Isn't it time to reduce fees for older docs?

In an email on Aug. 19, Dr. Nancy Whitmore, Registrar and CEO of the College of Physicians and Surgeons of Ontario (CPSO) announced that the college would encourage those recently retired to reactivate their licences with no application fee and a flexible approach to re-entry. Dear Dr. Whitmore: In response to your e-mail of August 19, 2022, I applaud your efforts to encourage recently retired physicians to return to the workforce. We now face a severe shortage not only of nurses, but of practising MDs. A recent Angus Reid poll found that only 14% of patients have a doctor and can get an appointment quickly. Although 80% have a family physician, half are unable to see their MD within a week. There is also a shortage of medical and surgical specialists with long wait times to see them in an office. Yet due to burnout, COVID-19 and income constraints, many nurses and physicians are leaving the workforce prematurely. As the saying goes, “It is difficult to fill a bathtub with the drain open.” Read: Can we blend Canada's public and private systems? Thus, in addition to fast-tracking the licensing of foreign graduates, we need to do whatever it takes to provide incentives to retain existing physicians and other health professionals. I respectfully suggest another option that might encourage older physicians to delay retirement and continuing to provide service to patients, namely a reduction in their annual fees. Older physicians are working fewer hours and paying a much higher portion of their gross income on overhead, and in Ontario—like the nurses—have received only a sub-inflationary 1% fee increase. If they receive a renewal invoice from the CPSO for nearly $2,000, many may feel that this is the “last straw” and decide to retire. For many years, the Royal College of Physicians and Surgeons of Canada, with 47,000 members, has offered a reduced fee to “long-term fellows” (i.e., active fellows with at least 40 years of membership). Currently this is $247, as compared with the regular annual fee of $990. The College of Family Physicians of Canada, with 38,000 members, discounts their national portion of annual fees from $823 to $559 for MDs aged 65 and over, and the Ontario chapter discounts its fees from $246 to $126. Those aged 70 and older can become “Life Members” with no annual fees. Younger physicians, especially general internists, derive much of their income from work in hospitals, where there is little or no overhead. Most older family physicians, general internists and medical sub-specialists in their later years have a predominately office-based practice. A number of surgeons work in private free-standing facilities. Many incur overhead charges of 40-50% of gross income. At the same time, many are working only part-time in the years prior to total retirement. Read: We need more privatization to save our crumbling health system A significant discount in annual fees should be affordable to the CPSO and to other provincial and territorial colleges. The COVID-19 pandemic greatly reduced the number of operations and other procedures, as well as the number of face-to-face interactions between physicians and patients. This likely resulted in a drop in the number of complaints and malpractice claims. This may partially explain the fact that a year ago, the CMPA reduced its fees for Ontario MDs by 20%, those from Quebec by 45%, and B.C. by 16%. Furthermore, the CMPA just announced an additional fee reduction of 45% for members living in Ontario, 56% for those in B.C., Alberta, and Quebec, and 90% for Saskatchewan, Manitoba, the Atlantic Provinces, and the Territories. The CPSO seems to have benefited as well. Unfortunately, I do not have figures for 2021, but committee costs fell from $11.9 million in 2019 to $9 million in 2020, and staffing costs from $49.4 million to $47.9 million. Total expenses dropped from $75.6 million down to $69.2 million. Revenues from membership fees was about $66 million and total revenue was about $80 million for both years. More than 15% of family physicians and 16% of medical and surgical specialists are aged 65 or over. In the near future, I suggest that the CPSO offer a greatly reduced annual fee to physicians and surgeons aged 65 or 70 and older, so hey will be encouraged to remain in the workforce and shorten wait-times for patients. Hopefully all colleges of physicians (and nurses) in other provinces and territories will follow Ontario’s lead. This should improve retention of older physicians and nurses, and help to alleviate the nation-wide shortage of health professionals. Please forward this letter to the appropriate persons and committees. Thank you very much. Ottawa physician Dr. Charles S. Shaver, AB, MD, FRCPC, FACP, is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association. Read: Most healthcare in Canada is publicly funded, privately delivered

Isn't it time to reduce fees for older docs?

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