) mechanisms in place to channel new graduates into the specialties where they are likely to be most needed rather than into the specialties most needed by teaching hospitals or most favoured by students. And despite the fact that we live in a hyper-active era of tweets and blogs in which the new generation seems to be constantly connected, there is no structured electronic meeting place for job hunters and job seekers. New graduates are somehow failing to figure out where the jobs are (and there are, in fact, plenty of communities desperately seeking specialists). In some cases, at least, the new specialists are simply the victims of the completely predictable fallout from that earlier medical school expansion. When those ministers of health agreed to fund an approximate doubling of medical school places, what did they think would happen when those students started graduating? Was there a plan in place to ensure that the complementary resources that are required for their practices would also be funded and in place?

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Frechette suggested, however, that a national health systems workforce planning body would be an important start. Australia, Britain and the U.S. all have such an entity. The report pointed to a number of factors that have contributed to the oversupply of specialists. Poor stock market returns in recent years have meant that some older doctors most of whom must finance their own pension plans have delayed retirement. And there has been a realignment or rationalization of tasks in health care, with nurses and physician assistants taking on responsibilities that were once left to doctors, freeing them up to do some tasks that used to fall to specialists. That effect, which Lewis called sensible, will only accelerate as less invasive treatments are brought on line. For instance, angioplasty opening blocked cardiac arteries with balloons and stents has replaced many open heart surgeries to bypass blocked arteries. Lewis suggested the cycle of training specialists which typically takes about nine years is out of sync with the cycle of assessing future medical system requirements. Forecasting health human resource needs more than three or four or five years out is a fools game, because medical science changes, health needs can change, technology can change and so on. But Frechette said there are some low hanging fruit problems that should be relatively easy to address. For instance, her study noted there are jobs going for the asking. And yet while it seems inconceivable in the era of Craigslist and LinkedIn, doctors are having a hard time finding these help wanted ads. Our research did discover that there are a lot of people who cant find jobs, including orthopedic surgeons who would gladly go to where the jobs are, but they dont know where they are, she said.