Across Canada, emergency departments have closed temporarily due to a lack of nurses and MDs, physicians have closed their offices, surgery has been postponed or cancelled, and wait times for patients have increased.
In Alberta, 20 per cent of residents, do not have a family physician. In 2021, 548 physicians left the profession, including 140 who left the province – nearly triple the number in 2019. Alberta MDs may soon ratify a new agreement with the provincial government, which might slow the rate of attrition.
However, we must use all the tools in the toolbox to correct the manpower shortage. These include increasing enrollment at Canadian medical and nursing schools, fast-tracking the licencing of foreign graduates, but importantly doing whatever is required to retain existing physicians and nurses.
Dr. Nancy Whitmore, Registrar of the College of Physicians and Surgeons of Ontario (CPSO) recently announced that the CPSO would encourage those who had recently retired to reactivate their licences with no application fee. I applaud her efforts, but have one further suggestion – a major reduction in annual fees for all older physicians.
Across Canada, as in Alberta, due to burnout, COVID-19, and income constraints, many nurses and doctors are retiring prematurely. There is a shortage of medical and surgical specialists with long wait times to see them in an office. We need to provide improved working conditions, financial and other incentives to retain senior nurses and physicians. As the saying goes, “It is difficult to fill a bathtub with the drain open.”
Older physicians are working fewer hours and paying a much higher portion of their gross income on overhead, and like the nurses, have received only a sub-inflationary fee increases. If provinces cannot or will not give realistic pay increases to physicians and nurses, they can at least facilitate a reduction of their expenses.
The usual annual renewal fee for a licence in Alberta is $2,150 and about $2,000 in most provinces with currently no discount for senior MDs. If an older physician receives an invoice for this amount, this may be the “last straw” that provokes premature retirement.
Certainly, precedents exist in other professional organizations to give discounted fees to these MDs.
The Royal College of Physicians and Surgeons of Canada offers a reduced fee to “long-term fellows,” ie active fellows with at least 40 years of membership. Currently this is $247, as compared with the regular annual fee of $990.
Also, the College of Family Physicians of Canada discounts their national portion of annual fees from $823 to $559 for MDs age 65 and over, and the Ontario chapter discounts their fees from $246 to $126. Those age 70 and older can become “Life Members” with no annual fees.
Younger physicians, especially general internists, derive much of their income from work in hospitals, where there is little or no overhead. Most older family physicians, internists, and surgeons have a predominately office-based practice. Many incur overhead charges of 40-50% of gross income and are working only part-time.
Across Canada, over 15 per cent of family physicians and 16 per cent of medical and surgical specialists are aged 65 or over; Alberta MDs are somewhat younger.
Hopefully, Alberta and all provinces will reduce their annual fees for older physicians and nurses so as to encourage them to remain in the workforce. We will need their knowledge and experience more than ever.
Ottawa physician Dr. Charles Shaver is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association.