Thread by @DennisKendel

Much has changed in my profession since I commenced family medicine practice in Saskatoon in 1972. Some of the changes that are now in progress or are pending are very positive. Others are disappointing. I'll focus on the positive changes first (1/18)

From the very outset of my career I was frustrated with Fee-For-Service (FFS) physician compensation as it tended to much more generously reward MDs focused primarily on procedural services & poorly compensate those spending time talking with patients (2/18)

In hope of addressing this compensation inequity, I became actively involved in leadership roles with the Saskatchewan Medical Association (SMA) culminating in my service as SMA President in 1979-80 (3/18)

The SMA would negotiate periodic increases in government funding for MDs & then exercised control over the allocation of those funds between the diverse array of medical disciplines. The procedural disciplines often argued that there work was more difficult (4/18)

When a new surgical procedure was introduced, it was often viewed as very complex & warranting high compensation. However if evolving technology reduced the complexity, the fee would never be lowered. Cataract extraction is an example of that phenomenon. (5/18)

I also yearned for the opportunity to work more collaboratively with other healthcare personnel in the provision of primary care services. That was not possible when all staff had to be funded from a family doctor's professional income (6/18)

So I am ecstatically supportive of the work now being led by the SMA to implement team based primary care and abandon FFS compensation for family doctors. I wish I were young enough to return to practice under such a model! (7/18)

On the flip side I am also seeing some emerging trends among procedurally focused medical disciplines that I find disappointing and disturbing. I see a concerted effort to expand the range of services they provide external to the Canada Health Act. (8/18)

The language of the Canada Health Act decrees that all "medically necessary services" shall be publicly funded. Cosmetic surgery has never been publicly funded. However almost all other medical services are deemed "medically necessary" (9/18)

When a new service was launched by any medical discipline, that discipline would ask the provincial/territorial Medical Association to insist that a fee code for that service would be added to the FFS Payment Schedule (10/18)

The inclusion of the service on the publicly funded Medical Payment Schedule would ensure that the service would be accessible by all citizens without direct payment on their part. (11/18)

If there was a wait time for access to the service , access would be medically managed based upon relative urgency of each patient's condition as opposed to ability to pay privately. Diagnostic imaging (DI) services would be an example (12/12)

When ultrasound was introduced as a new technology fee codes for this service were promptly implemented for radiologists and obstetricians/gynecologists. (13/18)

However it is noteworthy that fee codes for CT and MRI have never been introduced into the SMA payment schedule. CTs and MRIs performed in hospitals are funded through hospital budgets. Some of these procedures in private clinics are publicly funded (14/18)

I have summited a FOIP request to determine the what fee is currently paid to private clinics in Saskatchewan for each MRI and CT service but, to date, my request for information has not been honoured. (15/18)

The exclusion of an fee code for MRI in the SMA MSP payment schedule means that private clinics are bale to set their own "market prices" for people able to pay privately to circumvent the wait lines (16/18)

In follow up to recent events in Alberta I did some research on Medical Imaging Consultants, MIC which is Alberta’s largest #radiology partnership with 96 subspecialized radiologists, over 450 technologists, & 13 clinics. I reviewed their twitter account @MICimaging (17/18)

I found on their Twitter timeline multiple instances of public advertising for DI services that are not publicly insured. This is a disturbing new trend by some MDs to create & sustain a parallel private system which is much more lucrative but inequitable (18/18)

@threadreaderapp Please roll up