The provincial government needs to take “swift, decisive action” to address the “dysfunction” of Alberta Health Services. “That also means repairing our relationship with nurses and doctors, it means replacing managers with frontline staff, it means attracting additional health professionals from around the world.” These were the words of Danielle Smith in her victory speech on Thursday, October 6. How can she reform the system without causing chaos?
For many months, across Canada, emergency departments have closed temporarily, and physicians and nurses have retired prematurely. In Alberta and many other provinces, 20 per cent of persons have no family doctor.
Medical and nursing school enrolment is increasing, licencing of foreign graduates is being fast-tracked. Newfoundland and Labrador is so desperate that it is even offering $100,000 to doctors (and $50,000 to nurses) who were born, educated or had practiced in the province if they return and agree to work for at least five years.
The College of Physicians and Surgeons of Ontario (CPSO) in mid-August announced that it was encouraging recently retired MDs to reactivate their licences and to return to practice. I wrote the CEO, Dr. Nancy Whitmore, and in a recent article in The Red Deer Advocate (Sept 26) suggested that the annual licence fee be greatly reduced for older physicians, just as the fees for senior MDs are greatly reduced by the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. The annual licence fee is $2,150 in Alberta and close to $2,000 in most other provinces. When an older physician receives an invoice for this amount, it may well provoke retirement.
However, we need another incentive to keep older physicians working as long as possible. I propose government-funded short-term income stabilization.
Physicians may need to be off work for a few weeks or months due to a heart attack, minor stroke, fall resulting in a hip fracture, severe infection such as COVID-19, resection of a malignant bowel tumor, cardiac surgery, depression, a knee or hip replacement, etc. Especially if they have fixed overhead costs, this illness or surgery may result in permanent retirement. Private disability insurance is unfortunately generally unobtainable past age 65.
Precedents do exist. Recall that in 2003, the Ontario government set up a SARS Income Stabilization Program that paid up to 80% of physicians’ average monthly billings if they were quarantined, ill with SARS, or their hospital-based of office practices were adversely affected.
Very relevant is that Alberta has a Parental Leave Program which covers the pregnancy of an eligible physician and the adoption of a child. All provinces have similar plans; some also cover a surrogacy arrangement and some cover a spouse. Benefits are paid usually for 17 weeks, are taxable, and vary from $1000 in British Columbia, $1300 in Saskatchewan, $1400 in Manitoba, $1300 in Ontario, $1500 in Nova Scotia, and $1200 in New Brunswick, PEI, and Newfoundland and Labrador. Quebec has a complicated plan that pays specialists up to $2400 per week, but only for 12 weeks.
Alberta predicts a budget surplus for 1022-23 of $13.2 billion. I, therefore, propose that Alberta and other provinces and territories, if they are serious about utilizing senior physicians as much as possible, provide the following:
Practicing physicians and surgeons would be covered from age 65 to at least 80, with no waiting period. The MDs would receive 70-80% of their average monthly billings for 60, or preferably 90 days.
Across Canada, over 15% of family physicians and 16% of medical specialists are aged 65 and over. Hence, we must do whatever it takes to retain older health professionals.
Ontario NDP Health Critic France Gelinas recently remarked, “We need to incentivize health-care workers and treat them with the respect they are owed.”
Certainly, provincial governments and colleges of physicians and surgeons should translate their platitudes into financial benefits such as reduced annual licence fees and short-term income stabilization. These will help to keep older physicians in the workforce – even part-time. They can then continue to provide patients with much-needed expertise that only comes with many years of experience. This will lessen the burden on short-staffed emergency departments.
Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association.