From the link: http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high
Interesting post about why doctor salaries are high in USA.
Friday, January 27, 2012
Supply of nurses rises in Canada; 25 per cent growth in nurse practitioners
From the link: http://ca.news.yahoo.com/supply-nurses-rises-canada-25-per-cent-growth-200409270.html
An annual report released Thursday by the Canadian Institute for Health Information said there were 354,910 regulated nurses working in Canada in 2010, an increase of 8.8 per cent since 2006.
"Between 2009 and 2010, the nursing supply increased by two per cent, so if you look at the population, it increased by one per cent approximately, so we're seeing double the growth there," said Carol Brule, the institute's manager of health human resources.
The report on the supply of registered nurses, licensed practical nurses, nurse practitioners and registered psychiatric nurses is important for planning and policy decision-makers, she said.
Nurse practitioners have extra training that allows them to order certain diagnostic tests, perform some procedures and prescribe drugs and other therapies. Although their ranks are still small, the report shows they increased by 25 per cent in 2010, to 2,486.
Brule called it an "emerging profession" with a complementary role.
"They can work as part of health-care teams. They certainly have a very key role to play — they can support the work of physicians," Brule noted.
Canadian Nurses Association president Judith Shamian said it goes back to a simple message that there are about five million Canadians who don't have access to primary care — and nurse practitioners can provide that service.
She heralded the size of the increase in Ontario but said growth has been slower in other provinces.
"So the 25 per cent — hallelujah! Do we need to keep up the 25 per cent? We need to keep it up until all Canadians have proper access, and not just access, but timely access."
She also welcomed the overall growth in the nursing supply, but indicated nothing is simple in analysis of the statistics.
A report from her association a couple of years ago projected a growing shortage of nurses, yet the situation is confusing because there are nurses who say they cannot find full-time jobs.
"So it's kind of a mixed bag of things," Shamian said from Ottawa. "You will find in most organizations a fair amount of vacancies, but they might not be desired positions."
Shamian said she often hears that new graduates are working in multiple clinical areas or at more than one institution to pay their bills — making it more difficult to gain expertise in a specific discipline.
"You cannot become an expert if one day you work in maternity, the other day you work in the long-term care, and then you are in emergency room," she said, referencing the phrase "jack of all trades, master of none."
"So it's not the way to build an important workforce and a professional workforce. So yes, we have a lot more work to do in this area."
She said that in some provinces, it's difficult to recruit home care nurses because the salaries are often lower than in acute care.
"The number of registered nurses working in long-term care went down which is not good, because the people who go into long-term care facilities are sicker and sicker," she noted.
"But it's not clear to me if the numbers went down because there are vacancies or because long-term care facilities are replacing registered nurses with practical nurses, which are a cheaper workforce.
"And if that's the case, then it's a policy problem."
In terms of mobility, Brule said the "magnet provinces" of British Columbia, Alberta and Ontario were the top three destinations for work for Canadian-educated nurses who left their jurisdiction of graduation.
The age for nurses entering the workforce is often 30 or older, she said, and the 40-to-59 age group dominates the profession.
A breakdown shows that three-quarters of regulated nurses were RNs in 2010, while 23 per cent were licensed practical nurses and 1.5 per cent were registered psychiatric nurses. Those proportions have remained steady for the last five years.
There were 787 registered nurses per 100,000 population in Canada in 2010, the report said. In the early 1990s, there were 824 RNs per 100,000 population — a ratio that has not been achieved since that time.
Shamian said she's concerned that the number of managers has been going down every year.
"A manager — we have research — should be providing leadership to anywhere between 40 to 50 individuals, and if you don't have managers, then they cannot nurture and help the new graduates," she said.
TORONTO - Nurse practitioners are steadily gaining ground in Canada, according to a snapshot of nursing that shows overall growth of the workforce.
An annual report released Thursday by the Canadian Institute for Health Information said there were 354,910 regulated nurses working in Canada in 2010, an increase of 8.8 per cent since 2006.
"Between 2009 and 2010, the nursing supply increased by two per cent, so if you look at the population, it increased by one per cent approximately, so we're seeing double the growth there," said Carol Brule, the institute's manager of health human resources.
The report on the supply of registered nurses, licensed practical nurses, nurse practitioners and registered psychiatric nurses is important for planning and policy decision-makers, she said.
Nurse practitioners have extra training that allows them to order certain diagnostic tests, perform some procedures and prescribe drugs and other therapies. Although their ranks are still small, the report shows they increased by 25 per cent in 2010, to 2,486.
Brule called it an "emerging profession" with a complementary role.
"They can work as part of health-care teams. They certainly have a very key role to play — they can support the work of physicians," Brule noted.
Canadian Nurses Association president Judith Shamian said it goes back to a simple message that there are about five million Canadians who don't have access to primary care — and nurse practitioners can provide that service.
She heralded the size of the increase in Ontario but said growth has been slower in other provinces.
"So the 25 per cent — hallelujah! Do we need to keep up the 25 per cent? We need to keep it up until all Canadians have proper access, and not just access, but timely access."
She also welcomed the overall growth in the nursing supply, but indicated nothing is simple in analysis of the statistics.
A report from her association a couple of years ago projected a growing shortage of nurses, yet the situation is confusing because there are nurses who say they cannot find full-time jobs.
"So it's kind of a mixed bag of things," Shamian said from Ottawa. "You will find in most organizations a fair amount of vacancies, but they might not be desired positions."
Shamian said she often hears that new graduates are working in multiple clinical areas or at more than one institution to pay their bills — making it more difficult to gain expertise in a specific discipline.
"You cannot become an expert if one day you work in maternity, the other day you work in the long-term care, and then you are in emergency room," she said, referencing the phrase "jack of all trades, master of none."
"So it's not the way to build an important workforce and a professional workforce. So yes, we have a lot more work to do in this area."
She said that in some provinces, it's difficult to recruit home care nurses because the salaries are often lower than in acute care.
"The number of registered nurses working in long-term care went down which is not good, because the people who go into long-term care facilities are sicker and sicker," she noted.
"But it's not clear to me if the numbers went down because there are vacancies or because long-term care facilities are replacing registered nurses with practical nurses, which are a cheaper workforce.
"And if that's the case, then it's a policy problem."
In terms of mobility, Brule said the "magnet provinces" of British Columbia, Alberta and Ontario were the top three destinations for work for Canadian-educated nurses who left their jurisdiction of graduation.
The age for nurses entering the workforce is often 30 or older, she said, and the 40-to-59 age group dominates the profession.
A breakdown shows that three-quarters of regulated nurses were RNs in 2010, while 23 per cent were licensed practical nurses and 1.5 per cent were registered psychiatric nurses. Those proportions have remained steady for the last five years.
There were 787 registered nurses per 100,000 population in Canada in 2010, the report said. In the early 1990s, there were 824 RNs per 100,000 population — a ratio that has not been achieved since that time.
Shamian said she's concerned that the number of managers has been going down every year.
"A manager — we have research — should be providing leadership to anywhere between 40 to 50 individuals, and if you don't have managers, then they cannot nurture and help the new graduates," she said.
Supply of doctors at an all time high and a glut may be on the horizon
From the link: http://ca.news.yahoo.com/supply-doctors-time-high-glut-may-horizon-200354011.html
Now they say that there is an excerss of doctors !!! Can you believe this ?!!!
TORONTO - The doctor shortage of a few years ago is being resolved and Canada could be heading towards a glut of physicians, data in a new report on the supply of doctors suggest.
The number of practising doctors in Canada is at an all-time high, with nearly 70,000 active physicians working in the country last year. Out-migration of doctors has declined, licensing of international medical graduates has increased and medical schools are pumping out record numbers of new doctors, said the report by the Canadian Institute for Health Information.
"I think the actual story here is — boy, this was all so predictable and guess what? It's all coming to pass," said Dr. Morris Barer, a health policy analyst with the University of British Columbia's Centre for Health Services and Policy.
"The die has been cast, our future has been set in stone, and now we watch. And I think the people who should be really worried are the funders and policy makers across the country — because the cost pressures are going to increase dramatically."
Barer doesn't think Canada currently has a glut, but he's not sure the country had a shortage a few years ago either. He said there is no magic formula for figuring out what the right number of doctors is for a country.
"Too many factors need to be taken into account in thinking about that and I don't think that there's any science that could ever determine that for you," he said.
"It's partly a function of what you're willing to pay for and what sorts of other personnel you're prepared to train to provide certain parts of health care."
But more doctors probably means the push to rationalize the delivery of care by devolving some tasks to other health-care personnel — nurse practitioners or physician assistants — may suffer, Barer suggested.
Health economist Arthur Sweetman doesn't believe Canada has a glut of doctors yet either, but suggests it might be headed that way, with large medical school intakes still underway.
The problem isn't just about how many doctors the country has, but where they are practising and what their specialty is, he said, suggesting the country may be training too many pediatricians and too few gerontologists, ophthalmologists and orthopedic surgeons to cope when baby boomers become senior citizens.
"We have the short-term glasses on right now. We need to maybe put the long-term glasses on," said Sweetman, a member of CHEPA — the Centre for Health Economics and Policy Analysis — at McMaster University in Hamilton.
"Are are we still going to need the really high numbers that we're allowing into medical school now in eight or 10 years?" he questioned. "We need to be planning a decade ahead, because it takes a decade to train a physician."
Health economists have warned that in a system that is still largely based on paying doctors a fee for every service they do, an oversupply of doctors could see more doctors doing more tests and procedures on a smaller number of patients each in order to ensure they earn a decent living.
The report on the supply of doctors was released in tandem with one that delves into what provinces and territories pay doctors.
Trying to arrive at a representative figure is complicated because the health statistics agency doesn't get enough data to report on one stream that makes up about 25 per cent of the payments from provinces and territories to doctors, said Yvonne Rosehart, program lead for the physician team in CIHI's health human resources unit.
CIHI calls that stream "alternative" payments, referring to monies paid to doctors who are on salaries in family practices, who get bonuses to work in rural areas where the fee-for-service model doesn't really work, or who get other types of bonuses.
The remaining 75 per cent of payments to doctors covers fee-for-service billings.
Some doctors would make most of their income through the fee-for-service, but others would receive payments through a mixture of the two. For instance, some physicians may work the occasional hospital shift in addition to their private practice, earning a salary per shift for the one and fee-for service payments for the other, Sweetman said.
Looking at only the fee-for-service numbers, the agency estimates that on average family doctors earned a gross income of $239,000 last year and specialists earned a gross of $341,000.
Those figures would not be a doctor's actual income — a doctor who ran his or her own office would have to cover the office overhead out of those gross figures, Rosehart said.
The report said doctors' salaries increased by 7.4 per cent in 2010, down slightly from the 9.7 per cent and 8.8 per cent increases of the previous two years.
In terms of numbers, there were 203 physicians for every 100,000 Canadians in 2010, up 35 per cent from the rate in 1980. The number of doctors per 100,000 Canadians rose in all provinces and territories — except Yukon and Northwest Territories — over the past five years.
Now they say that there is an excerss of doctors !!! Can you believe this ?!!!
TORONTO - The doctor shortage of a few years ago is being resolved and Canada could be heading towards a glut of physicians, data in a new report on the supply of doctors suggest.
The number of practising doctors in Canada is at an all-time high, with nearly 70,000 active physicians working in the country last year. Out-migration of doctors has declined, licensing of international medical graduates has increased and medical schools are pumping out record numbers of new doctors, said the report by the Canadian Institute for Health Information.
"I think the actual story here is — boy, this was all so predictable and guess what? It's all coming to pass," said Dr. Morris Barer, a health policy analyst with the University of British Columbia's Centre for Health Services and Policy.
"The die has been cast, our future has been set in stone, and now we watch. And I think the people who should be really worried are the funders and policy makers across the country — because the cost pressures are going to increase dramatically."
Barer doesn't think Canada currently has a glut, but he's not sure the country had a shortage a few years ago either. He said there is no magic formula for figuring out what the right number of doctors is for a country.
"Too many factors need to be taken into account in thinking about that and I don't think that there's any science that could ever determine that for you," he said.
"It's partly a function of what you're willing to pay for and what sorts of other personnel you're prepared to train to provide certain parts of health care."
But more doctors probably means the push to rationalize the delivery of care by devolving some tasks to other health-care personnel — nurse practitioners or physician assistants — may suffer, Barer suggested.
Health economist Arthur Sweetman doesn't believe Canada has a glut of doctors yet either, but suggests it might be headed that way, with large medical school intakes still underway.
The problem isn't just about how many doctors the country has, but where they are practising and what their specialty is, he said, suggesting the country may be training too many pediatricians and too few gerontologists, ophthalmologists and orthopedic surgeons to cope when baby boomers become senior citizens.
"We have the short-term glasses on right now. We need to maybe put the long-term glasses on," said Sweetman, a member of CHEPA — the Centre for Health Economics and Policy Analysis — at McMaster University in Hamilton.
"Are are we still going to need the really high numbers that we're allowing into medical school now in eight or 10 years?" he questioned. "We need to be planning a decade ahead, because it takes a decade to train a physician."
Health economists have warned that in a system that is still largely based on paying doctors a fee for every service they do, an oversupply of doctors could see more doctors doing more tests and procedures on a smaller number of patients each in order to ensure they earn a decent living.
The report on the supply of doctors was released in tandem with one that delves into what provinces and territories pay doctors.
Trying to arrive at a representative figure is complicated because the health statistics agency doesn't get enough data to report on one stream that makes up about 25 per cent of the payments from provinces and territories to doctors, said Yvonne Rosehart, program lead for the physician team in CIHI's health human resources unit.
CIHI calls that stream "alternative" payments, referring to monies paid to doctors who are on salaries in family practices, who get bonuses to work in rural areas where the fee-for-service model doesn't really work, or who get other types of bonuses.
The remaining 75 per cent of payments to doctors covers fee-for-service billings.
Some doctors would make most of their income through the fee-for-service, but others would receive payments through a mixture of the two. For instance, some physicians may work the occasional hospital shift in addition to their private practice, earning a salary per shift for the one and fee-for service payments for the other, Sweetman said.
Looking at only the fee-for-service numbers, the agency estimates that on average family doctors earned a gross income of $239,000 last year and specialists earned a gross of $341,000.
Those figures would not be a doctor's actual income — a doctor who ran his or her own office would have to cover the office overhead out of those gross figures, Rosehart said.
The report said doctors' salaries increased by 7.4 per cent in 2010, down slightly from the 9.7 per cent and 8.8 per cent increases of the previous two years.
In terms of numbers, there were 203 physicians for every 100,000 Canadians in 2010, up 35 per cent from the rate in 1980. The number of doctors per 100,000 Canadians rose in all provinces and territories — except Yukon and Northwest Territories — over the past five years.
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