By DR. CHARLES SHAVER
About 2.3 million Ontarians lack a family physician and at least 3.1 million Canadians are on wait lists for surgery, diagnostic scans, or to see a specialist.
Last year in Ontario, largely due to a shortage of physicians and nurses, there were 867 temporary emergency department closures and 1199 closures of “vital hospital services.”
This was despite the province adding 15,000 nurses and 2400 physicians due to a breakdown of barriers for internationally and inter-provincially trained health workers.
As Manitoba Premier Wab Kinew warned: “The staffing crisis in health care is the defining issue. We need to plug the hole in the bottom of the boat.”
To retain our existing physicians, their fees must increase, overhead (including licence fees for older MDs) should be reduced and fringe benefits improved.
Overhead costs have been rising while fees have not kept pace. Ontario physicians now have a gross income lower than any other province except for Newfoundland and Labrador.
The physician shortage will take years to correct. Only 10% of applicants are accepted by our 17 medical schools. Few now choose to go into family practice, and with the administrative burden and lower net income, many after several years either go into another type of work, leave the province or quit medicine altogether.
Some 16% of Ontario physicians are at least age 65 and 8% age 70 and up. When younger, many medical/surgical specialists worked in hospitals where there was little or no overhead. In later years, they are in offices with overhead costs of 40-50%.
If the College of Physicians and Surgeons of Ontario refuses to grant them a discount from annual licence fees of $1,725, some may well retire prematurely. After all, most other medical associations do offer lower fees to senior MDs, as do the licensing bodies of New Brunswick and P.E.I.
I wrote to Dr. Nancy Whitmore, CEO of the CPSO, in September 2022, and urged her to give senior MDs a discounted licence fee. But I have yet to receive a reply.
Senior physicians may need to be off work temporarily due to a heart attack, joint replacement, or cancer surgery. Adequate private insurance is unavailable, so the Ontario and all provincial governments should provide short-term income replacement, much like it did after SARS in 2003.
This will incentivize those over age 65 to remain in the workforce as long as possible rather than retire permanently.
Most provinces have parental leave programs. Ontario and British Columbia pay only $1,300 per week for 17 weeks, Alberta $1,074 weekly for 17 weeks, Manitoba $2,000 weekly for 20 weeks and Nova Scotia the same for 26 weeks.
All provinces are actively competing for scarce health professionals.
British Columbia has launched a new payment model for family physicians. Under its new stabilization funding program, Alberta will be paying $30,000-40,000 to each longitudinal-care family physician in late January of 2024 and also next year. The Manitoba government is even reimbursing the licence fees of all its physicians for two years in an attempt to attract MDs to that province.
Many physicians now recognize that just as important as increased fees or salaries – which can be frozen or clawed back – are benefits.
Younger MDs are usually very mobile and can vote with their feet. They will gravitate to parts of Canada (or the U.S.) offering the highest fees/salaries, best benefit package, lowest living costs and taxes, and governments that will treat them with the appreciation and respect they deserve.
– Ottawa physician Dr. Charles Shaver is past-Chair of the Section on General Internal Medicine of the Ontario Medical Association. The views here are his own.