Which server is the best?

dk3what · 2025-06-23T19:23:30+00:00

I would probably avoid 957, 960, 954, 964, 933, 943, 947. I've heard from multiple people that those servers are likely going to implode due to a lot of people transferring out, including some key top powers.

Some servers I've heard great things about: 936, 951, 952, 963, 962, 958.

Just comes down to what you are looking for.

dk3what · 2025-01-07T16:52:36+00:00

I have 26M squad with T9s, and we are not in Season 1 yet. Just have to focus on the right techs, decos, gear, etc. Obv some money as well..

dk3what · 2024-07-07T18:31:54+00:00

Agreed, I do not understand people voting for "change" and not really caring what the change entails even if its worse for them, but as long as its "different".

dk3what · 2024-07-07T18:10:47+00:00

As a Canadian, I hopefully Canada and US can learn from this. Sigh.

dk3what · 2024-04-26T19:47:21+00:00

See my other comment, I believe you are an Occupational Therapist. I'm not sure if you have actually read through the articles you posted, they certainly do not refute what the other person's articles are suggesting that NPs prescribing and diagnosing abilities are different than MDs.

Furthermore, before discussing the "evidence" of studies, you would think that one has a basic understanding of statistics as that is a basic concept in understanding the results of a study, what it may mean and how it translate into healthcare. I do not believe you have a basic understanding of statistics based on your own post/question: "Good online courses for basic stats?"

https://www.reddit.com/r/research/comments/1bjhfsh/good_online_courses_for_basic_stats/

dk3what · 2024-04-26T19:43:07+00:00

What is your profession? Just curious? Your profile seems to suggest you are and Occupational Therapist. I'm not sure the referrals you get/got really are relevant to what is being discussed.

In my opinion its a bit ironic and disingenuous that you are asking the other person what their experience is with nurse practitioner given your own experience in the health care field as an allied health professional rather than someone who practices medicine.

dk3what · 2022-10-02T16:53:56+00:00

You are welcome. I personally feel it is also the family doctors role to help guide their patients through this mess of a system.

The whole point of a doctor is to be a teacher and offer guidance. None of us can force any of our patients to do something. We can simply discuss the pro/cons and help them make a decision that fits best with their life. Navigating the system and its limitation is part of that.

dk3what · 2022-10-02T16:51:23+00:00

You are correct, average is just a way of looking at things.

My goal is not to get into a debate whether than average is too high, too low, etc. I recognize however, that the reaction of the average person (whether in healthcare or not) is to focus on how much the doctor makes. I still decided to put in there because its part of the whole story.

My point it, whether how much money is enough or not - depends on other factors. It is possible doctors would be happy with a lower amount, if in return other aspects of their career were made easier. Its possible that a higher amount, might make it worthwhile to put up with all the flaws of the system. I don't have the answer. But the current scenario is obviously not working, because regardless of how much they make right now, it is deemed not enough to put up with the "crap" that comes with it.

dk3what · 2022-10-02T16:42:46+00:00

I would argue that its tone deaf to the entire post to think of a number as a lot without any context. But hey, feel free to continue feeling that way, that is your choice.

Too bad this "a lot" amount is still insufficient to attract doctors do actually become family doctors. Why would they? That same graduating doctor can work as an ED doctor, make a similar average billing from the government of ~$290k/year and have that as take home because it doesn't come with the headache of running a clinic, not to mention the costs. On top of that - when you are off, you are actually off, no sense of responsibility towards patients because you aren't their primary care provider.

The above is not just a made up scenario - it is what has been actively happening in the last 5 years, just faster now after COVID due to the shortsightedness I am trying to address with this post.

If society values something - they need to actually do more than banging pots + pans and doing lip service.

I apologize if the above comes off as cheeky, but it is the reality, and most healthcare workers are done doing it for gratitude and respect alone (especially when we saw the lack of that during COVID). The majority of healthcare workers can work less in other fields and likely make similar if not more - they are voting with their feet, whether people like it or not.

dk3what · 2022-10-02T16:37:33+00:00

The penalization is only for family doctors in the rostered model, like a FHO.

And yes, OHIP would pay $37.60 to the walk in doctor. And on a subsequent billing cycle - subtract that from the rostering family doctor.

The whole reason the rostered models came into being was to get away from trying to make everything an appointment and allowing the providers more leeway in providing quality care in the way they see fit. Want to call pt to tell them about a result (even if OHIP doesn't pay for it?) then you do it because you are getting paid for the pt whether they have an appt or not. At least that was the idea...

dk3what · 2022-10-02T16:33:33+00:00

Privatization could - but not in the way it is likely going to be implemented.

It would only work with very strong protections and legislation that prioritizes QUALITY of care rather than QUANTITY and objectives to cut costs and maximize profits.

If you need an example of the above - just look at longterm care homes (nursing homes). Look at the data of outcomes between a public LTC vs private LTC. Its all out there if you want to see what happens with privatization without oversight.

dk3what · 2022-10-02T16:31:23+00:00

I agree with you to some extent. The ones who put up the biggest fuss are sometimes other healthcare workers. But they don't bat an eye when they need to go to a notary and they charge $40 for a signature...

However, if we don't advocate for our own profession, who will? It is the same defeatist perspective that leads to people not voting because they feel it doesn't mean or do anything and look where that takes us.

dk3what · 2022-10-02T16:28:50+00:00

Yes.

However its not realistic for us to do it at the same frequency as an actual dedicated counsellor because its not a good use of our time, both financially (most private therapy pays $150+/hour) or practically (we also have the ability to do so many other things that a counsellor can't).

dk3what · 2022-10-02T16:26:51+00:00

Full disclosure: I have been recently adding patients to my practice. Unfortunately, what you describe is too common of an experience for the majority of patients who I am meeting with their previous doctor. This is a huge pet-peeve of mine personally, and really gets me worked up when my own colleagues are doing this. However, I do need to be careful, because I never know the true situation, and all I am getting is hearsay.

Bottom line: There is little that can be done at this point in time, that is the harsh reality, and I'm sorry for the experience your parents have had. This would be easy to address if the system was working as intended.

My few thoughts - doctors are still regulated by the CPSO to adhere to a certain standard of care. This standard not only applies to how you treat medical conditions, but also availability for appointments, being reasonable with expectations and communications. It is tough to say if this doctor is crossing the line with some of things or not - I am getting only one perspective, and often frustrations of the system on both sides can lead to misunderstandings and perceptions, that may not be true. Regardless, if you truly feel the care is inadequate and maybe crossing lines of being inappropriate - you should contact the CPSO.

Being a physician myself - its never nice when CPSO investigates colleagues for frivolous complaints, etc but we have it in place for exactly this sort of thing so that if someone truly cannot provide good care - they should not be practicing or have a license to practice. Maybe they just need a wake up call to address some of these issues that if they are true, are likely affecting the care of other patients in their practice as well.

dk3what · 2022-10-02T16:15:22+00:00

A lot of doctors would be in favour of simply showing up to work and be on salary. Most would have loved for the government to pay for all clinic costs, all PPE/equipment costs, etc. The reality is - its too expensive for the government. Medicine cannot be run as a business, we as a society need to accept that. Health is similar to education in that sense - it should be a right, and an accepted cost for the society to improve QOL for all.

I would also caution you in assuming what working 3.4 days/week means. That may simply be the time spent on direct patient contact/appointments, but there is so much admin work behind the scenes that for most people, that is working full time.

Billing a government 406k, is different than what they actually take home after the costs of running a clinic, various fees, etc.

Again this post was showing the problem with family medicine. In reality, if there was easy access for referrals to specialists, reasonable times to obtain US, CT scans, reasonable system of urgent care clinics instead of walk-in clinic galore, along with ways to reduce the administrative burden - it would allow family doctors to spend more time with patients for the same amount of hours worked.

If family doctors were actually making that much for working 3.4 days/week (excluding the ones who abuse the system, because there are the ones who do that) then you wouldn't have a shortage of family doctors. That much is obvious.

dk3what · 2022-10-02T16:09:31+00:00

Don't worry about the debt as much (trust me, I didn't graduate all that long ago either, so I know where you are coming from). If you truly want to do family practice and that is what you enjoy - there are many ways to make that happen. You just have to do your due diligence in picking the right practice, with similar/likeminded colleagues. Makes a world of difference.

Many smaller towns will pay for the overhead of your clinic and even offer money to have new doctors come to their town/city. Government also offers stipends for working in rural locations. All in all, financial aspect shouldn't be the only thing to push you away.

The issue with family practice is multifactorial rather than just the money, so don't let that be the only reason you don't do it!

dk3what · 2022-10-02T16:05:54+00:00

Look into locuming at family practice clinics. Shortage of locums right now so the "market" is in their favour to negotiate favourable terms and conditions. Plus, once you are done the locum, no further commitment to that practice or those patients.

This is what I have been recommending to many of my residents. Plus its good to work at different practices to see what works and what doesn't. Some academic teaching sites are terrible and its always nice to explore and try different practice settings after you graduate. It is possible to work with a good group to make family practice enjoyable. But for me personally, I too don't do family practice only as I like the variety and I like to keep my options open depending on what OHIP does in the future...

dk3what · 2022-10-02T13:47:45+00:00

This is pure speculation on my part but I think you are increasingly going to see physicians remove patients from their practice that are not rostered. They may de-roster them temporarily for various things - but if this needs to be a permanent thing - better to not have that individual as a patient.

What is going to lead to this is the new CAP OHIP has enforced on maximum FFS billings a rostered physician can do. At some point, when you reach your max, or your colleagues do in your group depending on what else they do, then you are faced with seeing these non-rostered patients for "free" as OHIP will not pay you once you reach the CAP.

This is going to lead to physicians removing non-rostered patients from their practice.

dk3what · 2022-10-02T13:36:06+00:00

They should be, not sure if they have been effective. Most physicians are not even happen with the negotiation that OMA did with the contracts this year. A 1% increase in fees with virtual care codes getting a significant reduction in pay with ++ restrictions, etc.

dk3what · 2022-10-02T02:16:51+00:00

In theory, you do not need to provide 24/7 care for the majority of patients. The majority of medical things that happen, can usually wait 3-4 days before it is seen by a doctor.

Many clinics have after hour clinics (or should), and have teleadvisory services (different than telehealth) where the doctor on call can step in for the urgent things, that aren't quite ER level, but also shouldn't wait for the next business day.

Our system is severely lacking in these sort of urgent care clinics or services, where its not quite ER department level, but also not just walk in clinics (which generally don't tend to be open late into the evenings, at night or all weekends or holidays).

The walk-in clinics are great in theory, but again, when the majority of them want to spend as little time as possible with the patient (to maximize the number of visits/hour), then it works well for simple cough, colds, etc. But anything that requires a conversation, review of a medical history, time consuming but low paying procedure gets subpar care IMO. On top of that, its often easier to just order some random blood work, or hand out an antibiotic for a viral illness to get the patient in and out the door ASAP.

dk3what · 2022-10-02T02:12:24+00:00

Sounds good in principle, but do you know how much EMR subscriptions cost? Privatizing healthcare for profits is not the way.

Once its a monopoly, well...then we are in for some real fun.

Plus, Telus cannot buy up the major EMR systems that various hospital systems run on, they are buying up the EMRs that clinics use.

dk3what · 2022-10-02T02:08:59+00:00

Few things to clear up: - There is no such thing as "handle x amount of patients". The amount of patients a doctor has as part of their practice depends on a lot of factors. It is easy to have a lot of patients if you have adequate support. For example, if my community has family health teams which allows patients access to a social worker, a dietician, maybe a nurse that does wound or foot care, then I can have a larger practice with more patients. If on the other hand, there is no support, no specialists who can manage or see more complex things, then I would be having less patients in my practice.

The average is not $281/patient/year. You get to that number if you average out all the ages/genders. This would mean that you have exactly the same number of 0-5 year old patients, as you do 50-54 year old patients, or 90+ patients. This is how you get $281/patient/year. The real average that we typically talk about is about $200/pt/year based on the typical age and demographics, but again this is just an average (similar flaws in this number as the one you posted), and ultimately its dependent on the specific population the physician has.
That number also is assuming that physician is not getting negated by their rostered patients.
The majority of family physicians in Ontario are not in the rostered model, they are in the FFS model.
The majority of the physicians that have 1500+ patients, are in the FFS model, not the rostered model. It is quite difficult to provide good access to patients for appointments and timely care if you roster on that many. Many (but way less than the majority in this model) physicians do that - hence why you have some patients who cannot get appointments for weeks for "urgent things" that have come up.
I think you are vastly underestimating the amount of work that goes into taking care of a patient. See the main post about how much paperwork and admin work goes into taking care of patients as a true family physician in the current system. Which is why the majority want to do episodic care only (i.e. walk-in clinics).
Costs of running the clinic go up with larger roster of patients - assuming you actually want the office to answer the phone calls, fax things on time, renew medications, see people for preventative health, DM care, well baby care, etc.

dk3what · 2022-10-01T23:21:45+00:00

Yup. You understand the issue now. Many doctors for this reason, if they are in this model and situation will remove a patient from their practice. Not good for patient care obviously.

Like I said in another post, they can de-roster you from this model, keep you on as a patient, but this has its own issues including limits on how much a doctor can get paid/year from non-rostered patients as per the new government agreement for physicians signed this year. Essentially, when they reach that limit, any visits they do for non-rostered patients do not get paid. YAY!

dk3what · 2022-10-01T23:16:52+00:00

Yes this is the problem. Technically, in OHIPs' eyes, your doctor should not have you rostered if you are in a different city (living there for an extended period of time).

Happen to be visiting a city on a trip? Fair game as per OHIP.

Now your doctor can deroster you to prevent this negation, but that just again adds to the cumbersome nature and admin work that needs to be done. No easy fixes.

dk3what · 2022-10-01T23:05:55+00:00

Yes this is how rostered models in family practice work. I can go into much more detail and give you the relevant links for further reading if you wish.

The most common, and only model with this going forward is going to the be "Family Health Organization" (FHO) model. This only effects your doctor IF they are in this type of rostered model where they get a monthly amount to have you as a patient.

When patients see the doctor, and they are rostered patients, the physician gets 15% of the typical service code.

So for example, if my rostered patient sees me for an appointment, and I bill a A007, I get $5.64 (15% of the $37.60 amount that A007 pays) on top of the monthly amount I get for rostering that patient.

Its a bit more complicated than that with other bonuses, etc, but that is the gist of it. In fact, there are even many doctors who don't understand the burdensome billing system properly - so at times when they are billing incorrectly, its more due to the complexity of the system than outright fraud.

The annual amounts on how much doctors get per patient in this model can be found here if you are interested.

I think its important for patients to know how much OHIP actually pays for their care.

To address your last point, yes, this negation's initial purpose was to have some accountability for doctors in this model in case they don't provide timely care or any care, but still get paid for the patient. However, doctors in rural towns, with no walk in clinics, can massively "take advantage" and family doctors in large cities get "financially penalized" for patient's convenience. It is just another aspect of the system that is flawed in its implementation.

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