From what Canadian physicians here south of the border tell me, the deal is you are 100% in or 100% out. Sort of like the “opted-out” status with Medicare here. So to be a private doc you’d have to be in an area where you could get enough patients willing to pay out-of-pocket.

And from what I hear, the provincial governments still try to find reasons to shut down such practices, even though legal. I’m going by what the Canadian docs here tell me. Does that sound accurate?

For example, implied in this article (links to Canada.com)

http://tinyurl.com/4ot4u5

the authorities seem to be looking for ways to find a private emergency clinic to be in some violation of the law.

1. I do have an agenda – I want to lower wait times. Our practice does it with efficiency so I figured I could add something to the discussion with my blog/comments. No financial interests to declare. My name is attached to all the my posts.
2. I don’t think it’s me that’s denying the wait lists. It’s all I blog about and it’s all published in nauseating detail across Canada (see http://www.ices.on.ca for stats in Ontario). We have a problem, we’re trying to improve the situation. What I’ve taken issue with is that when people in the US talk about wait times they rarely mention what happens in County and VA hospitals. I do not have stats on this – it’s a completely anecdotal observation from the small amount of training I’ve had down there and talking with friends.
3. Free market care is our safety net, not just the US. You’re just the biggest & closest supplier of it. We have some practices up here but they are not common.
3.As far as being a “hyper-defensive booster” — I liked that line. Deep down I prefer our system but I only claim to make a study of wait times. I’ll leave it to the politicians and economists to determine the most economical model. My preference is for universal coverage but not at any cost.

Good debate/ Good posts. Thanks Ian.

Now, that may be a decent way to control costs. It may be the best way. It may not. But let’s not pretend it’s not happening.

But consider the disparity between Dr. Atkinson’s $110,000 annual income vs. the presumed average of upwards of $170,000. The real issue is not the reimbursement itself, but the context in which you consider it. Presuming that she has an overhead in the lower range at 50%, her practice’s annual per patient revenue is $73. If a practice paying the higher supposed average income had even a worse overhead at 65%, their annual patient revenue would have been a much higher $162.

In either case, the revenue generated by primary care is a very small percentage of the annual cost of care that exceeds $6000/person in the US today. Put in that context, the problem in my opinion is that primary care is essentially irrelevant to the rest of the health care industry. For a brief period in the 1980s when it appeared that FPs would be empowered to control far more than their own revenue by being designated as “gatekeepers”, hospitals took an interest in primary care because of the potential revenue that it controlled. When it turned out that this control was illusory and hospitals lost all interest in primary care in favor of contracting directly as a “preferred provider”.

Yet the problem today is even worse than one of irrelevance. I believe that hospitals today view primary care as actually harmful to their revenue. In short, what has always been criticized as “bad utilization” has always been “good revenue” to a hospital. Using as an example a patient with a migraine, treatment in my office is going to be generally considerably less than $100 even if it involves a visit in the middle of the night and even a treatment plan for future avoidance of such urgent care, which is an inconvenience to both of us, while care in an ER will likely include an imaging study, a bill of several thousand dollars, and an invitation to come back any time for more of the same.

Given that context, it’s fairly easy to see who gets the free use of a state of the art facility, a paid staff, more limited work hours, better benefits, and better income. That’s how you spell respect on a professional level.

You are the person all of us are worried about, not just Ian (who seems to have an unspoken agenda??)

I graduated with an Economics degee and after going to med school spent 5 years doing general internal medicine, so I think I have something intelligent to say about this problem in general and your situation in particular.

When you say you were denied coverage, did you mean that was because you had a pre-existing condition? Another option is to get catastrophic hospital coverage with a high deductible to protect yourself from huge medical bills and pay out of pocket for the outpatient stuff.

Another alternative is to talk to a social worker about medicaid if $1000 is too steep (and it is certainly too steep for me!)

What alot of people advocate is putting the consumer in the position of cost-controller. Currently, if you have insurance, you demand for additional medical services is infinite as you don’t pay anymore. If you pay all (or a portion), you view each test and visit very carefully. What you might do is pay (out of pocket) a general internist to give you some straight talk about what your medical problem is and what is the minimal level of care you can get by on.

I know it might seem discouraging listening to what happens on this page about declining availability of doctors, but the availability is declining for the same reason that you don’t have insurance–the numbers just don’t add up right.
b

As one who was denied regular health insurance and who can’t afford Hippa coverage at $1,000 per month, what is your proposal Kevin for coverage for someone like me?

Than you Ian for speaking up for people like me.

AA