An Australian Audit Of Vaccination Status In Children And Adolescents With Inflammatory Bowel Disease

Table 1. Australian National Immunization Program (NIP) Schedule The primary aim of this study was to describe the compliance with current Australian guidelines for vaccination of children and adolescents diagnosed with IBD current at the time of the study [ 19 ]. A secondary aim was to review the serological screening for VPD in patients with IBD. Methods A multi-faceted retrospective review of immunization status was undertaken, with the inclusion criteria being age 0-18 years at diagnosis and on the IBD register. There were a total of nine gastroenterologists working across the two tertiary units [RCH and MMC] at the time of the study. Hospital records of all participants were audited, with any vaccinations administered recorded in the outpatient notes and/or a medication chart if administered at the RCH Immunization Drop-in-centre. A telephone interview survey was conducted with consenting parents using the parent-held child immunization record. The vaccination history was checked against the primary care physician and ACIR records. The routine primary childhood vaccinations and administration of the recommended additional influenza and pneumococcal vaccines was clarified. Therapies were categorized into four groups: ASA derivatives (sulphasalazine, osalazine, mesalazine and balsalazide); oral corticosteroids (prednisolone); immunosuppressive agents (azathioprine, methotrexate) and biologics (infliximab). The RCH patient’s hospital laboratory results were reviewed to identify if any baseline serological testing was performed to review the requirement for additional protection against VPD such as varicella and hepatitis B.

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Specialist numbers jump 11%

The numbers are affected by changes made in the way the AIHW categorises specialities. But even between 2011 and 2012 the growth in specialists was twice the growth in FTE GPs. Back in 2011, Jim McGinty, the chair of Health Workforce Australia, warned that specialisation had “gone too far”, claiming it was being driven by forces within the medical profession itself. He added that the capacity of GPs, generalists and support workers was not “being sufficiently valued or managed”. The AIHW report shows two-thirds of doctors were trained in Australia. It also reveals the small numbers of women in certain specialties, including in gastroenterology and hepatology. Only 18% of gastroenterologists and hepatologists are female, the report reveals, compared with 26% of specialist physicians overall. There were 612 gastroenterologists and hepatologists practising in Australia in 2012, the report said. Australian Institute of Health and Welfare: Medical report 2012 . Record numbers of doctors are working in Australia, but the growth of specialists still appears to be outstripping the growth in GPs. Between 2008 and 2012 the number of full-time equivalent (FTE) doctors per 100,000 people increased by 9% from 344 to 374. But the workforce report , released by the Australian Institute of Health and Welfare (AIHW) on Friday, suggests that despite increases in GP numbers, the numbers of specialist doctors is rising faster. The headline figure shows FTE specialists per 100,000 of the population rose by 11% over the four-year time period more than four times the growth in GPs which rose by only 2.5%.

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Fresenius Medical Care Forecasts Decline In 2014 Profit

Kill the Medical Marijuana Bill

The discrepancy may show a shift toward caution in the way Fresenius Medical, based in Bad Homburg, Germany , communicates with the market, Jefferies LLC analysts wrote in a note to investors today. Though the companys forecast doesnt include potential savings of about $60 million from a cost-cutting program, even adding those savings still results in a forecast that misses expectations, the Jefferies analysts wrote. The shares fell 5.7 percent, the most since July 2, to 49.82 euros in Frankfurt . Fresenius SE, which owns about 31 percent of the dialysis company, declined 4.2 percent, the most since August 2011, to 114.05 euros. Against Wall Every day last year I felt like my back was up against the wall because we had guidance that was very difficult, Powell said in a phone interview. This year we tried to create what I would call adequate guidance. Photographer: Prashanth Vishwanathan/Bloomberg A patient undergoes dialysis, aided by a Fresenius Medical Care AG machine, at a… Read More A patient undergoes dialysis, aided by a Fresenius Medical Care AG machine, at a dialysis clinic in New Delhi. Close Close Open Photographer: Prashanth Vishwanathan/Bloomberg A patient undergoes dialysis, aided by a Fresenius Medical Care AG machine, at a dialysis clinic in New Delhi. Theres room for a boost to the outlook once its clear how much money the cost-cutting program will save, Powell said. Fresenius Medical is reviewing lower-performing U.S. dialysis clinics, and Powell said he expects to close some of them. Fresenius SE forecast 2014 adjusted net income will rise 2 percent to 5 percent, excluding currency shifts, slowing from last years 14 percent growth rate. The parent companys slower growth rate is partly due to the dialysis units weak forecast, plus a more cautious stance on Kabi, its intravenous drugs unit, Alexander Kleban, a London-based analyst for Barclays Plc, said in a note to investors. We question whether management is taking too-cautious a tack in order to avoid a potentially negative surprise down the road, Kleban wrote. Still Difficult A very difficult reimbursement situation for Kabis products will continue this year, Fresenius SE CEO Ulf Mark Schneider said at a press conference in Bad Homburg . Schneider declined to comment on a Reuters report last week that Fresenius may bid for Danones medical nutrition unit in a deal that may be worth about 4 billion euros.

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Plus, the Feds recently called dispensaries “untenable,” so some state officials are bending over backward to appease those capricious animals. Washington voters enacted Initiative 502 to legalize recreational pot with the explicit understandinga promise from initiative sponsor ACLU of Washingtonthat it would not affect our medical cannabis law. But it’s clear that HB 2149 has the ACLU’s blessing, and all but three house Democrats supported it. Dick move, ACLU. We all want legal pot to work here, but let’s not start sending medical marijuana growers back to prison. Maybe we could wait until we can actually buy legal pot in a legal pot store before we start gathering up the riffraff? It is ludicrous to think that medical marijuana patients with 15-plant home grows are going to undermine our new legal pot law, with its two million square feet of warehouse grows and easily accessible stores. It is certainly far too early to know one way or another, and our legislature should avoid rash decisions. Interestingly, the state senate’s Republican leadership may be the best hope medical cannabis patients have to fend off this Democrat-sponsored attack on their civil liberties. Republicans can earn points with medical cannabis supporters by shutting down this Seattle Democrat attack on medical marijuana. You can help. Contact the legislative hotline at 800-562-6000 and ask your state senator to oppose HB 2149.

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Ban Urged For Non-medical Ultrasounds

“Of particular concern are recent studies in animal models that report subtle effects on the physiology and development of the fetal brain,” the joint policy statement said. Malegus said 10 to 20 minutes is the maximum amount of time expectant moms are exposed to the ultrasound procedure, similar to the medical ultrasound. “It doesn’t replace a medical (ultrasound) and that’s not what we’re there for,” Malegus said. “The medical procedure is not there to promote bonding, there’s no bonding at the hospital (during an ultrasound) whatsoever and that’s where we come in. “It’s not just Mom and Dad that come in, it’s their (other) children, their parents, grandparents, aunties, uncles, cousins, whoever they want to involve in this life event.” An editorial in the Canadian Medical Association Journal in January 2012 stated “Research in Canada has found the strongest evidence of fetal sex selection among some Canadians of Asian descent, including people from India, China, Korea, Vietnam and the Philippines.” The CMAJ editorial said a possible solution is for information on the gender of a fetus to be withheld until after 30 weeks when “an unquestioned abortion is all but impossible.” The editorial noted the gender of a baby is “medically irrelevant information, except when dealing with gender-related illnesses.” Republished from the Winnipeg Free Press print edition February 22, 2014 0 History Fact Check Have you found an error, or know of something weve missed in one of our stories? Please use the form below and let us know. * Required In which story did you find the error? * Please post the headline of the story or the title of the video with the error. What was the error? * Please post exactly what was wrong with the story. What should we have written?

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New study shows 1 in 6 newly graduated medical specialists can’t find work

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(CBC) The Royal College report on physician unemployment and underemployment (Note: CBC does not endorse and is not responsible for the content of external links.) The dean of the Northern Ontario School of Medicine says there’s an ongoing demand for new doctors trained in various specialties in northwestern Ontario, despite a nationalstudy’s findings that some recent medicalgraduates are having trouble finding work in their fields. The dean of the Northern Ontario School of Medicine, Dr. Roger Strasser, says there is plenty of demand for medical specialists in northwestern Ontario. (Yvon Theriault/CBC) Last week, the Royal College of Physicians and Surgeons of Canada reported that one-in-sixnewlycertified medical graduatesin Canada say they can’t find a position in their specialty areas. But NOSM dean Roger Strassersaid the study was limited in scope and the findings were only broken down to a provincial level. They did not examine the supply and demand of medical specialists in specific regions like northwestern Ontario. “I think it’s important when you look at the study not to jump to conclusions,” he told CBC News, addingthe study doesn’t consider how the demand for various types of specialized medicine might change in the future. Strasser said medical specialists who have the most difficulty finding jobs are likely located in other larger urban centresin the province. Dr. Stewart Kennedy, executive vice-president of academic and medical affairs at Thunder Bay Regional Health Sciences Centre, agreed. Dr. Stewart Kennedy, executive vice-president of academic and medical affairs at Thunder Bay Regional Health Sciences Centre, says northwestern Ontario is finally gaining much-needed medical specialists. (Nicole Ireland/CBC) “Sometimes [specialists are] unable to find a position in a locality that they want,” Kennedy said. “So I think we really have to look at the distribution of physicians [geographically].” ‘Advantage’ in northwestern Ontario Kennedy said NOSMis accomplishing its goalto graduate much-needed physicians and specialists to work at the hospital and in the region. “We had challenges with human resources for a good number of years,” he said. “We have increased medical student enrolmentby … 40 or 50 per cent over the past eight years, because we’ve had such shortages,” he said. “It’s playing to our advantage in northwestern Ontario because we are able to recruit top, talented doctors [who], at one point … always wanted to stay in an academic centre in eastern Ontario.” Strasser saidthe Royal College report shows the need for better medical workforce planning at the national level to ensure doctors are trained in the specialties where there is projected demand,and available to work in the geographic areas where they are needed. “It’s really looking to plan for and ensure the supply of the right physicians with the right skills in the right places …

go to website http://www.cbc.ca/news/canada/thunder-bay/medical-specialists-still-needed-in-northwestern-ont-1.2074393

Medical specialists still needed in northwestern Ont.

Dr. Roger Strasser

The report pointed to a number of factors that have contributed to the oversupply of specialists. Poor stock market returns in recent years have meant that some older doctors most of whom must finance their own pension plans have delayed retirement. And there has been a realignment or rationalization of tasks in health care, with nurses and physician assistants taking on responsibilities that were once left to doctors, freeing them up to do some tasks that used to fall to specialists. That effect, which Lewis called sensible, will only accelerate as less invasive treatments are brought on line. For instance, angioplasty opening blocked cardiac arteries with balloons and stents has replaced many open heart surgeries to bypass blocked arteries. Lewis suggested the cycle of training specialists which typically takes about nine years is out of sync with the cycle of assessing future medical system requirements. Forecasting health human resource needs more than three or four or five years out is a fools game, because medical science changes, health needs can change, technology can change and so on. But Frechette said there are some low hanging fruit problems that should be relatively easy to address. For instance, her study noted there are jobs going for the asking. And yet while it seems inconceivable in the era of Craigslist and LinkedIn, doctors are having a hard time finding these help wanted ads. Our research did discover that there are a lot of people who cant find jobs, including orthopedic surgeons who would gladly go to where the jobs are, but they dont know where they are, she said. Lewis said there are some other adjustments the system should consider. One is shortening the period of time it takes to train a specialist, which would allow planners to adjust the course more quickly if it appeared that a glut of doctors was forming. If your whole life is going to be doing hip and knee replacements, I think one can question whether it should take nine years of training, he said. Another suggestion involves sharing the wealth. He said it isnt uncommon to hear of small communities where patients have to wait to see a specialist but the three specialists in town arent keen to let a fourth hang a shingle. I think the one thing thats clear is there wont be a spontaneous solution that employs all of these new doctors effectively.

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Ge Healthcare Completes Acquisition Of Finnamore To Form Leading Uk Specialist Health And Social Care Consultancy

Financial terms of the deal were not disclosed. The acquisition will see GE Healthcares UK consultancy arm, formerly Performance Solutions UK, become GE Healthcare Finnamore, expanding its employee base to 70, many of whom are former clinicians, engineers and management consultants. The new firm will be led by John Deverill, formerly Managing Director of Finnamore. GE Healthcare Finnamore will be focused on partnering with NHS and other UK health and social care providers to help them improve operational efficiency, clinical outcomes and patient experience. The company will offer strategic consulting capabilities across integrated care, performance transformation, organizational development, finance and change management. Finnamore brings award winning expertise and relationships built over 20 years of operating in the UK market, to complement GE Healthcares existing consultancy expertise and UK client base. John Deverill, Managing Principal, GE Healthcare Finnamore said: This brings Finnamore together with one of the worlds leading healthcare companies, both with a shared vision to improve health and well-being and to support the development of patient-focused, integrated care. We are creating an organization that can grow and broaden its capabilities to help the NHS and other health and social care providers to improve their financial, operational and clinical performance on a sustainable basis using consultancy, technology, data analytics, and capital. The acquisition is part of GE Healthcares strategy to help healthcare providers navigate some of their most complex challenges in a climate of increased budgetary pressures as chronic disease incidence increases amongst an ageing population. Karl Blight, GE Healthcares General Manager in UK, said: GE Healthcare is investing in advisory capabilities as part of the companys objective to become a true strategic partner to our customers. GE Healthcare Finnamores consultants bring a real depth of expertise to help our UK customers address many of the efficiency challenges they face day to day. Andy Ward, former head of Performance Solutions UK, who will now lead GE Healthcares consultancy work across Northern Europe while continuing to advise the UK team during the integration period, explained: NHS England recently cited a potential 30 billion funding gap by 2020-21 if services continue to be delivered in the same way. We are well positioned to help combat that, drawing from GEs heritage of performance improvement and operational management, and Finnamores experience of quality delivery in the UK. This acquisition increases our scale and expertise to help our customers optimize capacity and ensure that patients are cared for and treated as efficiently and effectively as possible. GE Healthcare Finnamore will be based in London, close to GE Healthcares global HQ in Amersham. GE Healthcare has UK facilities in Amersham, Cardiff, Hatfield and Stevenage. Related Links Every day, hundreds of individuals and companies choose WebWire to distribute their news. WebWire places your news within numerous highly trafficked websites, generating leads and publicity.

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Flourishing healthcare specialist is on the move (From Romsey Advertiser)

Romsey Advertiser: Appoint Group founder Simon Berry, lead  recruitment consultant Erin Banner and Russell Mogridge, the business space director at commercial property consultancy Hughes Ellard

Search: Flourishing healthcare specialist is on the move 11:20am Tuesday 11th February 2014 in Hampshire Business Appoint Group founder Simon Berry, lead recruitment consultant Erin Banner and Russell Mogridge, the business space director at commercial property consultancy Hughes Ellard A HEALTHCARE recruitment specialist founded in a Hampshire living room just four years ago has relocated to larger premises due to expansion. Appoint Group sources nursing professionals for private sector clients across UK, from general and psychiatric hospitals, nursing and care homes to paediatrics and GP surgeries. In a deal through commercial property consultancy Hughes Ellard, the ten-strong company signed a five-year lease on a 3,200 sq ft office at three-storey Burlington House near Eastleigh . Appoint Group, owned and run by managing director Simon Berry, moved from Solent Business Centre, opposite Southampton docks, after outgrowing space. Burlington House is one of six buildings at Botleigh Grange Office Campus, Hedge End . The quoting rent for Appoint was 18 per square foot, equivalent to 57,600 a year. Hughes Ellard represented Burlington House landlord Highcross, a property fund manager specialising in property investment and development opportunities in the UK. Russell Mogridge, the director of business space at Hughes Ellard, which has offices in Southampton and Fareham , said: Appoint Group is another example of a successful Hampshire firm, having started from humble roots. Burlington House, which is fully occupied, will serve well the needs of Appoint.” He added: Botleigh Grange Office Campus continues to attract high-calibre companies because of the excellent standard of grade A accommodation, the landscaped setting and the proximity of the M27 motorway (junction 7). Other occupiers at Burlington House are State Securities, which provides asset finance solutions for businesses, legal firm Clarke Willmott, and Gleeds, the international management and construction consultants. Simon, a career recruitment consultant who graduated in business from Southampton Solent University , said: Appoint Group was founded from humble beginnings before the hiring of staff quickly meant relocation to Solent Business Centre after just a year. Demand for our services is such that there are now ten of us and, with plans to increase the team by at least 50 per cent every year, Burlington House matches our future expansion requirements. It is also an exceptionally smart and professional campus where we will be proud to host our clients. He added: The healthcare sector is dependent on particularly detailed and complicated legislation, especially surrounding recruitment and the introduction of new staff.

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Ottawa Medical Specialists Head To Egypt And Syria

Demand high but medical specialists not finding work in Canada

David Cain, a flight paramedic with 19 years of experience in war-zones and disaster areas paired up with Dr. Mohamed Omar, who directs FMTCC, a training and consultancy agency for doctors. The two will start in Egypt and make their way to Syria. The fighting in Syria has taken a devastating human toll, with the UN estimating that more than 100,000 people have been killed. The idea to go to the two countries started out just last week and the pair have already received more than $50,000 worth of medical supplies. Among the supplies donated to the pair are ventilators, breathing masks, injections to counteract the effects of chemical weapons and an ambulance. “It’s incredible to see. It makes me very proud to be a Canadian,” said Cain. “We know that it’s going to reach the people who are most needy,” he said. Omar moved to Canada from Egypt eight years ago and said he didn’t expect to get so many donations in such a short period of time. “Everybody here in Canada try (sic) to help any people any where in the world, so living here is very nice,” said Omar. They plan on leaving in the fall. @YahooCanadaNews on Twitter, become a fan on Facebook You Might Like

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Once trained, family doctors and many other primary-care physicians, like pediatricians or psychiatrists, can simply hang out a shingle and start billing for their services. Surgeons and others who require expensive infrastructure like operating rooms to do their jobs, are often hired by hospitals or health regions. A cardiac surgeon, for instance, costs a hospital $1.5 million a year, though the doctors income is only part of that, said Ms. Frechette. Physicians say the job market has been tightened in part because the expected wave of retirements has yet to materialize, with many older doctors deciding to keep working after investment losses. Sometimes, as well, the jobs are out there, but might require a new specialist to relocate across the country, not always easy if they have working spouses and children, said Mr. MacLean. Yet in areas where demand for doctors is still high, budget-constrained health institutions are often not hiring the additional specialists recently churned out, medical leaders say. I dont think there was downstream planning as to How do we accommodate them once theyre finished? said Dr. Johnson The problems can also be traced back to medical schools, where there is scant science behind deciding how many positions to allot to each field, said Dr. John Haggie, president of the Canadian Medical Association. We dont know as a nation or a province or a jurisdiction what kind of physician population we actually need going forward, he said. As a result, people often take a fairly opportunistic, almost random career path, and end up with skills that are fairly focused and difficult to accommodate where they want to be. Successfully predicting needs is not necessarily easy, given the five-year lag before a medical-school graduate finishes specialty training. Ms.

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More Specialists Question Safety Of Testosterone Therapy For Older Men

Food and Drug Administration about the potential hazards of using testosterone supplements in older men, another group of experts is raising concerns about the popular treatments. In a statement, specialists in hormonal therapy at the Endocrine Society said the risks and benefits of testosterone supplements for older men with age-related declines in testosterone levels must be investigated more carefully. Older men considering such regimens should be warned about the possible risks, particularly heart-related events such as heart attack and stroke, the group said. The Endocrine Society issued the warning after three recent studies revealed testosterone may not be safe for older men with a history of heart disease. The studies found these men had more heart-related events than men not on testosterone therapy . For example, in one study published recently in the journal PLoS One, an increased risk of heart attack was found in men younger than 65 with a history of heart disease , and in older men even if they didn’t have a history of the disease. Testosterone therapy has been widely advertised as a way to help aging men improve low sex drive and reclaim diminished energy, and use of the supplements is on the increase. Although the FDA approved testosterone therapy for the treatment of diseases involving the testes, pituitary and hypothalamus, it has not been approved for treating age-related declines in testosterone levels. Earlier this month, the FDA announced it is “investigating the risk of stroke, heart attack and death in men taking FDA-approved testosterone products,” based on the recent studies. The U.S. National Institute on Aging is also expected to release the results of research on the safety of testosterone. The study involved roughly 800 older men with low testosterone and symptoms associated with this condition, such as sexual and physical dysfunction. Since the men’s heart health was carefully monitored, the research is expected to shed more light on the safety of testosterone therapy. The Endocrine Society added that more large, randomized controlled studies are needed to investigate the risks and benefits of the treatment for older men. Meanwhile, the group advised that middle-aged and older men who are thinking about using testosterone therapy to treat age-related declines in this hormone should be warned about the possibility of heart-related side effects. The group said it is especially important for men who’ve had a heart attack, stroke or other heart-related event in the past six months to avoid testosterone therapy.

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B.C. medical specialists struggle to find work

In B.C., the number of unemployed specialists was slightly higher than the national average at 16.5 per cent. The findings are counter-intuitive, given patient complaints about accessing timely care and surgery. aNever in my medical career have I even heard of unemployed doctors, until now, so this comes as a real surprise,a said Dr. William Cunningham, president of the B.C. Medical Association. Cunningham has been practising medicine since 1986 and works in a hospital emergency department on Vancouver Island. The report doesnat address the issue of whether there are too many specialists for the Canadian health care system, in which operating room time and budgets are fixed. But it makes it clear that doctors are competing for resources, including operating rooms, hospital beds and money to pay their fees. The report also pinpoints reasons why newly certified specialists are having trouble finding work: older doctors are delaying retirement; established surgeons are protecting their precious (often only one day a week) operating room time so young doctors arenat getting the hospital/surgical positions they covet; and a lack of cohesion in medical resource planning and coordination between medical schools, governments and hospital or health care authorities. As well, there are relatively new categories of health professionals encroaching on doctorsa territory, such as advanced practice nurses, nurse practitioners and physician assistants. Respondents to the survey were graduates of Canadaas 17 medical schools and/or Canadian residency training programs in fields such as cardiac surgery, neurosurgery, nuclear medicine, ophthalmology, radiation oncology, urology, critical care, gastroenterology, general surgery, hematology and medical microbiology. The report does not include data on family doctors. While about one in five specialists or subspecialists said they are having challenges finding jobs, another 22 per cent of newly certified specialists said they are taking locum positions or other various part-time positions. Locums assume another doctoras duties during holidays or extended absences. In the survey, 40 per cent said they werenat happy they had to do that. The report draws attention to the fact that more than half of the respondents said they hadnat received any career counselling about the most promising job prospects while doing their training.

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Canadian Heroes Confront Horrors Of South Sudan Homeland

Most of the Canadian doctors in South Sudan were among the Lost Boys who escaped from civil war in the 1980s and walked on marathon journeys to Ethiopian refugee camps. As an 11-year-old in 1983, Dr. Bior heard the big guns booming at the beginning of Sudans second civil war. His mother told him it was just a thunderstorm, but he saw the soldiers and fled into the bush. His mother thought he was dead, until an aunt found him. A year later, with bodies littering the streets, he walked away from the town. Like thousands of other refugee children, he walked for weeks through the bush, avoiding militia ambushes and eating fruit to survive, traumatized by the sight of dying civilians, before crossing into Ethiopia. At a refugee camp, rebel leader John Garang told the children they must be fighters of a different kind: engineers and doctors to build their homeland when it won independence. He knew this country would need us in the future, Dr. Bior said. He was among the 600 children who boarded Soviet ships and planes for the journey to Cuba. After graduating from medical school there, some were accepted by Canada as refugees. They were not allowed to practise medicine, so Dr. Bior became a warehouse labourer, while Dr. Lul worked in a factory.

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CANADIAN DOCTORS DEMAND MORE PAY

It cited tax figures indicating that between 1971 and 1977 lawyers, dentists and accountants increased their incomes at a much faster rate than doctors. In Ontario, according to an association spokesman, the average net income for a doctor is about $53,000 a year. The doctors want their yearly incomes increased to well over $100,000 in some cases, and Mr. Geekie acknowledged that it was difficult to get support for this from ordinary Canadians making much less. Talks Break Down, Then Resume Ontario doctors were particularly upset last week when the provincial government tried to impose new fee schedules when negotiations with their representatives broke down. Although there have been further talks since then, many doctors saw the government’s move as the start of a process that could lead to state medicine and the transformation of doctors into salaried civil servants. The present Ontario fee schedule allows about $7.80 for an ordinary office visit, about $114 for an appendectomy and about $230 for complete obstetrical care over 11 months. Ontario has been proposing to raise these fees by some 10 percent a year over three years, while the Ontario Medical Association has been demanding twice that amount so doctors can ”catch up” with inflation. Talks in the last few days have narrowed the gap somewhat, and there was a possibility of an accord over the weekend. In Ontario 15 percent of the doctors do not participate in the system at all and charge what they like. Their patients recover part of the costs from the Ontario Health Insurance Program, to which almost all Canadians belong for about $19 a month for a single person and about $38 a month for a family; this fee also covers hospital costs. Some Bill for Extra Amounts Most doctors in Ontario and the rest of Canada accept the present system of publicly financed medicare because it helps to assure them of a minimum income. But in some provinces doctors are billing for amounts beyond those prescribed in the schedules.

article http://www.nytimes.com/1982/04/25/world/canadian-doctors-demand-more-pay.html