Ontario docs are leaving – patients have trouble finding good doctors

{December 7, 2012}   NOT ALL DOCS ARE EQUAL



A peculiarity of how physicians are paid

Only fee-for-service MDs, alone among professionals, get paid the same for a service regardless of how experienced they are
Written by Murray Waldman on November 16, 2012 for The Medical Post

In the ongoing debate about physician compensation, one unusual facet of how fee-for-service physicians are compensated is never debated: That is, every physician performing a certain service is paid exactly the same amount.

This is absolutely unique among professions.

If you want your house designed by Frank Gehry you’d expect to pay more than if it was done by a recently graduated architect. The same is true for lawyers; no one expects Eddie Greenspan to take a murder case for the same fees that a junior in his firm would charge.

However, if a professor of neurosurgery removes a meningioma in the finest teaching hospital in the province, he receives exactly the same compensation as a newly certified neurosurgeon working in a community hospital.

If a professor of neurosurgery removes a meningioma in the finest teaching hospital, he receives the same compensation as a newly certified neurosurgeon in a community hospital.In fact, the only other “profession” that does not factor experience and excellence into their compensation schedule in the ancient and honourable order of garage mechanics, who calculate their pricing on a totally imaginary system based on anticipated hours that a certain job would take.

For example, the dealership bills its mechanics at $75 an hour, and the manual says a brake job on a 2010 Jetta takes three hours, so the labour costs would be 3 x 75 = $225. In truth, a good mechanic can put in between 15 and 30 hours of work— according to the manual—a day.

Aside from that one would be hard pressed to find any profession, especially one requiring a university education, to have this type of compensation system.

This system does, however, have some profound consequences—the chief one being that as everyone is paid the same amount, it is anticipated that everyone will achieve the same results.

If our newly minted neurosurgeon is getting paid as much as the professor, then his results should be as good and that is in fact what is expected.

The “defence of stupidity” does not fly in cases of medical jurisprudence. (What I mean by the “defence of stupidity” can be seen in more mundane endeavours where someone says, “Well, of course, I ruined the cake, everyone knows I’m not the brightest bulb on the tree.”)

However, in medicine we are all held to what is an almost impossibly high standard. Since we are paid as well as the finest practitioners, we are expected to perform just as well.

The fact that there are remarkably few major medical disasters a year and our malpractice premiums are a tiny percentage of what our American colleagues pay is a tribute to the high quality of our medical education and the checks and audits that our hospitals and colleges perform.

The real but unrecognized factor responsible for the high quality of medical care in Canada is that little quirk in our compensation package.

Murray Waldman is a hospitalist at St. John’s Rehabilitation Hospital in Toronto.




Patients should know that in general, the best docs want to work in university hospitals in major world cities. These docs have the opportunity to see more rare cases and do more research bringing in million dollar grants. As a patient, although you’re the subject for the next research paper,  you will get the best treatment available. If you don’t mind foregoing the TLC and friendliness of the small community hospital, your chances of “survival” are better in the research-oriented city institutes. As posted before, I don’t expect a doctor to love or like me, but I would want him to get my diagnosis and treatment right, and not just call my symptoms “stress”.




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