Kids want to stay up late, eat whatever they want, and do homework when they feel like it.
Little bohemians let Mom and Dad pay the bills, repair the car, and keep the house running.
Government wants it both ways, too. Politicians tell doctors how to practice, how many hours to work, and which tests should not be ordered.
Politicians are happy to let doctors pay for medical offices and do everything else to keep clinics running.
Government Wants It Both Ways
If government wants self-motivated, entrepreneurial knowledge workers, who take responsibility for private practices, they cannot control doctors’ professional lives and treat them like employees.
If government wants employees, who follow rules and deliver ‘high quality’ care dictated by government, then politicians cannot expect doctors to assume the cost and responsibility of managing care.
Please Premier Wynne, make up your mind. Do you want employees or professionals?
New Medicine
Centrally controlled healthcare systems often have outstanding prevention and screening. The Soviet system had advanced public health for its time. Soviets solved gender inequality in medicine 40 years ago: 73% of family doctors were women in the 1970s.
Maybe doctors should support the radical, Liberal healthcare reform? Let’s see where it leads.
If politicians want bureaucrats running healthcare, let them have it. Put doctors on salary.
Salaried doctors could see a set number of patients.
Government could fund private clinics and hire the staff.
Government could pay for all the management work doctors now do for free.
Many docs would love to show up at 9, punch a clock, take coffee and lunch breaks, and then punch out again at 5.
Public Employees
After years working with police officers, I grew to envy their lack of freedom and the inherent inefficiency of their jobs.
They were forced to sit for hours waiting for a coroner to show up. They drank coffee after coffee just because a silly rule said they could not leave the emergency department until one detail was signed off.
Did they complain? Sure.
But were they stressed? Not really. They were bored to death.
Faced with a choice between bored-to-death with a great pension and early retirement, versus stressed-and-burned-out with no pension or retirement, many doctors would choose the salary.
Negotiations
Doctors in Ontario want to get back to negotiations with government. It’s the same old thing: negotiators will try to get as much money as possible out of government, while compromising as much freedom and autonomy as doctors will ratify.
Maybe the days of doctors, as independent contractors, have ended in Ontario?
Maybe doctors should consider a salaried and government-runs-everything model?
What could doctors lose, at this point? Even the Soviets had some great healthcare until their money ran out.
Government wants it both ways. Politicians want to control doctors and, at the same time, let doctors finance and manage clinics.
Doctors should not keep fighting to work as independent contractors, if government insists on managed care. Many doctors would be much better off, not just financially.
Private clinics currently offer the most efficient part of Canadian Medicare. But why should doctors be the only ones fighting to keep them?
The only thing doctors would lose, if they gave in to government, is their professionalism. But no one sees much value in professionalism anymore, besides doctors.
Social leaders, like the Toronto Star and the Ontario Human Rights Commission, want medical technicians, not professionals, with personal opinions and clinical judgment.
If government wants it both ways, doctors should stop supporting the current, dysfunctional relationship.
No one wins when spoiled kids sponge off weak parents. Let the kids own the consequences of their actions.
Doctors should let politicians own their own mess. I wonder how patients would like the outcome?
photo credit: today.com
”For every complex problem, there is a solution that is simple, neat and wrong!” – Mencken
There is no simple health care answer as shown by the fact that you basically blogged a different point of view very recently, Shawn.
“Doctors Must Lead or Lose Privilege – Bill 210”
Great comment, Gerry. I love Mencken.
I wrote this post tongue in cheek. I hope no one thinks I am advocating to look seriously at a Soviet approach to healthcare! Certainly, anyone who knows history would see my comments like an essay about high arctic navigation tips from the captain of the Titanic.
Thanks so much for reading and sharing your comments!!
Shawn
I got your tongue in cheek Shawn. Our communist physician colleagues warned me years ago that what our governments have been doing is going down the same slippery slope to the lowest form of patient care that they experienced. They advised me to fight against it hard. I took any and all action; to Rae Days with the Queen’s Park rally, and closed my family practice. All collective actions eventually led to an attempt at a restoration using family health teams etc.. But here we go again. When our leadership cannot see the big picture into the future, and divide us, and continually think that an “association” can fend off government erosion, we will fail. We need constitutional protection. And if drastic action is needed, I will be there again.
Hey Nick! Great to hear from you.
I think we need all the advice we can get right now. People do not see the big picture, or if they do, they think that they like what they see. People do not read history and do not know anyone who remembers working in rigid, state-owned systems.
Thanks so much for taking time to read and share a comment! I hope you are well.
Cheers
Shawn
In the 1970s when Medicare was in its infancy, Stephen Lewis, leader of the provincial NDP, said that we cannot afford to put doctors on salary.
I took the beginning of your blog as sarcastic but the last part not so much. There are many doctors in Ontario who would love to get off the treadmill.
As usual, I agree with your observations, Gerry.
I WAS trying to get people to consider salary but couched in a post that puts radical control as part of the discussion. Salary talks must include discussion about where salaried systems tend to end up. Most people only discuss salary and forget about the system characteristics necessary to support salaries. But what’s even worse, we have a government who seems to want the control of a rigid, salaried approach, while letting doctors shoulder the costs of running and managing clinics.
PS Stephen Lewis often says things that drive me nuts, but I like the one you shared!
“I love Mencken.”–Shawn Whatley
The only thing I knew about Mencken was that one quote. Because of your comment I took the time to look him up and found the audiobook “In Defense of Women. I just started listening to it and am hooked. I hope he is being sarcastic as so far I am smiling and laughing out loud (LOL).
Sadly I I will have to cut down on reading “No More Lethal Waits”, which I just got to earlier this week.
😉
🙂
I sure appreciate you reading No More Lethal Waits, but please don’t feel bad for reading something else!!!
Governments are exactly stupid enough to take your suggestion about salaries. There are plenty of doctors who are naive enough to think that salaries are a workable option, and that bureaucrat-run “jobs” are as effective and rewarding as independent professional practice . The result is a National Health Service with 1 1/2 to 3 minutes per patient, and free “dental care” (ie free extractions).
You are right, Roger. We’re stuck in the middle right now. Either we should fight for independence or fight for salaries.
Letting government have their cake and eat it too is not working.
Thanks for sharing your thoughts!!
Shawn
Dear Shawn,
I very much enjoy reading your blog, and really enjoyed reading No More Lethal Waits. I work as an ER physician in Barrie, so I see your recommendations as very timely.
I wanted to thank you for your post on encouraging doctors to write, which helped motivate me to start my own blog about my impressions on the state of modern health care, and working in Haiti.
This discussion of Soviet health care reminds me of Stalin’s “Doctor’s Plot”. Several Soviet physicians were accused of attempting to assassinate Soviet leaders, and arrested. It’s important to note that this was more about antisemitism, but the idea of targeting a professional group has parallels to the government’s vilifying of physicians in this province.
Hey Coryn!
I sure appreciate you taking time to read and share a comment! It’s really exciting to hear from someone just up the road from me. You site looks really great: clean, loads fast, and attractive. I love the picture. Readers can check you out here. You write REALLY well! I hope you keep writing. They say most blogs fail after 3 years….so that’s your target….I’ll help keep you accountable, if you want.
Thanks for sharing your comment about Stalin. I believe we need to read and share more history. People think that governments will never treat citizens poorly: “This is Canada!” There’s always a reason to vilify certain groups. Right now, it is perfectly ok to limit doctors rights. Just check out all the labour laws exemptions for doctors: Industries and Jobs with Special Exemptions and Rules.
Again, really great to hear from you!
Cheers
Shawn
PS THANKS for reading No More Lethal Waits!!
I guess this article, in my mind, resolves the question as to where you personally stand as an OMA Board member!
My family suffered under communism in Yugoslavia and my aunt, a paediatric cardiologist, retired, saw the same dangers and communist encroachment that we now face in Ontario. Our few hopes that separate us from communism in a democratic system is to rely on the judicial branch and the Charter challenge, and if doctors finally stand up, resist, and act like true democrats.
Excellent comment, Nick!
I sure appreciate you sharing details about your family’s experience. Too many people forget that those hateful regimes came in by popular demand. Too few of us value freedom and constitutional democracy. I guess I’m a bit crazy for valuing it too much, but I fear the worst when we treat it so cavalierly.
I hope you are well!
Best
Shawn