Treating doctors and nurses fairly in these pandemic times

“Canadians shouldn’t have to choose between staying home when they’re sick and putting food on the table. Paid sick leave will protect workers and their families, protect their jobs, and protect their workplaces. It is an important step in the fight against COVID-19.” – Seamus O’Regan Jr., Minister of Labour. The Trudeau government has finally introduced Bill C-3, which would amend the Canada Labour code to provide 10 days of paid sick leave per year to workers in the federally regulated private sector. Now that cases of the new Omicron variant have been reported in Ottawa—the first ones in North America—as well as one in Quebec, B.C. and Alberta, these words become even more significant. For over a year, Jagmeet Singh and many other MPs and journalists have called for this. However, federal and provincial health ministers should ensure that physicians, nurses, and all health professionals are fully covered. It is not enough for politicians to simply call us “heroes.” Health professionals are exhausted and burned out and some are quitting. There is an increasing shortage, especially of nurses. At a minimum, governments need to provide them financial security. Yukon has had a paid leave rebate for self-employed persons, which pays for up to 10 days, but is limited to $378.13 per day—low for physicians. Private disability insurance is generally unavailable to cover MDs against COVID-19 related loss of income. For example, the Ontario Medical Association plan has an elimination period of at least 30 days and is unavailable to those over age 65; many with pre-existing illnesses would also be excluded. Yet in 2018, 16% of specialists and 15% of family physicians practising in Canada were over age 65. All physicians—not just those in hospitals—need income replacement from day one if they are forced to self-isolate or become ill with COVID-19. This might be similar to the SARS Income Stabilization Program in 2003 in Ontario. According to the Canadian Institute for Health Information, as of June 15, nearly 95,000 Canadian health workers had become infected with COVID-19. About 7% of cases in Canada were in health professionals. As of November 10, according to the Canadian Federation of Nurses Unions, 55 had died, including at least four physicians. One of these was a 48-year-old emergency physician from Regina. Read: Healthcare workers demand Trudeau fast track paid sick leave policy Rather disconcerting and not sufficiently emphasized is the prevalence of “breakthrough” infections. For example, fully vaccinated persons accounted for 38% of new cases in Quebec, 41% in Ontario, 43% in Manitoba, and 34% in Saskatchewan. In Quebec, 65% of recent admission to hospital were doubly vaccinated. In Ontario, 19% of hospitalized COVID-19 patients had received both doses and 35% in Saskatchewan. In Manitoba, 43% of those in the hospital and 18% in the ICU were fully vaccinated. These numbers should improve as children are vaccinated and high-risk groups receive booster shots. However, it seems that although vaccines are crucial, we must continue to use all the tools in the toolbox. These include border controls (which might reduce the influx of additional cases of the Omicron variant), adequate paid sick benefits, social distancing, and mask mandates in certain crowded indoor areas. Inasmuch as experts now admit that the virus may be airborne, there should possibly be greater use of N95 masks. When despite these measures, certain regions are overwhelmed, we need the ability to transfer ill patients to other provinces. In June, Ontario accepted 51 patients from Manitoba, and two were also sent to Alberta and Saskatchewan. When a surge occurred in Saskatchewan in October, that province sent 27 patients to Ontario. Quebec must be part of this. It is now reporting more than 1,100 new cases per day—the highest since late April. If the situation worsens, it may attempt to transfer its own patients elsewhere. However, treating physicians must be given assurance that they will be properly paid. As I elaborated in my previous articles (Medical Post, published November 3 and ProfessionSanté, published November 19), Quebec does provide portable hospital benefits, but despite Section 11 of the Canada Health Act, it is the only province not to sign the Reciprocal Medical Billing Agreement (RMBA). As a result, if an Ontario intensivist were to treat such a patient, there would be two options. First, bill the Quebec government directly, and likely receive a lesser fee than would be paid by OHIP. Second, attempt to bill the patient directly, and likely receive absolutely no payment. Read Dr. Shaver on: Jean-Yves Duclos should push for full medical portability for his Quebec constituents In fairness to physicians, Ontario and other provinces should make it clear that the CEO of a hospital may try to refuse to accept a Quebec patient unless the Quebec Health and Social Services Minister Christian Dubé signs the RMBA. New Federal Health Minister Jean-Yves Duclos reacted with speed and decisiveness to the new Omicron variant. He and Conservative Health Critic Luc Berthold are both from Quebec. They should collaborate and urge Dube to sign well before the pandemic becomes a crisis in that province. Dr. Charles S. Shaver was born in Montreal, moved to the U.S. at age 2, and returned to Canada in 1970. He is past-chair of the Section on General Internal Medicine of the Ontario Medical Association.

Treating doctors and nurses fairly in these pandemic times

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