Use loan repayment to fund benefits for Ontario MDs

Recently, the Ontario government notified its physicians that they would be required to repay over the next 12 months some $521 million that was given in April 2020 to cover increased costs and reduced patient volumes due to COVID-19. No interest would be charged. Only a few years ago, we were called “Healthcare heroes” and some may find it ironic that the Ministry of Health now wants every penny back, especially considering the many examples of wastage at all levels of government. Ontario, a few years ago, already had three times more health bureaucrats per capita than Sweden, four times more than Australia, and 10 times more than Germany. During 2022, the Bank of Canada paid out $26.7 million in raises and bonuses to staff. Over 80% of staff received a raise or bonus—averaging $11,000 per person. The Trudeau government spent $18 million sending bureaucrats to a four-day German book fair. And of course, Governor General Mary Simon spent $71,000 on limousines for her recent conference in Iceland. If, indeed, the Advance Payment Program COVID-19 loans must be completely repaid, in fairness and to make it more palatable to Ontario physicians, most or all of the money should be put in a special, “physician benefits fund.” Once the Ontario Medical Association has completed negotiations with the government, they should be earmarked for new and improved existing programs that would benefit physicians, rather than being squandered or frittered away. Here are a few possible examples: In Ontario, 16% of physicians in practice are age 65 or greater and 8% are at least age 70. Like their patients, some may need to be off work due to a myocardial infarction, knee or hip replacement, cancer surgery, etc. Private short-term disability insurance is unavailable or has major exclusions for pre-existing illnesses and long periods before one can collect benefits. This may cause many physicians to simply retire permanently—a huge waste of manpower when the healthcare system is short-staffed. So, to encourage them to return to work—even part-time—Ontario (and all provinces) should provide government-funded short-term income replacement. I suggest MDs from ages 65 to 80 receive 70%-to-80% of their previous income for 60 to 90 days with no waiting period. I discussed this personally in Windsor in early May with Ontario Medical Association president Dr. Andrew Park. There is a precedent for this idea. In 2003, after SARS, the Income Stabilization Program in Ontario compensated doctors for 80% of their lost income if they were ill with SARS, forced into quarantine or suffered a major drop in income due to a loss of clinic, operating-room time, or fewer patient visits to a private office. The Advance Loan repayment could help act as seed money to fund this initially. This year, and in subsequent years, money could also come from the recent increase in the Canada Health Transfer ($46 billion over 10 years). My second proposal involves improving Parental Leave Programs. Most began around 2004. Ontario now pays $1,300 per week for 17 weeks. Manitoba pays $1,400 per week for 20 weeks, Nova Scotia $1,500 per week for 17 weeks, and New Brunswick pays $2,000 per week for 26 weeks. In fairness to younger physicians, I therefore suggest that money from repayment of the loan, as well as funds from the Canada Health Transfer, also be used to increase the weekly payment and also the duration of coverage. My third proposal is reducing the annual licence fees for older MDs. Most are working part-time, and unlike their younger counterparts who are hospital-based, often pay 40%-to-50% overhead at private clinics. The College of Physicians and Surgeons of Ontario is encouraging newly retired physicians to reactivate their licences. Last fall, I suggested in a letter to the CEO, Dr. Nancy Whitmore that it also give a major discount to senior physicians, much as provided by the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, and licencing bodies of PEI and New Brunswick. I discussed my proposal over the telephone with a senior physician from the CPSO but I have never received a written reply from Dr. Whitmore to my very reasonable suggestion. Recall that the CPSO expects physicians to respond promptly to lawyers, insurance companies, etc. Instead, in the spring, I received only a standard invoice indicating that the annual licence fee had not changed for several years, and was in fact lower than that of several other provinces. The Manitoba government recently announced that it would reimburse all physicians for their licence fees for two years. I therefore propose, if the CPSO remains intransigent, that the Ontario government reimburse senior physicians for at least half of their annual licence fee. As we have seen across Canada, it is politically easy for provincial governments to freeze or roll back fee increases. However, once put into place, it is much more difficult to cancel fringe benefits such as I am proposing. These benefits will help to attract physicians to Ontario, and most importantly, retain them for as long as possible. Ottawa physician Dr. Charles S. Shaver is past-chair of the Section on General Internal Medicine of the Ontario Medical Association. The views here are his own.

Use loan repayment to fund benefits for Ontario MDs

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