As feds and provinces squabble, what do Canadian docs actually need?

“I think what we were hoping for was to see cooperation and collaboration between levels of government toward solutions in what is our failing healthcare system. And I think, unfortunately, that we fall very short of that mark.” —Dr. Katharine Smart, CMA past-president Manitoba Premier Heather Stefanson recently reiterated the need for Ottawa to increase the Canada Health Transfer from 22% to 35%. But at a federal-provincial/territorial meeting in Vancouver, Federal Health Minister Jean-Yves Duclos argued that the provinces’ focus on dollar amounts and health transfer percentages was a “futile fight,” and the premiers should instead focus on achieving results, such as recruiting and retaining health professionals. Read: Isn't it time to reduce fees for older docs? Duclos refused to indicate how much additional money he was prepared to transfer to the provinces. Before the meeting was over, the premiers sent a letter indicating that no progress had been made. Duclos then indicated that he was “disappointed and a bit angry.” Meanwhile, Quebec Premier François Legault asserted, “Mr. [Justin] Trudeau thinks he’s better than (health minister) Christian Dube at choosing how to spend the money.” Stephen Lewis stated that the provinces would have a greater chance at success if they collaborated more on items that they all should seek to improve. Instead, “The only thing they seem to be able to unify on is keeping Ottawa the hell out of it.” Can this impasse be resolved? Certainly, the current situation is dire. Emergency departments across Canada have closed for days at a time, and physicians and nurses have retired early. About five million Canadians have no family physician. What can be done? Read: Can we blend Canada's public and private systems? Medical and nursing school enrolment is increasing, and the licensing of foreign graduates is to be fast-tracked. The Canadian Medical Association is advocating for a nationally portable medical licensure. As a start, there has already been interest in regional licensure among the Atlantic premiers. Several experts have proposed team-based care with salaries and fringe benefits for physicians. In addition, as I outlined in my previous article of October 23, we also need incentives to keep older physicians working as long as possible. Across Canada, more than 15% of family physicians and 16% of medical specialists are aged 65 and over; a decade ago it was only 10%. I therefore propose government-funded short-term income stabilization. Physicians may need to be off work for a few weeks or months due to a heart attack, severe infection such as COVID-19, resection of a malignant bowel or breast tumor, prostate or cardiac surgery, depression, a knee or hip replacement, etc. Sadly, private disability insurance is usually unobtainable past age 65. Most important as a precedent are the maternity benefits offered across Canada. Ontario has a Pregnancy and Parental Leave Policy. Most provinces pay benefits for 17 weeks. Amounts vary from $1,000 per week in British Columbia to $1,300 in Ontario to $1,500 in Nova Scotia. Quebec has a complicated plan that pays a lump sum and then higher benefits for only 12 weeks. Note that ALL provinces have these benefits. They have been in existence for at least 15 years. Once one province negotiates such a benefit, the others quickly follow. Younger physicians are mobile, and some may leave for provinces that do offer these benefits. With the prospect of nationally portable medical licensure, this will put great pressure on Quebec if it is the only province that opposes benefits such as short-term disability for older physicians. Readers who are younger physicians may initially feel that these matters do not concern them. However, before long, they will be age 65 and over, and will be grateful that the disability plan was put into place. Although governments often get away with physician fee freezes and even cutbacks with little public disapproval, even those who perceive MDs as being overpaid would oppose cancelling fringe benefits once given. I therefore propose that all provinces and territories provide the following: Practising physicians and surgeons would be covered from age 65 to at least 80, with no waiting period. The MDs would receive 70-80% of their average monthly billings for 60, or preferably 90 days. At the Francophonie Summit in Djerba, Tunisia, Quebec Premier Legault met briefly with Prime Minister Trudeau. According to Legault, they agreed to meet again in December to discuss—among other things—health transfers. Quebec, Ontario, and Manitoba, with provincial deficits, in particular need additional federal healthcare funding. For Ottawa to subsidize such a program would be an example of targeted health transfers which would help to “retain health professionals” just as was stressed by Duclos in Vancouver. Yet by claiming exclusive provincial jurisdiction, Quebec may well protest any “strings attached” to indirect federal funding of physicians. Ottawa could then simply pay them directly. Recall that the Interim Federal Health Program pays physicians treating refugees directly at provincial/territorial health insurance rates. MDs are also paid directly by Ottawa for treating federal prisoners and until 2013, were paid directly for members of the RCMP. It is time for all provincial governments to provide their physicians with financial benefits such as short-term income stabilization. These will help to keep older physicians in the work-force—even part-time. Some 80% of patients seeking help in emergency departments could have been managed otherwise by family physicians. Hence, this will lessen the burden on these understaffed, overcrowded facilities. Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association. The views here are his own. Read: We need more privatization to save our crumbling health system

As feds and provinces squabble, what do Canadian docs actually need?

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