Recently patients have died unexpectedly in emergency departments in New Brunswick and in Ajax (just east of Toronto), Ontario. Due to exhaustion, burnout, and poor working conditions, many health-care workers have quit, forcing emergency departments across Canada to close temporarily. About five million Canadians have no family physician, and are forced to go to walk-in clinics. No wonder that health care has surpassed inflation as the top national issue of concern according to a Nanos poll.
Manitoba Premier Heather Stefanson recently reiterated her request that Ottawa increase the Canada Health Transfer from 22% to 35%. But at a federal-provincial/territorial meeting in Vancouver, Federal Health Minister Jean-Yves Duclos refused to indicate how much additional money he was prepared to transfer to the provinces. He felt that the premiers should instead focus on results such as recruiting and retaining health professionals. Before the meeting was over, the premiers sent a letter indicating that no progress had been made. At a virtual meeting on December 9, they again called for a meeting with Justin Trudeau to discuss health funding.
What can be done? Medical and nursing school enrolment is increasing. British Columbia is tripling the number of spots for family physicians trained outside Canada to obtain a licence; other provinces are also fast-tracking foreign nursing and medical graduates. The Canadian Medical Association is advocating for a nationally portable medical licensure. As a start, there has already been interest in regional licensure among the Atlantic premiers. Several experts have proposed team-based care with salaries and fringe benefits for physicians.
I outlined in my previous article the need for incentives to keep older physicians working as long as possible such as reduced annual licence fees. Across Canada, over 15% of family physicians and 16% of medical specialists are aged 65 and over; a decade ago it was only 10%.
Yet these physicians may need to be off work for a few weeks or months due to a heart attack, severe infection such as COVID-19, resection of a malignant bowel or breast tumor, prostate or cardiac surgery, depression, a knee or hip replacement, etc. This illness or surgery may result in permanent retirement. Sadly, private disability insurance is usually unobtainable past age 65.
Most important as a precedent are the maternity benefits offered across Canada. Alberta has a Parental Leave Program which pays up to a maximum of $1074 per week. All provinces have similar plans. Benefits are paid usually for 17 weeks, are taxable, and vary from $1000 in British Columbia and New Brunswick to $1500 in Nova Scotia. Quebec has a complicated plan that pays a lump sum and higher benefits but for only 12 weeks.
Note that ALL provinces have had these benefits – usually for at least 15 years. Once one province negotiates such a benefit, the others quickly follow. Younger physicians are mobile, and some may leave for provinces that do offer these benefits. With the prospect of nationally portable medical licensure, this will put even greater pressure on a province that opposes benefits such as short-term disability for older physicians.
Readers who are younger physicians may initially feel that these do not concern them. However, before long, they will be age 65 and over, and will be grateful that the disability plan was put into place. Although governments often impose physician fee freezes and even cutbacks with little public disapproval, even those who perceive MDs as being overpaid would oppose cancelling fringe benefits once given.
I therefore propose that Alberta and other provinces and territories 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.
For Ottawa to subsidize such a program would be an example of targeted health transfers which should be agreeable to Duclos and welcomed by most provinces. Yet by claiming exclusive provincial jurisdiction, Quebec may well protest any “strings attached” to indirect federal funding of physicians. Ottawa could then simply pay them directly. Recall that the Interim Federal Health Program pays physicians treating refugees directly at provincial/territorial health insurance rates. MDs are also paid directly by Ottawa for treating federal prisoners, and until 2013, for members of the RCMP.
Short-term disability coverage will help to keep older physicians in the work-force - even part time. Some 80% of patients seeking help in emergency departments could have been managed otherwise by family physicians. Hence, this will lessen the burden on these overcrowded, understaffed facilities.
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.