Anglais

OMA to tackle thorny issue of pay gaps between medical specialties

Published

6 années ago

octobre 20, 2018

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Meantime, the OMA is seeking redress for fee cuts and freezes that doctors have been hit with in recent years.

But it’s patients who ultimately pay the price when physician fees are out of sync with health-care needs. When physician services are overvalued, there is less money available for lower-valued colleagues and for other parts of the health system such as hospitals and homecare.

The imbalance presents medical students with an incentive to specialize in overvalued specialties, such as radiology, cardiology and ophthalmology.

The contract dispute was at the binding arbitration stage prior to the June provincial election. But the province’s new Progressive Conservative government wanted to take a stab at resolving it, so the two sides went back to the bargaining table.

However, talks broke down earlier this month because the province isn’t offering as much new money as the OMA wants. The two sides remain billions of dollars apart.

This coming Monday, the ball will be back in the court of an arbitration board led by William Kaplan, a seasoned lawyer, mediator and arbitrator. In resolving the dispute, the board has two main questions to address:

How much more should the province pay the approximately 30,000 doctors who bill OHIP, including part-timers?

How should funding be divvied up among the 35 different medical specialty groups?

It’s this second question that the 200-plus members of the OMA’s governing council will grapple with when they gather Sunday at a Toronto hotel. Their plan is to come out of the meeting with recommendations for the arbitration panel to consider.

It’s accepted that some physicians should be paid more than others. Doctors who deserve higher wages include those who have spent more years in training, do more complex and intense work, have higher overhead costs and work longer hours.

But it’s also recognized that the existing system of compensating physicians is unfair. Disparities have grown over the decades, fuelled in part by improved technology, much of which is funded by taxpayers.

These technological advances have mostly benefited “proceduralists” such as radiologists, ophthalmologists and cardiologists. Because they are paid per procedure — for example, per diagnostic test or operation — these specialists are able to work faster and bill OHIP more.

Those physicians who have not benefited as much are known as “cognitive” specialists. They include infectious disease specialists, pediatricians, psychiatrists and geriatricians. They also include family doctors (who are not formally considered specialists.) These doctors use their experience, learning and interpretative skills to determine diagnoses and provide treatment advice.

Restoring fairness to the compensation system is what the medical profession refers to as “achieving relativity.” But progress on this has been glacial, despite repeated efforts over the years. The OMA’s governing council passed a motion in 2010 to achieve pay equity across every specialty by 2024, but the association is not on track to reach that goal.

The slow pace of change is acknowledged in a report by the OMA’s Relativity Advisory Committee, which is going to be up for debate on Sunday. “Income relativity disparities have existed in the medical profession for a long time, and the Ontario Medical Association has identified this as an important issue requiring correction,” the report says. “There have been many efforts over the past 25 years to develop an appropriate relativity model.”

The relativity report reveals the highest billing specialties are overpaid to the tune of 52 per cent and the lowest billing ones are underpaid to the tune of 30 per cent.

Among recommendations contained in the report is one to cut the pay of the four top-billing specialty groups by up to 1 per cent annually for 11 years. Those four specialty groups are radiologists, ophthalmologists, cardiologists and gastroenterologists.

The report also recommends payment top-ups of up to 4 per cent annually for 28 underpaid specialty groups. For another three specialty groups, there would be no redistribution of funding.

At the end of the 11-year plan, inequities would be significantly reduced, but still not eliminated. The highest billers would still be overpaid by 10 per cent and the lowest billers underpaid by the same amount.

The report does not spell out what kind of changes an individual specialist could expect in annual income under the plan, but to get a sense of that, one just has to cross reference data from the Canadian Institute for Health Information.

According to 2016 CIHI data on Ontario physicians, the average payment to an ophthalmologist was $691,575, while the average payment to a psychiatrist was $210,188.

The committee’s proposals to address relativity would see the ophthalmologist’s pay cut by just under $7,000 in the first year of the 11-year plan. A psychiatrist would see a top-up of just over $4,200 in the same period.

Council will vote on the proposals to address relativity on Sunday. Those that are passed will then be presented to the arbitration board as recommendations from the OMA. They are not binding.

The proposals are not going over well with some specialists who would see their pay cut. In late September, the day after the relativity committee presented its report to the OMA’s 24-member board of directors, radiologist Dr. David Jacobs announced his resignation from the board.

Jacobs, who is also vice-president of the Ontario Association of Radiologists, wrote an open letter to doctors in which he warned that Sunday’s special meeting “will further divide” the OMA. He announced intentions to form a breakaway association of specialists who could negotiate their own payment deal with the province.

Jacobs has not responded to requests for an interview. It’s unclear how much support his movement has.

In response to the breakaway threat, the OMA’s board has come up with an additional approach to address relativity. This idea, which will also be debated Sunday, would allow individual specialty groups to make their own recommendations on how to deal with relativity to the arbitration panel. Different specialties would be able to voice their unique concerns rather than relying solely on the OMA to speak on behalf of the entire profession.

In a written statement to the Star, OMA president Dr. Nadia Alam indicated the association would stand a better chance of remaining intact if this new approach is adopted.

“We’re confident that the profession can work through the relativity challenge without fracturing, and that the overwhelming number of OMA doctors support the OMA’s role as their bargaining agent. After five years of cuts and freezes, this is not a time to provide an opening for divide and conquer which is a real risk if the profession were to fracture.”

But some physicians are unhappy with the OMA’s response and charge that the organization is bowing to pressure from the high-billing specialists. London family physician Dr. Frank Warsh, who maintains a blog about the goings-on in the profession, recently expressed doubt the relativity dilemma will be resolved any time soon.

“Doctors from lower-earning specialties have good reason to be pissed. Relativity has been a festering problem in the profession for decades, and only a handful of the highest-billing specialties stood to lose anything under the new framework,” he wrote in reference to the relativity committee’s proposals.

“Seeing as the plan is being changed to meet the demands of specialists looking to go their own way regardless, it’s hard to see this whole process playing out to a conclusion,” he continued.

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

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Anglais

Nostalgia and much more with Starburst XXXtreme

Published

3 années ago

août 10, 2021

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Get a taste of adventure with Starburst XXXtreme based on the legendary NetEnt Game. The nostalgic themes are sure to capture fans of the classic version as they get treated to higher intensity, better visuals, and features. The most significant element of the game is its volatility. Patience will not be an essential virtue considering the insane gameplay, and there is a lot of win potential involved. It retains the original makeup of the previous game while adding a healthy dose of adrenaline.

Starburst Visuals and Symbols

The game is definitely more conspicuous than before. The setting happens over a 5-reel, 3-row game grid with nine fixed win lines, which function if a succession from the left to the right reel is present. Only those players that that attain the highest win per bet line are paid. From a visual standpoint, the Starburst XXXtreme slots illustrates lightning effects behind the reels, which is not surprising as it is inherited from the original version. Available themes include Classic, Jewels, and Space. The game is also available in both desktop and mobile versions, which is advantageous for players considering the global pandemic. According to Techguide, American gamers are increasingly having more engaging gaming experiences to socialize to fill the gap of in-person interaction. Starburst XXXtreme allows them to fill the social void at a time when there is so much time to be had indoors.

Starburst XXXTreme Features

Players get to alternate on three features which are Starburst Wilds, XXXtreme Spins, and Random Wilds. The first appears on reels 2,3, or 4. When these land, they expand to cover all positions while also calculating the wins. They are also locked for a respin. If a new one hits, it also becomes locked while awarding another respin. Starburst XXXtreme offers a choice between two scenarios for a higher stake. In one scenario with a ten times stake, the Starburst Wild is set on random on reels 2,3, or 4, and a multiplier starts the respin. The second scenario, which has a 95 times stake, starts with two guaranteed starburst wilds on reels 2,3, or 4. it also plays out using respin game sequence and features. The game also increases the potential with the Random Wilds feature to add Starburst Wilds to a vacant reel at the end of a spin. Every Starburst Wild gives a random multiplier with potential wins of x2, x3, x5, x10, x25, x50, x100, or even x150.

The new feature is sure to be a big hit with the gaming market as online gambling has shown significant growth during the lockdown. AdAge indicates the current casino customer base is an estimated one in five Americans, so Starburst XXXtreme’s additional features will achieve considerable popularity.

What We Think About The Game

The gambling market has continued to diversify post-pandemic, so it is one of the most opportune times to release an online casino-based game. Thankfully Starburst XXXtreme features eye-catching visuals, including the jewels and space themes. These attract audience participation and make the gameplay inviting. The game also has a nostalgic edge. The previous NetEnt iteration featured similar visuals and gameplay, so the audience has some familiarity with it. The producers have revamped this version by tweaking the features to improve the volatility and engagement.

That is characterized by the potential win cap of 200,000 times the bet. Starburst XXXtreme does not just give betting alternatives for players that want to go big. The increase of multipliers also provides a great experience. If the respins in the previous version were great, knowing that multipliers can go hundreds of times overtakes the game to a new level.

Players should get excited about this offering. All of the features can be triggered within a single spin. Whether one plays the standard game or takes the XXXtreme spin route, it is possible to activate all of the features. Of course, the potential 200,000 times potential is a huge carrot. However, the bet size is probably going to be restricted and vary depending on the casino. It is also worth pointing out that a malfunction during the gameplay will void all of the payouts and progress. Overall, the game itself has been designed to provide a capped win of 200,000 times the original bet.

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Anglais

‘We’re back’: Montreal festival promoters happy to return but looking to next year

Published

3 années ago

juillet 23, 2021

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In downtown Montreal, it’s festival season.

In the city’s entertainment district, a musical act was conducting a sound check on stage Friday evening — the second day of the French-language version of the renowned Just For Laughs comedy festival. Tickets for many of the festival’s free outdoor shows — limited by COVID-19 regulations — were sold out.

Two blocks away, more than 100 people were watching an acoustic performance by the Isaac Neto Trio — part of the last weekend of the Festival International Nuits d’Afrique, a celebration of music from the African continent and the African diaspora.

With COVID-19 restrictions continuing to limit capacity, festival organizers say they’re glad to be back but looking forward to next year when they hope border restrictions and capacity limits won’t affect their plans.

Charles Décarie, Just For Laughs’ CEO and president, said this is a “transition year.”

“Even though we have major constraints from the public health group in Montreal, we’ve managed to design a festival that can navigate through those constraints,” Décarie said.

The French-language Juste pour rire festival began on July 15 and is followed by the English-language festival until July 31.

When planning began in February and March, Décarie said, organizers came up with a variety of scenarios for different crowd sizes, ranging from no spectators to 50 per cent of usual capacity.

“You’ve got to build scenarios,” he said. “You do have to plan a little bit more than usual because you have to have alternatives.”

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Anglais

MELS new major movie studio to be built in Montreal

Published

3 années ago

juillet 23, 2021

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MONTREAL — MELS Studios will build a new film studio in Montreal, filling some of the gap in supply to meet the demand of Hollywood productions.

MELS president Martin Carrier said on Friday that MELS 4 studio construction will begin « as soon as possible », either in the fall or winter of next year. The studio could host productions as early as spring 2023.

The total investment for the project is $76 million, with the Quebec government contributing a $25 million loan. The project will create 110 jobs, according to the company.

The TVA Group subsidiary’s project will enable it to stand out « even more » internationally, according to Quebecor president and CEO Pierre Karl Péladeau. In the past, MELS Studios has hosted several major productions, including chapters of the X-Men franchise. The next Transformers movie is shooting this summer in Montreal.

Péladeau insisted that local cultural productions would also benefit from the new facility, adding that the studio ensures foreign revenues and to showcase talent and maintain an industry of Quebec producers.

STUDIO SHORTAGE

The film industry is cramped in Montreal.

According to a report published last May by the Bureau du cinéma et de la télévision du Québec (BCTQ), there is a shortage of nearly 400,000 square feet of studio space.

With the addition of MELS 4, which will be 160,000 square feet, the company is filling part of the gap.

Carrier admitted that he has had to turn down contracts because of the lack of space, representing missed opportunities of « tens of millions of dollars, not only for MELS, but also for the Quebec economy. »

« Montreal’s expertise is in high demand, » said Montreal Mayor Valérie Plante, who was present at the announcement.

She said she received great testimonials from « Netflix, Disney, HBO and company » during an economic mission to Los Angeles in 2019.

« What stands out is that they love Montreal because of its expertise, knowledge and beauty. We need more space, like MELS 4, » she said.

There is still not enough capacity in Quebec, acknowledged Minister of Finance, the Economy and Innovation Eric Girard.

« It is certain that the government is concerned about fairness and balance, so if other requests come in, we will study them with the same seriousness as we have studied this one, » he said.

Grandé Studios is the second-largest player in the industry. Last May, the company said it had expansion plans that should begin in 2022. Investissement Québec and Bell are minority shareholders in the company.

For its part, MELS will have 400,000 square feet of production space once MELS 4 is completed. The company employs 450 people in Quebec and offers a range of services including studio and equipment rentals, image and sound postproduction, visual effects and a virtual production platform.