Most docs love to work; they find patient care fulfilling. Many can’t believe they get paid for the privilege of helping patients.
Many of us would work for free.
Seriously.
Talk about money or income makes most doctors squirm. We have jobs we love and higher than average incomes. We forget the sacrifice of training.
Politicians and media know this. Like lion trainers with whips, journalists make doctors cower by whipping out a headline about incomes.
Personal Incomes, Patient Needs
Doctors conflate their personal incomes with patient services. They know patients wait, and that the province is short of money. Ergo, if only doctors took a cut in personal incomes, then patient services would improve. But they’re confused.
The schedule of benefits – the fees that physicians get paid – does not exist because government likes doctors. It does not exist to pad physicians’ incomes. The schedule is designed to drive physician behaviour towards meeting patient needs.
Fees Fix Care Problems
Unmet medical need creates demand for new fees or adjustment to old ones. A new fee drives physicians to change behaviour to meet the need defined in the fee code. If you cut a particular fee, physicians’ behaviours change to service other, equally pressing, medical concerns.
For example, attaching a bonus for Family Docs to accept unattached complex patients after discharge from hospital makes it easier for these patients to find Family Docs. Everything doctors do relates to helping patients. All things being equal, doctors will provide care that the government promotes with higher fees, regardless of physicians’ individual altruism.
The MOH-OMA negotiations are about patient needs and how best to meet them, not individual MD incomes.
Fees and Access
Economists teach that prices impact supply. When supply drops, prices increase. If the government fixes a low price, supply decreases.
For example, over the years government slashed fees for community doctors doing hospital work. Guess what? Almost no community doctors spend a significant part of their day doing hospital work anymore.
You can decrease price and in the short run people will still be able to access services. But very soon, supply and/or quality will decrease.
Doctors and Privilege
Privilege relates to more than just income. Society honours physicians, to varying degrees, with respect, deference and a degree of autonomy. Patients do not begrudge what their doctor earns when they are sick themselves.
Society does not privilege doctors only out of the goodness of its collective heart.
People know that if they want some of the strongest students to sacrifice their youth in medical training, society needs to value the sacrifice. Students must be attracted into training.
When governments and media attack doctors and slander them as greedy, when patients look on doctors as undeserving recipients of their tax dollars, and when politicians arbitrarily slash doctors’ fees, our best students change their minds.
For example, before primary care reform, dozens of residency positions in family medicine went unfilled. Students looked to any other field besides family medicine. Society communicated that it did not value primary care. Only after major funding reforms in the early 2000s did students return to family medicine residencies. Now residencies are all full, for now.
Patient Needs Before Doctors’ Guilt
Physicians must not focus on their own squeamishness about money. They need to focus only on patient needs.
Doctors must put their sympathies with patients ahead of government budgets. We need to focus on how to convince the government to fund solutions for patient care.
Physicians, please don’t let the media suck you in to thinking this is about your income. It’s not. It never was. It has always been, and must continue to be, about patient care.
photo credit: businessnewsdaily.com
Shawn
Great to see you being proactive and engaged and presenting thoughts that all docs should participate with. Some tweets today talked about being engaged as I believe docs have significant and real world first hand experiences and need to press HC to listen and change. If anyone is focused on $$ it’s the govt. They’ve misspend, lied, cause patients to suffer physically and mentally waiting in months long waitlines.
I hope all physicians will collectively present new ideas to the govt and pess for change as you and so many others like Dr Fullerton do each and every day.
Docs are not all great administrators as all aministrators are not docs. But if I wanted to run a medical system, physicians would be my first choice to lead not the business admin grads. This is simply adversarial and painting docs and patients into a corner to prove their point borders on deceit and a complete breakdown of trust.
Thanks so much for taking time to be involved, read and comment on these issues!
Everyone from all along the political spectrum predicts that healthcare must change or collapse. We saw the first damage to the Medicare ship in 2012. This is much worse.
You offer a balanced solution – not all docs are admin, just as not all admin are docs. I only hope politicians will start listening. We need informed people in the public, like you, to fuel the fire.
Thanks again for reading and commenting! I always feel encouraged reading your note.
Best regards,
Shawn
Shawn, I only quibble with you on one point. The iceberg hit the Titanic of Medicare in 1986 not 2012. We have been rearranging the deck chairs on the Titanic since then. 2012 was only another lurch downward.
Gerry
Well said. Can’t disagree with that.
The only positive thing in all of this is that the government was so thorough with its attack. A piecemeal, divide and conquer approach would have made it easier to hang the system malaise on doctors. With their carte blanche blood shed, they must own the carnage. I hope enough physicians and patients educate themselves to demand change. The political spin masters are out in force. Winkler didn’t have the guts to champion change in his report; he told the Medicare captains to drive straight forward.
I sure appreciate you reading and commenting. This whole business makes one rethink the effort expended to ‘partner’ with a machine that can turn and legislate whatever they want. What kind of government system is that?
Thanks again.
Rather despondent,
Shawn
Well written Shawn. Love the comments from others. Once again the mainstream media is in the pocket of government. I was not surprised as the CBC reported that the OMA rejected a 2.5% increase each year over three years without ever mentioning that would be after a new cut of $500 Million from MD fees to a new baseline. How do we live in a democracy when the media won’t report the other side?
Nick
Thanks for taking time to read and comment, Nick! Great to hear from you.
I think many docs find it really disheartening to be slandered so much with misleading information and incorrect details (lies?). We spend our lives trying to help people, not fight. Politicians and journalists spend their lives looking for a fight. We make an easy target.
OMA rejected a “raise” that was 1/2 of a very conservative estimate of annual growth. Hoskins ‘offered’ to pay for 1.25% of growth but not the 1.5%; he expected docs to pay for that. PLUS, growth greater than expected would be ‘reconciled’ – e.i., clawed back. We’ve seen growth over 3% in the past. PLUS, Hoskins offered to cut over 1/2 billion dollars up front.
No one else could treat citizens like this. What kind of society is this? Seriously, doesn’t anyone care about democracy anymore?
Again, I sure appreciate you taking time to comment! I’m trying to figure out if there’s anything we can do. Even if the Liberals recant on their attack, what prevents them from attacking again in 2017?
Hope you are keeping well!
Best,
Shawn
Yes, I have been very disheartened over the years by inaccurate public estimates of my earnings – for the record in the 35 years I have worked in Canada I have never made over $100,000. I work part time now so I certainly won’t be collecting that sum.
However what upsets me much, much more is that we as Canadian Physicians have allowed the Canadian Health care system to deteriorate drastically ON OUR WATCH!
Yes, we have had plenty of assistance in wrecking Medicare – the ridiculous 14 Provincial/Territorial bureacracies, Canadian’s absurd pride in their “Universal” Health care system and their fear of change which prevents them from evaluating other more effective “universal” health systems etc. etc.
However I do not believe we will make any impact until we are SEEN to take the moral high ground.
I believe we should accept the Ontario Government’s punitive financial arrangements – after all unlike many Ontarians we don’t NEED the money – with 2 conditions.
First that the Ontario Government makes public accurate financial information about Physician earnings in addition to other clinician earnings Nurse Practitioners, PAs and Midwifes – including hours and benefits.
Second that physicians be permitted a greater role in the necessary negotiations about the future of Medicare.
As long as we continue to whinge about money when we have more than most we cannot expect anyone to take us seriously!
Wow. Great comments, Dr. Robertson! Thanks so much for sharing them.
I agree. We own much of the current mess. What we didn’t cause, we might have been able to mitigate. Your suggestions about comparing MDs to other providers’ incomes holds merit, too.
I also could agree with your comments about accepting the cut if this was 2012. We held the exact opinion you advise: take a cut but insist on transparency and partnership. We got neither. Now we face even bigger cuts 2 years later.
You are probably right; many doctors could weather a 5% cut. Having said that, many could not. New graduates face a 30% cut with the proposed legislation. As they work to build their practice and pay off debts, I cannot find words strong enough to express my displeasure. I started a tiny rural practice last August. I dipped into savings and haven’t been able to make a positive month on my balance sheet yet. A cut would hurt me personally for sure.
But it must not be about us! Cuts to new patient incentives, after-hours and weekend fees, on-call stipends…all these will mean less access for patients. Egregious!
OMA offered 0% fee increases for 2 years. We only asked that government fund the 140,000 new patients (babies and immigrants). We want government to work on finding solutions for needs that we struggle with now: complex patients, system integration, patient waits. Government refused. Hoskins was told by the finance department to cut, not negotiate.
Thanks again for sharing your thoughts! We need much more of this!
Highest regards,
Shawn
Thanks so much for creating a great collection on this issue! I hope readers get a chance to check out your site http://www.ontariosdoctors.com/.
Best
Shawn
Shawn…I don’t think the consumer is upset or concerned in any way about doctors income. We live in a society where investment bankers make millions with far less education and sacrifice then doctors. You provide people with care & attention to their health which gives us all a “quality of life” that wouldn’t exist without you. So no further explaination on your well earned compensation required. You earn every penny. It’s the govt minions that put the negative thoughts in the publics mind.
HC is an absolute mess and getting worse under the so called guidance/leadership from the libs. How they can ignore the logic presented by Dr Day and be OK with the knowledge that people suffer physically/emotionally in wait lines. Worse case some die. Our priorities as a society are somewhat skewed, we allow our elected govt to lie, cheat and misspending billions of our $$ with nothing from us. We actually reelect them. If your broker lost your money you would be ballistic….not with govt….they get a pass. They create a negative dialogue about doctors $ and then sit back and watch the explainations of your earnings pour out.
You owe no one any explaination of your earning other than….you earned it.
Keep up the thoughtful writing
Don
I sure wish everyone shared your thoughts, Don!
I’ve seen a number of people argue how every worker in society is important (I agree), so we should pay everyone the same regardless of training, responsibility and risk. It’s not even a Marxist idea, more Communist.
Politicians value re-election over everything else. As long as healthcare shares a harness with elections, we will suffer with handouts and waste followed by cuts and waits.
Thanks again for reading and commenting!
Best regards,
Shawn