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Old Nov 3rd 2017, 10:18 pm   #1
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Default A conversation and debate re Canada FP health services v UK NHS

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Originally Posted by Wanderingdoc;12374327I
guess this would be an income-generator, but clearly a commitment is required longer term.
required.

There is mention of taking on retiring GP’s lists (even in part, which I guess, could almost mean cherry-picking higher income generators?) so this may be a quick way to increase my list size. Out of interest, what type of patients would be an ideal balance between higher billing and keeping your sanity whilst consulting? ;-)
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We have our own practices and belong to the local Division so one doesn't have to do the NH stuff. We see our own NH patients and get remunerated accordingly. There may a move to get us to cover say more patients in the homes centralizing the process and making it efficient. College doesn't like cherry picking although it does happen.

Taking on a list saves a lot of work if the retiring Doctor is good and ideally has charting on EMR. Avoid loading your list with youngsters, it doesn't pay the bills. Older people get more stuff going wrong and need your services more. Chronic disease management fees ease the pain.
Bejaysus whatever happened to the Hyppocratic Oath? What's all this shit about maximising income streams?
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Old Nov 3rd 2017, 10:28 pm   #2
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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Originally Posted by Novocastrian View Post
Bejaysus whatever happened to the Hyppocratic Oath? What's all this shit about maximising income streams?
Don't forget, doctors will soon be eligible for taxation, they have to be prepared.
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Old Nov 3rd 2017, 10:28 pm   #3
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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Bejaysus whatever happened to the Hyppocratic Oath? What's all this shit about maximising income streams?
Yeah we sign that with blood at qualification... Oh hang on, no, I use medical evidence and not obey " the healing gods" of ancient Greece

Greek gods don't pay the bills. Where Family physicians are scarce then the older population typically have greater need to have a regular family physician irrespective of recompense to the physician to look after often multiple significant pathologies.

Youngsters needing the pill with busy jobs often find walk in clinics more convenient. Complex medical patients do not do well with piecemeal consultations with multiple clinicians at WICs.

Oh... It's Hippocratic, as in the animal BTW

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Old Nov 3rd 2017, 10:29 pm   #4
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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Don't forget, doctors will soon be eligible for taxation, they have to be prepared.
Yeah, like we haven't been paying taxes already... that green eyed monster
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Old Nov 3rd 2017, 10:34 pm   #5
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

Wanderingdoc, occasionally cattle come lumbering into this thread, it is never clear why... they are harmless but do emit a fair bit of methane so stand well back and avoid naked flames
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Old Nov 3rd 2017, 10:48 pm   #6
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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Wanderingdoc, occasionally cattle come lumbering into this thread, it is never clear why... they are harmless but do emit a fair bit of methane so stand well back and avoid naked flames
Thanks for the heads-up on that one. I was about to bite, but refrained, having a brief recollection of the retort your other half offered up to the an accountant who had a rant at docs not too far back in this thread. I don’t mind answering (civil mannered) questions when it comes to our profession, perhaps to clarify thinking, but have little time for rudeness I’m afraid and prefer not to engage.
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Old Nov 3rd 2017, 10:57 pm   #7
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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Thanks for the heads-up on that one. I was about to bite, but refrained, having a brief recollection of the retort your other half offered up to the an accountant who had a rant at docs not too far back in this thread. I don’t mind answering (civil mannered) questions when it comes to our profession, perhaps to clarify thinking, but have little time for rudeness I’m afraid and prefer not to engage.
I love these two really, we do need the wider grumpy old man demographic represented on the forum but sadly they are on occasion a bit clueless. As I say, they will wander back to their field once they get bored.

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Old Nov 3rd 2017, 11:00 pm   #8
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

Said accountant does know what he is talking about btw and came up with very valid points. I have no truck with that. Ignorance and needless sniping is another matter

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Old Nov 3rd 2017, 11:05 pm   #9
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

The whole concept of moving to a new and different system and way of life is actually very exciting. I guess the others (non-medics) posting have their own worldly views in various other spheres of everyday life unattached to medicine. I bet there’s actually plenty to learn from them of value from their journey into new lands. Look forward to it actually. The BE forums seem great so far, albeit from the little I’ve read on it.
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Old Nov 4th 2017, 12:09 pm   #10
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

Diary of a GP
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Old Nov 4th 2017, 12:27 pm   #11
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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Makes for almost macabre reading.

To those who have made the move to Canada, how does it compare? On a day to day basis that is.
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Old Nov 4th 2017, 11:50 pm   #12
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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that green eyed monster
For a while, one of my daughters dated a son of the head of orthopedics at the Mayo Clinic. That family had a lifestyle that gave me pause; a string of islands, some aeroplanes to get to them. Ordinary doctors not so much.

The reason your tax avoidance and income maximization posts invite comment is just the scent of hypocrisy, tax avoidance by people who create wealth and employment is one thing, tax avoidance by servants of the state providing a necessary service is another. Doctors enjoy a degree of respect in society which is not consistent with an attitude of income optimization.

FWIW, I've ordered the plate "SIOH" for my toy car. Safe Income On Hand is a CGT avoidance measure by which I have funds for the car. I am not claiming to be poor nor a diligent tax payer but I'm not taking government funds nor looking to be a pillar of the community.
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Old Nov 5th 2017, 1:10 am   #13
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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For a while, one of my daughters dated a son of the head of orthopedics at the Mayo Clinic. That family had a lifestyle that gave me pause; a string of islands, some aeroplanes to get to them. Ordinary doctors not so much.

The reason your tax avoidance and income maximization posts invite comment is just the scent of hypocrisy, tax avoidance by people who create wealth and employment is one thing, tax avoidance by servants of the state providing a necessary service is another. Doctors enjoy a degree of respect in society which is not consistent with an attitude of income optimization.

FWIW, I've ordered the plate "SIOH" for my toy car. Safe Income On Hand is a CGT avoidance measure by which I have funds for the car. I am not claiming to be poor nor a diligent tax payer but I'm not taking government funds nor looking to be a pillar of the community.

This response simply supports post 701. Both yours and Novocastrian's language seem to suggest that the pair of you are stuck in some sort of time warp "servant of the state", "Hippocratic Oath" "Pillar of the community"...

You use rather a somewhat bizarre reference to back up your argument which confirms your lack of knowledge as to the general medical profession in Canada. What relevance an orthopedic surgeon who may well have inherited money prior to becoming an orthopedic surgeon but also one who works in the United States whose health system is completely skewed and not comparable with that in Canada, somewhat defeats me.

You clearly subscribe to the Trudeau one trick pony line rather than an informed one, both of you come across as embittered and somewhat vindictive. You have absolutely no idea how much tax I pay so don't try and preach to me about how guilty I should feel when trying to advise newly arrived doctors as to how to set up their business.

It may seem a somewhat alien idea to you that doctors have businesses here, employing several people-lt is different in the UK but there again you are evidently speaking without accurate knowledge to back up your argument, something that you seem to do frequently on this forum.

As I said in post 633, I have absolutely no problems discussing matters with somebody who knows what they're talking about-in that case JonboyE rather than someone who clearly has an issue with doctors and who has simply shown his true colours.

If it irks you so much to read about doctors advising other doctors then why respond? Why not simply just ignore the thread which is essentially there to try and advise family physicians. I steer well clear of for example the immigration forum as I do not have adequate knowledge of this to guide people and also threads from say engineers asking advice which I leave in the capable hands of engineers already on the forum. It certainly doesn't put you in a good light.

The problem is that when the likes of yourself and others come blundering into the thread which is not a general thread, it is specifically one for family physicians, then I am certain that you will start dissuading either ourselves or indeed potential doctors contemplating the move here, from commenting. I would say that Canada, is certainly not awash with doctors, particularly family physicians and some of us spend considerable time off forum advising these prospective doctors -perhaps you would prefer that this thread be shut down and us simply not bother? You would be the first to moan that you cannot access medical care from those greedy doctors.

Maybe a better idea would be to allow physicians to communicate with physicians without ill-informed criticism from people such as yourself about how we should and shouldn't run our businesses. I would never presume to do that with you but you somehow feel that is okay for you to do so.

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Old Nov 5th 2017, 6:40 pm   #14
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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Makes for almost macabre reading.

To those who have made the move to Canada, how does it compare? On a day to day basis that is.
I hope that this isn't representative of how all general practice is in the UK but I have suspicions that it might be. Even when we moved here in 2009 demands were ramping up and that was in a fairly rural practice not an inner city one that was described above. The problem there seems to be that there seems to be no control in the UK, the powers that be issue edicts which have to be obeyed, new patients have to be taken on despite practice lists are bursting at the seams, targets have to be met. It seems to be less about actual on the ground looking after the patients.

Here, there is more control, there is a lot less tick box medicine. Patients appreciate you and when we have a holiday in the Summer, they say that it is good to recharge batteries, they don't want a knackered burnt out doctor. They seem to be a lot litigious - in the UK, if someone got cancer, weirdly someone was to blame ... Here, they accept that sh1t happens.

We work hard, we can work our choice of hours, at the moment we see patients between 8.30am to 12.30pm and 1.30pm-5pm although there is usually overrun. We deal with incoming lab results, electronic letters from patients, deal with pharmacy requests, phone patients, probably much like the UK between patients or at lunch or in the evening depending on how organised you are.

The ridiculous culture of home visits does not exist here. This was crazily time consuming in my UK practice as patients were scattered all over the practice area. Somehow patients manage to get into the office- in the UK patients see it as a right to get a home visit whether they need it or not- we were fairly bad-ass about visiting but still had to do a good number of them. We had an ECP who helped out with these which eased the burden.

After work, I finish charting, I like to get all referrals off ASAP so write referrals to specialists (we are our own secretaries), I personally run through the next day, going through the schedule so I am prepared. I am less organised than Snoop... She usually has most of her stuff done and dusted by the time she gets home. I often am doing stuff into the evening but don't mind as I actually enjoy my work- something which it seems is becoming more of a rarity working as a GP in the UK
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Old Nov 5th 2017, 8:44 pm   #15
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Default Re: Calling on Canadian Family Practitioners/ex UK General Practitioners

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I hope that this isn't representative of how all general practice is in the UK but I have suspicions that it might be...seems to be no control in the UK, the powers that be issue edicts which have to be obeyed...targets have to be met...
Sadly that seems to be the way of so many things in the UK...targets rather than results. It wouldn't be so bad if the targets were meaningful or controllable.
Quote:
They seem to be a lot litigious - in the UK, if someone got cancer, weirdly someone was to blame ... Here, they accept that sh1t happens.
I wonder if that's more a religious thing over here. God's will and all that...needing another angel
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