Many doctors now recognize that effective benefits are just as important as increased fees or salaries — which can be substantially clawed back or frozen at any time.
Published Dec 04, 2023 • Last updated 12 hours ago • 3 minute read
According to a recent Fraser Institute report, although Canada ranks highest compared to 29 other countries in health-care expenditures as a percentage of GDP, it is 25th for MRIs, 26th for CT scanners, and 25th for psychiatric beds.
Yet, as new Manitoba Premier Wab Kinew recently stated, “The staffing crisis in health care is the defining issue in the health system.”
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At present, nearly 2.3 million Ontario residents lack a family physician, 165,000 in Ottawa. Moreover, Ottawa physician Dr. Doug Gruner has warned, “The crisis is only going to get worse.” By 2026, about one-quarter of Ontarians will be without a family physician. There is also a severe shortage of medical and surgical specialists.
This 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 per cent overhead, in contrast to deriving largely overhead-free income from hospital work. Importantly, fees have not kept pace with expenses. Ontario MDs now have a gross income lower than in any other province except Newfoundland and Labrador.
Only 10 per cent of applicants are accepted to Canadian medical schools; few choose family practice; and many prematurely go into another type of work or leaving the province.
Increasing enrolment at Canadian medical schools and fast-tracking foreign graduates will all take time. What can be done now?
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In most provinces, about 15 per cent of MDs in practice are at least age 65. In Ontario, 16 per ent of physicians are 65 or older; eight per cent are over 70. Annual licence renewal fees are $1,725 in Ontario and more than $2,000 in many provinces. More than a year ago, I wrote to Dr. Nancy Whitmore, CEO of the College of Physicians and Surgeons of Ontario, urging that she give a major discount for senior physicians, much as is offered by New Brunswick and Prince Edward Island. I have received no reply. 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.
This underscores the fact that all provinces are actively competing for scarce health professionals. British Columbia has launched a new payment model for family physicians, and Premier David Eby says the doctor shortage is 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 medical/surgical specialists) will worsen.
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One much-needed benefit is short-term disability for older MDs. Some of them may need to be off work at different times for health reasons: heart issues; joint replacements; cancer surgery, etc. Private disability insurance is not available, and thus many MDs facing major surgery or severe illnesses simply retire permanently — a huge waste.
Instead, Ontario and other provincial governments should provide income replacement for those age 65 and over for 70 to 80 per cent of their previous income for two to three months. Following SARS, the Ontario government reimbursed MDs who were ill with the disease, forced into quarantine, or suffered economic loss from closed clinics, operating rooms and offices.
Many physicians now recognize that just as important as increased fees or salaries — which can be subsequently clawed back or frozen — are effective benefits.
Besides the creation of health teams and increased remuneration of doctors, provincial ministries of health must provide new benefits and improve existing ones, especially to retain older, experienced physicians. These doctors 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 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.
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