sky-high doctor salaries are problematic!
RedesigningDoctor's Compensation: It's About Time
Let's face it, the way doctors are paid at the moment ain't exactly doing our health any favors. Time for a change? You bet! But remember, there's no perfect model.
Everybody who's ever swung a hammer knows this. You can either pay your construction worker by the project or by the hour — each method got its pros and cons. But what matters most for a top-notch outcome? Good ol' site supervision.
So while doctors' unions are foaming at the mouth, we can't really blame Quebec's Minister of Health, Christian Dubé, for aiming to set performance objectives and indicators for doctors.
These medical professionals are exquisitely sensitive about their autonomy. They've hissed and whistled whenever the government dared stick its nose into their practice. They nearly derailed the creation of health insurance in 1970 with their brawling.
That's why they've hoarded their independence, despite having just one client. Seems like they've found the best of both worlds!
Same with their pay structure — per act. It encourages them to work more alright, but it ain't necessarily boosting population health. Lots of acts are redundant and superfluous.
Some doctors have managed to build themselves a veritable fortune by milkin' this system — pumpin' out more paid acts or shying away from complicated cases. Not exactly healthy, now is it?
With over 13,000 acts, this system's turned into an absolute clusterf*ck. Even doctors are struggling to navigate it, and 90% of them employ specialized firms to handle billing.
All this complexity is a nightmare for medical federations trying to ensure fair remuneration across all specialties.
But that review's a real squeaker, as highlighted by a lawsuit from pediatricians accusing the Quebec Federation of Specialists of injustice.
And as the Auditor General has underlined, this messy system has been costing Quebec taxpayers millions of dollars for years. They've been footing the bills for doctors who were billin' without actually seein' patients, thanks to certain medical innovations.
In any other industry, technological advancements usually mean lower prices for consumers. But in healthcare, doctors end up winin' when tariffs for acts they can now perform more swiftly due to new tech aren't reduced.
In his Bill 106, deposited last Thursday, the Minister of Health wants to be able to adjust tariffs to achieve a better balance. By reallocating funds, more attractive opportunities like home medical practice could be created.
But the bill's primary objective is a shift towards "capitation" — half of doctors' pay would come from flat rates for each patient they look after.
Instead of the protectionism fostered by fee-for-service, flat-rate remuneration encourages teamwork and delegation of tasks to other professionals, such as nurses and social workers. This would enable family doctors to focus on tasks only they can perform.
But transitioning to capitation without setting productivity targets for doctors would be risky.
Christian Dubé wants 25% of doctors' remuneration to depend on meeting targets. His goal is to ensure that every Quebecker has access to a family doctor by 2026. Right before the next elections, 17% of patients are currently without a family doctor.
The Fédération des médecins omnipraticiens du Québec (FMOQ) considers this goal unrealistic, stating that 1500 more family doctors are needed.
While the number of doctors has increased in Quebec, salary increases appear to have motivated some of 'em to slack off a bit.
Some doctors are workaholics, but about a third bill for three days or less per week. Current staffing levels suggest there's plenty of room to improve.
The specifics of the bill remain vague. A lot of details will be ironed out through regulations, which doctors are rightfully uneasy about.
Beyond patient coverage targets, it's essential to measure the quality of services with various indicators, such as readmission following a visit or chronic disease follow-up.
Above all, it's crucial to guarantee patients can acquire an appointment with a healthcare professional within a reasonable timeframe. Otherwise, it's all smoke and mirrors.
Given the pitiful state of the healthcare network, it's understandable that Quebec wants to move swiftly. But the bill's catchin' doctors by surprise, especially as their unions are currently in negotiations. They're bein' presented with a brand-new compensation model based on idyllic conditions that don't yet exist on the ground.
For more insights:
- Read the article "Pediatricians' request for injunction against their union"
- Consult the report of the Quebec Auditor General on doctors' remuneration.
- The current physician compensation model, based on per-act remuneration, encourages doctors to work more but may not necessarily enhance population health, as it allows some doctors to accumulate wealth through redundant and superfluous acts.
- The Quebec Minister of Health, Christian Dubé, aims to set performance objectives and indicators for doctors, which has caused dissent among medical unions sensitive about their autonomy.
- The proposal to shift towards "capitation" - half of doctors' pay coming from flat rates for each patient - would encourage teamwork and delegation of tasks to other professionals, like nurses and social workers, allowing family doctors to focus on tasks only they can perform.
- The bill's primary objective is to transition towards capitation and set productivity targets for doctors, with 25% of doctors' remuneration depending on meeting targets, to ensure that every Quebecker has access to a family doctor by 2026.
- The Fédération des médecins omnipraticiens du Québec (FMOQ) considers this goal unrealistic, stating that 1500 more family doctors are needed to achieve it.
- Beyond the patient coverage targets, it's essential to measure the quality of services with various indicators, such as readmission following a visit or chronic disease follow-up, and guarantee patients can acquire an appointment with a healthcare professional within a reasonable timeframe.
