Let’s talk about doctor’s pay

Doctors have been given benefits under incorporation in lieu of receiving wage hikes and that’s not right. Doctors are on both sides of the issue. The Canadian Medical Association has come out against any changes to these benefits while 450 doctors signed an open letter to Finance Minister Morneau in favour of tax reform.

  Dr. Rita McCracken supports tax reform. Photo: Huffington Post

The existing tax system allows for the questionable practice of “income sprinkling” where family members are paid even when they don’t contribute to the doctor’s business. In Ontario, children and spouses are allowed to be paid as members of doctor’s corporate boards.

Doctor practices are unlike other small business. They operate private businesses while being paid through the public healthcare system.

Some doctors are uncomfortable the existing breaks. Dr. Hasan Sheikh says:

“There is nothing unique about a physician’s work that makes income sprinkling okay for them and not for others (Globe and Mail Sept. 22, 2017.)”

As usual, proposed tax changes are political fodder. Some premiers have condemned them, even though the details have yet to be released. Manitoba Premier Brian Pallister calls them “class warfare.” Nova Scotia Premier Stephan McNeil worries about the ability to attract doctors and small business to the province. B.C. Finance Minister Carole James concerns are more nuanced:

“I certainly believe in closing tax loopholes, I believe that’s important, but I also don’t believe there was good consultation done.”

That’s Morneau’s failing. He announced the changes in the downtime of summer and faces a storm brewing in the fall. Only now is he consulting provinces.

One of the doctors in favour of tax reforms is Dr. Ritika Goel. The existing system doesn’t even benefit all doctors fairly:

“So, for example, if you have a single mother who is a physician she would be paying higher tax rate than a mother with a spouse that she’s able to income sprinkle and we don’t believe that’s fair (CBC’s The Current, Sept. 19, 2017).”

Another doctor is opposed to the changes. While acknowledging the issue of tax-fairness, she is bitter about existing compensation. Dr. Brenna Velker told The Current:

“I think that as physicians, you know, we all understand that those who make more money need to pay more tax, that’s how society works. The problem that I think a lot of us are running into is that we’re feeling really beat down. So, any of the forms that I fill out and of the phone calls that I make, or you know, e-mails, or anything like that, any other communication with my patients is unpaid. You know, it really leaves a bad taste in your mouth.”

Doctors deserve fair wages. They are dedicated and hard working. They incur more student debt and they start earning money later in their career.

“Let’s stop talking about propping up a broken tax system that benefits some Canadians and not others based on the title of their profession and not the nature of it,” adds Dr. Sheikh.

Instead of granting doctors dubious tax breaks, they should be given appropriate pay and benefits that dignify their profession.

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The problem is doctor distribution, not shortage

The number of doctors in Canada is increasing faster than population growth says Dr. Michael Rachlis on CBC Radio’s The Current:

  photo: Nancy Bepple

“We’ve been increasing the number of physicians at about three per cent per year for the last 10 years and the population is only going up at one per cent per year.”

Another of the panellists on the program, Dr. Danielle Martin, author and VP at Women’s College Hospital, warns of a surplus of doctors:

“In fact you know in some parts of the healthcare system, people are worried about a glut and you hear stories of people coming out [of medical schools] and being unable to find a job.”

That’s certainly not the view from the streets of Kamloops. NDP candidate Nancy Bepple regularly visited lines of people lined up at a clinic to see a doctor. An estimated 30,000 Kamloopsians don’t have a family doctor (one-third of the population). In B.C. overall, it’s 15 per cent.

Why can’t people find doctors if there’s so many of them? Are they hiding?

Well, some of them have chosen to work for a salary rather than billing for each patient. They work exclusively in hospitals says Dr. Chris Pengilly of Victoria, another of the panellists. He calls them “hospitalists.”

They prefer to work only 40 hours a week. Who can blame them? And they are paid better. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. After paying staff and rent, a family doctor would have to earn $400,000 a year, to take home that much; and work longer hours with less support.

The choice is obvious says Dr. Pengilly:

“So anybody coming out of medical school with a big student loan, which do you think they’re going to go for? A family physician [with] no time in hours a week or a hospitalist 40 hours a week and $300,000 with minimal expenses?”

Furthermore, hospitalists don’t want to work alone says Dr. Rachlis “Well, I say good for them that they’re looking to work in teams with other groups, with other physicians.”

One-half of Canada’s physicians focus on sports medicine or palliative care, says Dr. Martin:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

The current model is not working because doctors no longer want to work in the silos of a fee-for-service practice.

It’s ironic that the provincial government has created a hospital environment which doctors prefer to work but one that removes them from the general public.

The solution is obvious but the BC Liberals have been slow to implement it: Build walk-in clinics and hire doctors on a salary basis. Everyone, doctors and patients alike, will be happier.

It’s going to cost more because the government will own the clinics. But the alternative, privately-built clinics, is a failure. The reason that two walk-in clinics in North Kamloops closed their doors is because doctors don’t want to work for less in an environment where they don’t have the same support that hospitalists enjoy.