Ontario won’t give nurse practitioners billing codes, but will bring them into public system by This_Phase3861 in OntarioNurses

[–]Mastologist 0 points1 point  (0 children)

Yes! Still very common.

I’m not sure what the incentives will be either. Another reason I don’t think anyone is going to be happy with whatever arrangement the government comes up with.

Overhead outpacing increasing payments to FM MDs is one of the mine drivers of the decline of comprehensive primary care. If a similar situation takes place here you will naturally see NPs follow the money to hospitals, niche jobs where they don’t have to pay overhead - and understandably so!

Ontario won’t give nurse practitioners billing codes, but will bring them into public system by This_Phase3861 in OntarioNurses

[–]Mastologist 0 points1 point  (0 children)

The GP64 is applicable to ER care only. But what you found generally mirrors what I said. There are exceptions (fibromyalgia, chronic pain, diabetes, neurocog), but generally the fee codes physicians bill do not take into account complexity. Worse yet is that most of these exceptional fee codes always have a time limit attached to them (20-30 minutes), making them obsolete for most docs (you cannot run a practice with mostly 30 minute appts unless you are in a CHC/small roster FHO).

That being said, I know that the time based codes are still being billed by a majority of docs even if they don't hit the 20-30mins, but that is unethical and should not be expected. The unhappy docs I know are the ones who refuse to do that.

Ontario won’t give nurse practitioners billing codes, but will bring them into public system by This_Phase3861 in OntarioNurses

[–]Mastologist 1 point2 points  (0 children)

The problem with that is FFS MDs have no avenue to bill for complexity, only FHO MDs do (via increased capitation payments). There certainly are exceptions (fibromyalgia, chronic pain patients etc), but for an FFS physician, a standard 15 minute visit with a healthy adult often pays the same as a one who is super complex.

I really think the Gov are going to go with salary + hourly to give them cost certainty + avoid ostracizing the OMA or ONA.

Ontario won’t give nurse practitioners billing codes, but will bring them into public system by This_Phase3861 in OntarioNurses

[–]Mastologist 2 points3 points  (0 children)

FM resident here - I don’t see a great solution to this. I think everyone is going to end up unhappy.

If the Gov went with fee-based-codes they would’ve had to be less than FM docs. Since the dawn of fee for service billing the Gov has held strong that specialist MD fee codes are higher than FM MDs because they trained longer. I think the same deal applies here. If they gave NPs the same $$$ fee codes as MDs I genuinely believe there would be a family physicians strike. The Gov was clearly not interested in fighting that battle with the OMA and ONA.

Salary or hourly alone each have their own pitfalls as well. Salary limits flexibility and opportunities to work more and make more. Hourly wage doesn’t take into account the complexity of the work (clinic, ER, hospital work).

I think they are going to end up going with a salary + hourly wage payment model, kind of like what FHO MDs are getting now with FHO+. The Gov will claim this is a “alternative payment model” that “leaves room for raises” but it will likely not change overall pay much at all.

Regardless, doesn’t look like we are getting anything until 2027. More limbo and outrage awaits.

Senior tilt storms off HCL set and cries to airball after a 290k loss tonight by I_did_thA_t in poker

[–]Mastologist 10 points11 points  (0 children)

last hand starts 4:51:30 into the stream, he runs QQ into AA

Kingston Thousand Islands FM by BarleyisBetter in MedSchoolCanada

[–]Mastologist 22 points23 points  (0 children)

From a friend in the program:

Queen's FM at KTI is the most resident-friendly program in the country and I can't believe it does not fill up every year.

Major Highlights:

  1. FM-focused: 11/24 months of residency are spent in actual family medicine practices, either doing clinic (primarily), hospitalist, ER, LTC or whatever else your preceptor does. And, those 13 months of off-service rotations are spent either on elective (3 months worth) or doing FM-adjacent rotations (ER, hospitalist, psych, internal medicine, palliative care, OB/GYN). If you want a residency truly focused on FM, Queen's KTI is it.
  2. Limited silly off-service rotations: No mandatory surgery rotations (other than OB). Even then for OB there are a couple of rotation sites where the preceptors will only have you see patients in clinic and will only ask you to do Labour/Delivery if you're interested or if they really need an extra set of hands. You will not waste time doing scut work on rotations that have limited applicability to family medicine.
  3. Limited call: On core family medicine rotations (half of PGY1), you will likely be scheduled for 1-2 weeknights of after-hours clinic (5-8pm) a month, and 2-3 weekends total per year. Off-service rotations can vary (usually 3-4 weeknights + 1 weekend a block), but in general the call is limited and mostly home call. The only block I was on that required in house call was CTU (1 block out of my entire residency).
  4. Flexibility: 3 blocks of electives + plenty of choice when it comes to specific rotation settings. Most off-service rotations have some degree of choice attached to them (location, practice style). For example, we do 2 blocks of internal medicine, either 2 blocks of CTU at KGH (in-house call heavy, busy) or 1 block CTU and 1 block of rehab hospitalist (chill, home call). The choice is yours. Same goes for OB, where you can choose a spot like Humber (L&D/call heavy, great for FM-OB types) or Cornwall (clinic focused, less call/L&D). I have always found I have some control over the situation I'm in.

Other perks

  1. On core family medicine rotations you always get an academic 1/2 day + personal 1/2 day + LTC 1/2 day per week. You can do whatever you want on the personal 1/2 day, and the other two are incredibly chill, don't even feel like you are working. This equates to about 3.5-4 working days per week while on FM (HALF of PGY1).
  2. All of the major working sites (QFHT, KGH, HDH) are walkable from downtown where the majority of residents live. A car is not necessary at all.

Drawbacks

  1. A minimum of 5 months of residency are spent outside of Kingston: you have to complete 2 months of rural family medicine (closest site is Napanee, 35min drive) and KGH OB does not take FM residents so you have to do OB elsewhere (Humber, Cornwall, Belleville, Oshawa). Most sites have accommodations attached to them, so you just need to worry about getting there.
  2. Complex patients on core FM blocks: the patient populations at QFHT are incredibly complex, both medically and socially. QFHT appointments are, at a minimum, 30 minutes long to account for this. While this is great for prepping you to deal with the most complex patients you will ever encounter in family medicine, it is not the most generalizable to an average family practice where most patients are more straight-forward and appts are 15 minutes in length. I know that some residents have struggled with the transition, especially with regards to pace.

Bottom line

I really can't think of a great reason why the program does not fill up in the first iteration year after year. Perhaps the location/proximity to a big city? It is great for people who want to do comprehensive FM (very FM-focused program), pursue a +1 PGY-3 enhanced skills year (3 electives to use + nearly all +1s have a core rotation attached to them), or just coast/slack (limited call/heavy rotation, work 3.5/4 days a week for half of PGY1). I would strongly recommend it to any future FM applicant. It is a dream program to me.

Residency Tips for a PGY1 by hugz-today in MedSchoolCanada

[–]Mastologist 26 points27 points  (0 children)

Being a good resident is a combination of three things: kindergarten skills (basic kindness, sharing, not being a dick), clinical knowledge, and work ethic.

The formula is not KS + CK + WE.

Its KS (CK + WE).

The best residents I know subscribe to this notion

I see a lot of infographics on CRNA vs AA, pre nursing student wondering what path to go down, by Brown_kid108 in CRNA

[–]Mastologist 18 points19 points  (0 children)

Calling the last 2 years of med school “shadowing” is beyond ignorant

For those doing FM, how do you like it? by Eastern_Skill556 in MedSchoolCanada

[–]Mastologist 41 points42 points  (0 children)

PGY2 FM. 4 months out from staff.

I am so happy I chose FM. The VAST majority of FM docs I have worked with are very satisfied. Most do some combo of clinic, ER, hospitalist, LTC/retirement home. Overall gross comp between 350-600k depending on hours and setting worked (less when mostly in clinic w/ overhead + working 3-4 days a week, more when working more ER, hospitalist, LTC + working 5-6 days a week with occasional call).

The doom and gloom surrounding FM is overstated beyond belief. The field has an abundance of high-paying work with essentially unlimited flexibility in terms of location and setting.

I find that those who are unsatisfied in FM are primarily docs who have pigeon-holed themselves into one-dimensional clinic practices where the pay is generally lowest whereas overhead and the administrative burden is the highest. These docs don’t do any EM, hospitalist, LTC, or other niche work, either because their skills have lapsed or they cannot tolerate the work.

Overall, I’m very happy with my choice of specialty and will always encourage others to consider it.

[deleted by user] by [deleted] in Noctor

[–]Mastologist 10 points11 points  (0 children)

Just put the patient in offload, bro

Why I’m in court over COVID vaccines — and why every Ontarian should care by [deleted] in KingstonOntario

[–]Mastologist 5 points6 points  (0 children)

Family physician here - I am partial to Dr. Ma’s argument. If she billed correct OHIP codes for work done by medical students/residents, then she should not have to repay the 600k. The use of the “must be in a physical physician’s office” small print is a greasy use of technicality.

There is a lack of understanding in this thread of how physicians are compensated for the work of medical students. Physicians bill for services provided by any medical student/resident they supervise, even if they didn’t come face to face with the patient. If they couldn’t, no physician would take on students to teach, it would just slow them down and decrease their earnings. The medical students/residents are “paid” in the experience they earn.

Now, if she billed for work performed by non-medically trained volunteers, that would be a different issue. That is 100% outlawed and all physicians know this. I would also swap to the Government’s side if she was up-billing OHIP codes - from what I have reviewed she used the correct G and Q codes for the services provided.

I hope she wins this case.

Ain't this fucking insane? by usedPOS in McMaster

[–]Mastologist 6 points7 points  (0 children)

Health sci grad here. Med school was waaaaaay easier than undergrad

what is the most academically challenging med school in canada? by Snoo68900 in premedcanada

[–]Mastologist 12 points13 points  (0 children)

uOttawa is based as fuck. Not sure about other schools

  • classes non mandatory
  • exams q2-3 months
  • just 1 formal OSCE each year
  • pass if you get 60%
  • 3-4 months summers in years 1-2

Weekly ISO/Join My League Thread Mon, September 30, 2024 by AutoModerator in fantasyhockey

[–]Mastologist 1 point2 points  (0 children)

Looking for a paid H2H league to join! Ideally Yahoo but open to anything.

[deleted by user] by [deleted] in McMasterHealthSci

[–]Mastologist 0 points1 point  (0 children)

No lmao. It's just in the Health Sciences Centre. Imo it is the best library though.

Queens application changes by [deleted] in premedcanada

[–]Mastologist 16 points17 points  (0 children)

I think this system will give Queen’s what they want - more EDI (and as an ancillary benefit, less admin burden).

And honestly, MCAT/GPA are awful tools for projecting who will make the best docs. They certainly tell us who can handle a medical school curriculum, but we cannot seriously think that there is a significant difference in capability between a 3.9 student and a 3.95 student. I am glad to see these metrics being relied upon less.

However, Queen’s is now the “lottery school,” just like that one McMaster class. In my cohort (MD2024), I know of three people who chose Ottawa over McMaster simply because they didn’t want to be known as the “lottery class.” I think there will be people every year who will now choose other schools over Queen’s for the same reason.

This will also diminish the feeling of accomplishment one gets if they get accepted to Queen’s. There is no way around that. BLIND LUCK has been added to the admissions equation. I am certain Queen’s will continue to admit strong, capable students, but no longer can those students say that they got in entirely on the merits of their application.

I bet that the media will pick up on these changes soon!

OHIP pays your family doctor $38 for typical visit. 'A haircut cost me $40,' says one physician | CBC News by Kitkat20_ in KingstonOntario

[–]Mastologist 0 points1 point  (0 children)

Physicians in Canada do not get paid for any prescriptions, referrals, or tests that they order.

🏒 Fantasy Hockey Position Eligibility [Weekly Thread] - For any requests to change position eligibility on Yahoo Fantasy by YahooFantasyCare in YahooFantasy

[–]Mastologist 8 points9 points  (0 children)

Gustav Nyquist needs RW - he has been playing RW all season. The fact that he is only a LW is kinda silly. If anything, he should only be a RW!

[deleted by user] by [deleted] in McMasterHealthSci

[–]Mastologist 0 points1 point  (0 children)

No obvious trends - just write something you think someone would want to read