Why should physicians give up pay raises to subsidize government waste?
It's noble that some Quebec doctors want to forgo pay bumps. But all that does is let government off the hook
Last week, a story about a group of Quebec doctors rejecting a proposed pay raise garnered international attention. Nearly 700 physicians, who are part of the Médecins québécois pour le Régime public, signed a petition demanding the cancellation of pay raises for Quebec physicians, negotiated on their collective behalf by the Fédération des médecins spécialistes du Québec and the Quebec's federation of general practitioners (FMOQ). Signatories have requested that the funds be reallocated to other areas in the health care system.
The news, naturally, elicited plenty of positive responses: The Washington Post called the move "utterly Canadian;" a CNN contributor was even more forthright, writing, "God bless these doctors in Canada."
Certainly, the gesture is incredibly altruistic. Yet at the same time, it perpetuates the idea that doctors in Canada earn more than they deserve — that they should make personal financial sacrifices for the sake of the system for which they work. But we don't really expect that of any other working professionals in Canada, so why would we expect it of doctors? Why can't nurses, medical aides, hospitals and so forth be properly funded, and physicians receive the compensation they deserve?
Costs for independent contractors
The cohort from Quebec mirrors other groups across the country, who, to their credit, do an excellent job of garnering media attention and leveraging politicians, interest groups and institutions both at home and abroad. What is concerning, however, is that the public often consumes their messaging as a unified representation of the state of health care.
It is worth remembering that physicians often spend more than a decade on post-secondary education while accruing an average debt of nearly $100,000. Once licensed, they are categorized as independent contractors and are therefore not eligible for the same pensions and benefits — drug coverage and maternity leave — as other public employees. This is an important detail that even our own prime minister fails to grasp.
One also can't help but wonder if the action from Quebec doctors is helpful given the recent government cuts (or threatened cuts) to health care — direct or indirect — including proposed tax reform floated by the Trudeau government, which will have had a huge impact on incorporated physicians across the country, as well as billing clawbacks in Ontario.
Governments pursue these changes based on the premise that doctors can afford and will accept a cut, and by signing a petition in rejection of pay increases, Quebec doctors have de facto conceded that that is true. Bizarrely, this petition has come on the heels of their own physician trainees threatening to strike because of deteriorating work conditions, mental health and quality of life.
The current state of health care in Canada is characterized by chronic doctor shortages, inhumane wait times, hospital overcapacity and dwindling community care resources. This perfect storm has created an environment of palpable patient and doctor dissatisfaction.
A cautionary tale
A growing number of international studies and analyses have collectively described Canadian health care as underperforming and at significant risk of falling even further behind world leaders like Australia without a radical re-think. Those who believe that the solution is an expansion of our current model would be wise to learn from the cautionary tale of the National Health Services in the United Kingdom, which appears on the verge of collapse.
Junior doctors there are in open revolt, protesting against the damaging actions of health secretary Jeremy Hunt, who has overseen cuts to front-line care and compensation. This has the potential to become a reality here, too, with many versions of that story currently unfolding in Canada..
Given this lens, it is reasonable to ask why physicians — who are members of the public, like everyone else — should voluntarily sacrifice part of their income to subsidize governments that have wasted valuable health care resources. Until our elected officials prove that they will invest taxpayer dollars wisely and demonstrate robust returns, the suggestion that individual citizens should give up even more is a tall ask.
This is all to say that honest and open conversations about how to improve our system are desperately needed. During this year's critical provincial elections in Ontario and Quebec, health care is poised to be the most important issue facing voters. We should resist the temptation by politicians to frame health care around divisive matters of doctors' pay and demand that their platforms focus on policy.
Adam Kassam is currently chief resident in the department of Physical Medicine & Rehabilitation at Western University. Born and raised in Toronto, Ontario, Adam received an undergraduate education from Cornell University, an MD from Dartmouth Medical School and a Master's in Public Health from Columbia University.
- A previous version of this column incorrectly stated that the Quebec Medical Association negotiated the pay raises on behalf of the doctors who signed the petition. In fact, the raises were negotiated by the Fédération des médecins spécialistes du Québec and the Quebec's federation of general practitioners (FMOQ)Mar 14, 2018 10:06 PM ET