Connect with us

Anglais

Ontario seeks to cut pay for family doctors, but MDs dispute claim they make too much for too little work

admin

Published

on


The provincial government wants to claw back how much it pays thousands of Ontario family doctors and force them to put in longer hours, arguing they are averaging $400,000-plus annually for what amounts to part-time work.

Doctors are up in arms over the proposals and charge that the government has got it wrong when it comes to their workload. They warn if they are hit with another pay cut — on top of one imposed four years ago as well as an ongoing compensation freeze — patients will pay the price because family physicians will be driven from the field.

Dr. Tara Kiran, vice chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto, said she worries deep cuts being proposed by the province will make if difficult for patients to find family doctors.
Dr. Tara Kiran, vice chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto, said she worries deep cuts being proposed by the province will make if difficult for patients to find family doctors.  (Rene Johnston / Toronto Star)

“I’m worried that the deep cuts being proposed will make it near impossible for people to find a family doctor, and that will have repercussions for the whole health system,” family doctor Tara Kiran, vice chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto, wrote in an email.

The two sides have been arguing their cases before a board of arbitration, which completed seven months of hearings Sunday. The Ontario Medical Association contends the government has built its case upon faulty findings by the provincial auditor.

The arbitration board is tasked with resolving an almost-five-year-old contract dispute between the government and the OMA, which represents the province’s 31,000 practising physicians.

Read more:

Province eyeing creation of ‘super health agency,’ sources say

Schism within government on how to deal with the Ontario Medical Association puts premier and health minister at odds

MDs question motives, results of vote by specialists trying to break away from OMA

The government’s proposed changes to family medicine (also known as primary care) are among the most controversial issues the board has been asked to weigh in on as part of its deliberations over the size of the physician services budget. Ontario now spends more than $12 billion — or 10 per cent of the entire provincial budget — on doctors.

The three-member board is expected to come down with binding decisions this spring, ending phase 1 of the arbitration process.

Phase 2, expected to be even more contentious, will address how to divvy up the pot of money among some 35 specialty groups.

All of this is happening at the same time the province is undertaking a massive restructuring of the entire health system. Next week, the government is expected to announce the creation of a new “super health agency” to replace more than 20 smaller agencies. Sources say the super agency will oversee primary care.

The 5,300-plus family doctors facing the prospect of pay cuts comprise about half of Ontario’s roughly 11,000 practising primary care doctors. They work in more than 800 group practices across the province, known as “family health organizations,” or FHOs.

FHOs were developed in 2007 to improve primary care — for example, by increasing access through after-hours availability — largely through changing financial incentives for doctors.

Twelve years later, the government argues it has paid for improvements in care, which have not materialized and that the price is too high to expand this model further.

In the past, family doctors were paid mostly through fee-for-service, which saw them reimbursed for every service rendered. There is an inherent incentive in the fee-for-service model to have high-volume practices; the more services provided, the more money made.

But under FHOs, doctors derive the bulk of their income through “capitation,” a form of compensation that reimburses them a set amount for each patient signed up with them — no matter how many times a patient is seen or even if a patient is not seen. The amount varies according to a patient’s age and health.

Three-person board of arbitration tasked with resolving OMA contract dispute: Ron Pink, OMA nominee, left, Bill Kaplan, board chair, centre, and Kevin Smith, health ministry nominee.
Three-person board of arbitration tasked with resolving OMA contract dispute: Ron Pink, OMA nominee, left, Bill Kaplan, board chair, centre, and Kevin Smith, health ministry nominee.  (Rene Johnston/Toronto Star)

In 2016/17, the average FHO doctor (with 1,300 patients) made $406,390, according to the government’s written submission to the arbitration panel. That compares to $214,015 for a family doctor paid fee-for-service.

(Physician compensation is not the same as income. From their compensation, FHO doctors have to pay for overhead costs such as staff salaries and rent. Arrangements vary from practice to practice, with the health ministry, hospitals and local communities also pitching in for non-physician expenses.)

Some fee-for-service family doctors and specialists have even taken to social media to argue that their FHO peers are paid too much.

The government’s submission states that FHOs have become so popular, the number of doctors working in them has surged by 154 per cent since 2008/09. To contain costs, the ministry says it was forced to limit their growth starting in 2012.

The government is now seeking to cut the pay of FHO doctors by an average of 9 per cent each, or about $33,600. That would be on top of a cut of 2.65 per cent the province imposed in 2015, as well as a compensation freeze in place since 2012.

In making its case, the government relies heavily on the 2016 provincial auditor’s report, which states that FHOs have not proven their worth. FHO doctors were paid $522 million more in 2014/15 than they would have received if they were paid fee-for-service, according to the report.

That was, in part, because they were paid for 1.8 million patients rostered with them, even though they did not actually see those patients, the auditor wrote.

“The $522 million is significant, as it indicates that the physicians were not providing core primary care services as often as they should be (or expected to be) and/or that base capitation payments are excessive,” the report reads.

The auditor found that an average FHO doctor works only 3.4 days per week.

The province made significant investments in FHOs, but “most objectives (were) not met,” wrote the auditor, charging that they failed to increase access to care, quality and continuity of care and cost effectiveness.

FHOs have not delivered on commitments to provide after-hours care, the auditor said, adding they have also not done much to shorten wait times for primary care.

Many patients get their primary care elsewhere, including walk-in clinics, other family doctors and hospital emergency departments, meaning the province is paying twice for these patients to be treated, according to the report.

The auditor concluded by urging the province to review how much it pays these doctors to ensure taxpayers are getting good value for money.

In addition to seeking pay cuts, the province wants more work and accountability from FHO doctors. The government wants the average physician to put in a 36-hour work week.

“It’s a very expensive model to deliver primary care physician services and it is not performing optimally,” government negotiating team member Bob Bass told the arbitration board on a recent hearing day. “From the government’s perspective, significant change is required to both moderate the costs and improve the quality.”

But the OMA says the government has built its case on bad information from the auditor who failed to understand how they work.

OMA lawyer Howard Goldblatt said the government is more intent on prescribing or dictating a solution without really diagnosing the problem.
OMA lawyer Howard Goldblatt said the government is more intent on prescribing or dictating a solution without really diagnosing the problem.  (Supplied photo)

“It was done by accountants, not by doctors,” OMA lawyer Howard Goldblatt told the arbitration panel, referring to the auditor’s report.

“The government is more intent on prescribing or dictating a solution without really diagnosing the problem,” he continued.

The OMA wants the government to join it in studying FHOs so that any decisions taken are based on what it contends is accurate information.

The auditor erred by calculating the workload of FHO doctors based on the number of patient visits, the OMA charges.

It stands to reason many patients would have fewer appointments, given one reason for creating FHOs was to move doctors away from high-volume, fee-for-service practices, the OMA argues. Financial incentives were changed to encourage doctors to deal with multiple conditions in a single visit rather than call patients back for multiple visits.

(Depending on the doctor, those working in fee-for-service family practices may also deal with multiple conditions in a single visit.)

The auditor also failed to take into account the fact FHO doctors are more likely to communicate with patients via email and phone since their pay is no longer based on face-to-face visits, the OMA adds.

Then there is all the paperwork that comes with working in a FHO, noted Kiran who practices out of one in downtown Toronto. Because FHOs provide full-service family medicine, there is much administrative work associated with appointments, tests and referrals, she explained, adding that FHO doctors also spend time communicating with other providers in a patient’s circle of care.

“This work is what can lead to burnout and frustration, and is not accounted for in the government’s proposals,” she wrote in her email.

Kiran and the OMA warn the proposed changes to family medicine will drive doctors back to practising high-volume, fee-for-service medicine.

“Family doctors would be forced to see a ludicrously high volume of patients in-person each day,” she said. “For patients, this would likely mean shorter appointments, less flexibility to bring up multiple problems in a single visit, and less flexibility to call or email your doctor about an issue.”

The OMA points out another reason for introducing FHOs was to address past shortages of family doctors by making family medicine more attractive. The proposed changes threaten to turn back the clock on those gains, doctors argue.

In a written brief submitted to the arbitration panel, the OMA used strong language to warn of dire consequences if the arbitrators and government get it wrong:

The ministry’s proposals have “the potential to cause huge destabilization in primary care … The very real risk to patient quality of care and provider well-being cannot be ignored.”

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle



Source link

قالب وردپرس

Anglais

These US entities partnered with the Wuhan Institute of Virology — time for a criminal investigation?

admin

Published

on

By

(Natural News) The Wuhan Institute of Virology from which the Wuhan coronavirus (COVID-19) is believed to have “escaped” has a number of questionable partnerships that are worth looking into in light of the pandemic.

Most of them are universities, including the University of Alabama, the University of North Texas, and Harvard University. There is also the EcoHealth Alliance, the National Institutes of Health (NIH), and the National Wildlife Federation.

While the relationships between these entities and the Wuhan Institute of Virology may be completely innocent, there is no way to really say for sure without a proper investigation. And this is exactly what Secretary of State Mike Pompeo is calling for, as is the nation of Australia.

Pompeo and the folks down under, along with millions of Americans, would really like to know the true origins of the Wuhan coronavirus (COVID-19). An increasing number of people simply are not buying the narrative that the novel virus originated in bat soup at a Chinese wet market, and this even includes mainstream media outlets like Fox News.

The only way to really determine what was going on at the Wuhan Institute of Virology, and who else might have been involved. is to open the place up for an international investigation. But communist China is against this, of course, accusing Australia of “petty tricks” and collusion with the United States.

“Overnight, I saw comments from the Chinese Foreign Ministry talking about a course of activity with respect to Australia who had the temerity to ask for investigation,” Pompeo is quoted as saying in response to China’s aggression against a proposed investigation.

“Who in the world wouldn’t want an investigation of how this happened to the world?” he added.

As the U.S. aims to get back on track economically speaking, Pompeo believes that now is the time to hold communist China, the Wuhan Institute of Virology, and whoever else may have been involved accountable for unleashing this pandemic on the world.

“Not only American wealth, but the global economy’s devastation as a result of this virus,” Pompeo further stated. “There will be a time for this. We will get that timing right.”

Continue Reading

Anglais

New U.S. analysis finds that lab in Wuhan, China was “most likely” origin of coronavirus release

admin

Published

on

By

(Natural News) While American Leftists and most of the Democrat Party continue to serve as apologists for the Chinese Communist regime over its role in creating and then perpetuating the coronavirus pandemic, a new U.S. government analysis concludes that COVID-19 “most likely” escaped from a lab near Wuhan city.

The Washington Times reports that the analysis cataloged evidence linking the outbreak to the Wuhan lab and has found that other explanations for the origins of the virus are not as credible.

The paper reported:

The document, compiled from open sources and not a finished product, says there is no smoking gun to blame the virus on either the Wuhan Institute of Virology or the Wuhan branch of the Chinese Center for Disease Control and Prevention, both located in the city where the first outbreaks were reported.

However, “there is circumstantial evidence to suggest such may be the case,” the paper says.

“All other possible places of the virus’ origin have been proven to be highly unlikely,” said the report, a copy of which was obtained by the Times.

ChiCom officials have claimed that the virus’ origin is unknown. However, Beijing initially stated that coronavirus came from animals at a “wet market” in Wuhan where exotic meats are butchered and sold in disgusting conditions.

Chinese officials claim that COVID-19 went from bats to animals sold in the market last year, then infected humans.

U.S. intelligence officials have increasingly dismissed that explanation, however, as attention has begun to focus on evidence suggesting that Chinese medical researchers were working with coronavirus in the country’s only Level 4 facility, which is in Wuhan.

U.S. Army Gen. Mark A. Milley, chairman of the Joint Chiefs of Staff, has said that intelligence agencies are investigating whether the virus escaped from a lab or was the result of a naturally occurring outbreak, but that analysts have ruled out reports that COVID-19 was manmade.

‘The most logical place to investigate the virus origin has been completely sealed off’

“At this point, it’s inconclusive, although the weight of evidence seems to indicate natural,” the general said on April 14, “but we don’t know for certain.”

The analysis said that the wet market explanation does not ring true because the first human diagnosis of coronavirus was made in someone who had no connection to the wet market in question. And according to Chinese reports, no bats were sold at that particular market.

At the same time, several questionable actions and a growing paper trail provide clues that the virus actually escaped from a lab, even as China begins to clamp down on those information streams.

Continue Reading

Anglais

The biggest media lies about the coronavirus: Origins, treatments and vaccines

admin

Published

on

By

(Natural News) If there is one thing that most everyone can agree on concerning the Wuhan coronavirus (COVID-19) pandemic, it is the fact that there is no shortage of conflicting information out there about the nature of it. And the mainstream media is certainly doing its part to steer the narrative as part of a larger agenda, using plenty of misinformation along the way.

The following are among the most commonly parroted lies about the Wuhan coronavirus (COVID-19) that aim to distort the facts and deceive you into believing falsehoods about this pandemic:

Media LIE: The virus is not man-made

From the very beginning of this thing, the official narrative was that the Wuhan coronavirus (COVID-19) came from a Chinese wet market where bats and other “exotic” animals are sold as meat. But the world later learned that it actually more than likely “escaped” from the Wuhan Institute of Virology.

The mainstream media and social media platforms went nuts trying to censor this information and even called it  “fake news.” But eventually it became undeniable that bat soup was not responsible for spreading the Wuhan coronavirus (COVID-19) around Wuhan and eventually to the rest of the world – hence why we continue to call it the Wuhan coronavirus rather than just COVID-19.

We have even seen attempts by the media machine at making the Wuhan coronavirus (COVID-19) a racial issue because there are supposedly more “people of color” coming down with it than people with fair skin, which further detracts attention away from the source of this virus.

Media LIE: Hydroxychloroquine is extremely dangerous and doesn’t work

The minute that President Donald Trump announced that hydroxychloroquine may be an effective, and very inexpensive, remedy for the Wuhan coronavirus (COVID-19), the mainstream media immediately began decrying this claim as fake news, even though Anthony Fauci himself praised hydroxychloroquine back in 2013 under Barack Obama as being some type of “miracle cure” for SARS (severe acute respiratory syndrome).

There have even been studies conducted that were designed to intentionally smear the drug as both ineffective and dangerous, though one in particular purposely left out zinc, which appears to be a critical co-factor in supporting the effectiveness of hydroxychloroquine – in other words, politics as usual.

Media LIE: Only a vaccine can save us from coronavirus

Many politicians and public health officials are parroting the lie that the only way America can come out of lockdown and go back to “normal” is to get vaccinated with some future vaccine for the Wuhan coronavirus (COVID-19) that does not even yet exist. A vaccine, we are repeatedly told, is the only thing, or perhaps some new “blockbuster” antiviral drug, that can cure the world of this scourge and make everything happy and wonderful once again.

Meanwhile, not a peep is being made about things like intravenous (IV) high-dose vitamin C, which is being successfully used in other countries to stem the tide of infections without the need for new drugs and vaccines.

By omission, nutrition is pointless

Speaking of natural approaches to overcoming the Wuhan coronavirus (COVID-19) that are being systematically ignored by the mainstream media and most in politics, have you heard anyone mention the importance of nutrition in all of this? We did not think so, and this is intentional.

Regular readers of this site over the years should know by now that the single-most important thing you need to do to stay healthy besides exercising regularly is to feed your body the nutrition it needs to naturally ward off illnesses, including those associated with the Wuhan coronavirus (COVID-19).

Research compiled by the Lewin Group reveals that nutritional remedies such as calcium, vitamin D, folate, omega-3 fatty acids, lutein, zeaxanthin, and more all play a critical role in fortifying the immune system, which, if properly nourished, should have little problem fending off disease.

Continue Reading

Chat

Technologie1 mois ago

Service de traduction de documents PDF en ligne en toute simplicité et abordable – Protranslate est disponible 24 heures par jour et est offert en plus de 60 langues

Anglais3 mois ago

These US entities partnered with the Wuhan Institute of Virology — time for a criminal investigation?

Anglais3 mois ago

New U.S. analysis finds that lab in Wuhan, China was “most likely” origin of coronavirus release

Anglais3 mois ago

The biggest media lies about the coronavirus: Origins, treatments and vaccines

Actualités3 mois ago

Andrew Scheer demande une mise à jour économique d’ici l’été

Actualités3 mois ago

Plusieurs tours cellulaires incendiées au cours des derniers jours

Actualités3 mois ago

Danemark: le déconfinement ne semble pas avoir accéléré la propagation de la COVID-19

Actualités3 mois ago

Le maire de Joliette peu rassuré par le déconfinement en cours

Actualités3 mois ago

Un homme de 61 ans tué à l’arme blanche à Montréal

Actualités3 mois ago

Pas de déconfinement pour les commerces de Kahnawake

Actualités3 mois ago

Quel avenir pour les restos-bars sportifs?

Actualités3 mois ago

Éclosions de COVID-19 à l’Hôpital Pierre-Boucher de Longueuil

Anglais3 mois ago

Nobel Prize winner who discovered HIV says coronavirus was definitely released from Wuhan lab, contains HIV DNA

Anglais3 mois ago

Must-see infographic: The “Death Science” Depopulation Trifecta … Biological weapons, vaccines and 5G, all aimed at humanity

Anglais3 mois ago

Dead coronavirus victims found stacked in U-haul trucks in front of New York City funeral home

Anglais3 mois ago

Bill and Melinda Gates are preppers: Couple began storing food in their home years ago in case of a pandemic

Anglais3 mois ago

Nearly half of severe coronavirus cases involve neurological complications

Anglais3 mois ago

Global survey of deaths reveals coronavirus kills 10% of those diagnosed with symptoms, making it 100 times deadlier than flu

Anglais3 mois ago

Homeland security scientist confirms that natural sunlight kills coronavirus

Anglais3 mois ago

Big Pharma is rigging everything to make sure approved coronavirus “treatments” don’t actually work at all, while things that do work are discredited or criminalized

Anglais2 années ago

Body found after downtown Lethbridge apartment building fire, police investigating – Lethbridge

Styles De Vie2 années ago

Salon du chocolat 2018: les 5 temps forts

Anglais2 années ago

This B.C. woman’s recipe is one of the most popular of all time — and the story behind it is bananas

Anglais2 années ago

27 CP Rail cars derail near Lake Louise, Alta.

Anglais2 années ago

Man facing eviction from family home on Toronto Islands gets reprieve — for now

Santé Et Nutrition2 années ago

Gluten-Free Muffins

Santé Et Nutrition2 années ago

We Try Kin Euphorics and How to REALLY Get the Glow | Healthyish

Anglais2 années ago

Ontario’s Tories hope Ryan Gosling video will keep supporters from breaking up with the party

Anglais1 année ago

A photo taken on Toronto’s Corso Italia 49 years ago became a family legend. No one saw it — until now

Anglais2 années ago

Condo developer Thomas Liu — who collected millions but hasn’t built anything — loses court fight with Town of Ajax

Styles De Vie2 années ago

Renaud Capuçon, rédacteur en chef du Figaroscope

Anglais2 années ago

This couple shares a 335-square-foot micro condo on Queen St. — and loves it

Mode2 années ago

Paris : chez Cécile Roederer co-fondatrice de Smallable

Anglais2 années ago

Ontario Tories argue Trudeau’s carbon plan is ‘unconstitutional’

Anglais2 années ago

100 years later, Montreal’s Black Watch regiment returns to Wallers, France

Anglais2 années ago

Trudeau government would reject Jason Kenney, taxpayers group in carbon tax court fight

Styles De Vie2 années ago

Ford Ranger Raptor, le pick-up roule des mécaniques

Technologie1 année ago

YouTube recommande de la pornographie juvénile, allègue un internaute

Affaires2 années ago

Le Forex devient de plus en plus accessible aux débutants

Anglais2 années ago

Province’s push for private funding, additional stops puts Scarborough subway at risk of delays

Trending