Skip to content

SHAVER: Solving the family physician dilemma

All provinces except Quebec have now signed up for additional federal-provincial health transfer funding. Alberta recently concluded an agreement in principle with Ottawa for over $24.2 billion over 10 years – the seventh to do so after Ontario, Manitoba, and the four Atlantic provinces. Admittedly, this was only 16 per cent of the increased amount that the premiers had been demanding. However, Premier Daniele Smith called it a “productive first step.”
32191919_web1_stethoscope-AUB-200306
A District of Houston resolution asking the provincial government to improve health care for rural British Columbians has been accepted by northern elected officials. (THE CANADIAN PRESS/Sean Kilpatrick)

All provinces except Quebec have now signed up for additional federal-provincial health transfer funding. Alberta recently concluded an agreement in principle with Ottawa for over $24.2 billion over 10 years – the seventh to do so after Ontario, Manitoba, and the four Atlantic provinces. Admittedly, this was only 16 per cent of the increased amount that the premiers had been demanding. However, Premier Daniele Smith called it a “productive first step.”

Of note is that Quebec Premier Francois Legault earlier remarked, “It’s not just a question of money but the big challenge now is to find workers and ensure that we have some flexibility.”

Nearly six million Canadians lack a family physician. Foreign graduates make up 35 per cent of Alberta’s physician workforce. Since 2015, over 3600 physicians became permanent residents of Canada, but only a third work in health-care. Many provinces are fortunately creating mechanisms to fast-track a number of them to full licensure.

Moreover, Ontario recently announced that it would recognize the credentials of health professionals already licensed elsewhere in Canada. Shortly thereafter, PEI Premier Denis King indicated that the Atlantic Physician Register had been finalized, and would launch on May 1. This would allow a doctor licenced in one Atlantic province to practice in all of the other three. He stated that the goal was to “improve mobility within the region and cut down on unnecessary red tape.”

A recent poll by the Canadian Medical Association showed that 95 per cent of MDs supported pan-Canadian licensure and were also more likely to provide coverage to rural and remote communities.

This is an excellent first step but I would now suggest that at all provinces offer reduced licence fees for older MDs.

Younger physicians, particularly general internists, derive much of their income from work in hospitals, and incur little or no overhead. Most older family physicians, internists, and medical subspecialists, in their later years, have a mainly office-based practice. Many surgeons work in private, free-standing facilities. Most of these older physicians are not only working just part-time, but must pay 40-50 per cent overhead costs.

Like the nurses, they have been experiencing only sub-inflationary income increases for many years. The renewal fee for a licence is $1792 in Alberta and about $2000 in most provinces. If an older physician receives an invoice for this amount, it may provoke retirement.

For years, the Royal College of Physicians and Surgeons of Canada has a reduced its fee by 75 per cent for specialists with 40 years of membership.

The College of Physicians and Surgeons of Canada charges no fee to “Life Members”, ie those age 70 and older. The Canadian Medical Association also gives a discount to older members.

Of note is that the College of Physicians and Surgeons of New Brunswick discounts its annual licence fee by 66% for those age 70 and older; PEI cuts its fee by 50 per cent for those age 65 and up.

The “Alberta is Calling” campaign is attempting to recruit health and other skilled workers from other parts of Canada. Will older doctors chose to relocate if the Alberta College of Physicians and Surgeons refuses to give them the lower licence fee that they enjoyed in their home province?

At least 15 per cent of Canadian physicians are at least age 65. The average age of MDs is highest in New Brunswick, Nova Scotia, and PEI.

We rely on these senior physicians to prevent an even further deterioration of our health delivery system. Licensing bodies in all provinces and territories should do their part to encourage them to remain in practice by lowering significantly their annual fees.

The creation of health teams, increases in medical school enrolment and fast-tracking of foreign graduates will take years; in the meantime, we need to keep older MDs in the workforce.

Certainly, during our shortage of both family physicians and medical/surgical specialists, we need “all hands on deck.”

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. The views here are his own.