With all due respect to Globe and Mail Public Health Reporter André
Picard and his assessment that the social-media voice of
Ontario doctors is sounding "shrill, self-indulgent, and
counterproductive" as they continue their dispute with the
Ontario government over fee cuts, I would counter that, given their
current situation, our physicians are acting in a perfectly
rational manner. After all, who among us, when backed into a corner
and with no means of escape, wouldn't scream, shout and say
whatever it takes in order to call some attention to our
If ever there was a group of people caught between a rock and a
hard place it is Ontario's doctors. As Mr. Picard correctly
points out, the government has unilaterally cut doctors' fees
by 4.45 per cent this year. Less discussed is how physicians are
trapped in a system that gives them no options and no way out.
Doctors can't make up the decrease in their income by seeing
more patients because of government-imposed maximums on the
services allowable per patient even when the patient requires extra
services; they can't extra-bill for services because that's
against the law; and they can't opt-out of the system because
Canadians are not permitted by law to pay for healthcare services
outside of our publicly funded system. In other words, for doctors,
there is no escape other than to leave the country or leave the
profession. Is that what we want?
At the same time, doctors' costs are either staying the same
or increasing. As Mr. Picard correctly identifies, doctors have to
pay overhead (although to say, as he did, that some have 0 per cent
overhead is misleading). Whether for rent, office staff, supplies,
equipment, insurance or more, doctors have expenses for which they
must pay market prices. They can't arbitrarily cut, say, their
receptionist's negotiated salary or tell their landlords
they're going to pay less rent; if they did they would be sued
or kicked out of their premises. As their top line goes down while
their expenses either stay the same or go up, doctors are caught in
the middle. Maybe doctors shouldn't "whine", as Mr.
Picard says, about high overhead but by the same token, maybe the
public should understand that doctors have to pay their bills and
at the end of the day, what they take home is substantially less
than what they are given.
Maybe Mr. Picard is also correct when he says that doctors
shouldn't complain that plumbers make more per hour than they
do because, after all, many others, such as child-care workers, are
badly underpaid. Fair enough. These members of society however,
enter the workforce at least a decade before doctors do and they do
not enter the workforce hundreds of thousands of dollars in debt
for the training required for the job. But it would behoove us to
mention that others in the health care field make a lot more and to
question why that is. Why is it, for example, that hospital
administrators, who are also paid by tax payer dollars yet
aren't tasked with the burden of literally saving lives, are
paid so handsomely? Why does the government see fit to not ask the
likes of Mt. Sinai President and CEO Joseph Mapa (2014 salary -
$688,907.07), Sunnybrook's Executive Vice President and Chief
Medical Executive Andy Smith (2014 salary - $434,062.60) or Markham
Soufville's President and Chief Executive Officer Janet Beed
(2014 salary - $418,964.68) and the long list of other hospital
administrators who make the Public Sector Salary Disclosure List: Hospitals
and Boards of Health (a.k.a. The Sunshine List), to accept
unilateral pay cuts?
Mr. Picard is correct when he says that binding arbitration
would be the most sensible short-term option. The OMA should issue
a written, formal invitation, published in the newspaper,
requesting the Ontario government to put the matter to binding
arbitration. A panel comprised of one arbitrator chosen by the OMA,
one arbitrator selected by the Ontario government, and a third,
selected by the other two arbitrators, should be formed to resolve
the matter. Until then, it's a safe bet the doctors will
continue their war of words on social media. Yes, their voice might
be shrill, but that doesn't mean we shouldn't hear what
they're saying. And yes, it might reflect poorly on physicians
to have their sense of entitlement showing but that doesn't
mean they are not entitled. Most particularly doctors surely have
an entitlement to be treated respectfully, which is certainly not
our government's current modus operandi.
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