Ontario needs to boost doctor pay and benefits

According to a recent Fraser Institute blog, when compared to 29 other wealthy countries with universal healthcare systems, Canada ranked as the third-highest spender (12.3% of the economy), behind only the United Kingdom (at 12.4%) and Germany (12.9%). Yet, Canada is 26th for MRIs, 27th for CT scanners and 25th for psychiatric beds.At present, nearly 2.3 million Ontario residents lack a family physician. Moreover, Ottawa physician Dr. Doug Gruner warned: “The crisis is only going to get worse.” By 2026, about a quarter of Ontarians will be without a family physician. There is also a severe shortage of medical and surgical specialists. This situation is present across Canada.It is due to multiple factors. There is an increased administrative burden and overhead costs for family physicians have increased. Many older specialists work part-time and are now in offices with 40% overhead, in contrast to deriving largely overhead-free income from hospital work when they were younger. Importantly, fees have not kept pace. Ontario MDs now have a gross income lower than any other province except for Newfoundland and Labrador. Read: Dr. Charles Shaver: A plea for federal action on portable health benefitsOnly 10% of applicants are accepted to Canadian medical schools, few choose family practice and many are prematurely going into another type of work or leaving the province. Increased enrollment at Canadian medical schools and fast-tracking of foreign graduates will all take time. What can be done now?In most provinces, about 15% of doctors in practice are at least age 65. In Ontario, 16% of physicians are age 65 or greater and 8% at least 70. Annual license renewal fees are $1,725 in Ontario and over $2,000 in many provinces. Over a year ago, I wrote to Dr. Nancy Whitmore, CEO of the CPSO, and urged that she give a major discount for senior physicians, much as is offered by New Brunswick and P.E.I. I have received no reply. Of note is that most other medical organizations such as the Canadian Medical Association, the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada do offer a lower rate to older MDs. The Manitoba government is even reimbursing the licence fees of all its physicians for two years, in an attempt to attract more to the province.Read: Isn’t it time to reduce fees for older docs?This underscores the fact that all provinces (and countries) are actively competing for scarce health professionals. British Columbia has launched a new payment model for family physicians, and Premier David Eby pledged that the doctor shortage was his number one priority. Alberta Health Minister Adriana LaGrange is studying a new primary care compensation model. Thus, if Ontario does not improve its pay and benefit package, access to family physicians and to medical/surgical specialists will worsen.One much-needed benefit is short-term disability for older MDs. Some of them may need to be off work due to a heart attack, knee or hip replacement, cancer surgery, etc. Private disability insurance is not available, and thus many physicians facing major surgery or severe illnesses simply retire permanently—a huge waste considering our shortage of manpower.Instead, Ontario and other provincial governments should provide income replacement for those age 65 and over for 70% to 80% of their previous income for two or three months. Recall that following SARS, the Ontario government reimbursed clinicians who were ill with SARS, forced into quarantine, or suffered economic loss from closed clinics, operating rooms and offices.Of note is that all provinces except for P.E.I. have parental leave programs. Ontario and British Columbia pay only $1,300 per week for 17 weeks and Alberta $1,074 per week for 17 weeks. However, Manitoba pays $2000 weekly for 20 weeks and Nova Scotia the same for 26 weeks. Many physicians now recognize that just as important as increased fees or salaries—which can be subsequently clawed back or frozen—are benefits. Younger ones especially are mobile, and will vote with their feet, and gravitate to parts of Canada offering the highest fees, best benefit package, lowest living costs and provincial governments that will treat them with the respect and appreciation that they deserve.Besides the creation of health teams and increased remuneration of doctors, this implies that provincial and territorial ministries of health must provide new and improved benefits, especially to retain older, experienced physicians. They will then be incentivized to remain in the workforce as long as possible. In our crisis situation, we need all hands on deck. Ottawa physician Dr. Charles 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. An earlier version of this article recently appeared in the Ottawa Citizen.

Ontario needs to boost doctor pay and benefits

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