If MDs aren’t essential, who is?
During the pandemic, many physicians remain on-call for emergencies, but have suffered a major drop in income as routine office visits, diagnostic and surgical procedures are postponed. For example, an orthopedic surgeon, no longer permitted to perform elective hip and knee replacements, may be still expected to repair a fractured hip.
Most MDs are small businesspeople with ongoing overhead costs during the pandemic. In addition, 42% of Canadian medical school graduates had debts of at least $120,000 and 13.1% of over $200,000. Because of fee cuts and billing clawbacks over several years, many older physicians have postponed retirement until well into their 70s. Physicians of all ages – like most Canadians - cannot endure a major, prolonged disruption of their cash flow.
Across Canada, nearly 190,000 operations have been postponed. Ontario will resume elective surgery in a few weeks. Surgery has resumed in PEI, Alberta, and Manitoba, with BC, Saskatchewan, and in New Brunswick in mid-May. Quebec and Nova Scotia have announced no plans.
Some provinces have shown respect and appreciation to their physicians. Nova Scotia is offering fee-for-service MDs an income stability program, paying 80% of their 2019 billings plus COVID redeployment work. Newfoundland and Labrador, PEI and Saskatchewan have limited agreements to redeploy physicians, with no payback requirement.
Premier Legault urged physicians to assist in chronic care facilities and 2,000 MDs agreed. Yet this does not meet the needs of most Quebec physicians.
Ontario is offering only an interest-free loan. It will ”top up” billings to 70% of the average during May, June, and July, but will then take back all of the money from November to March. This will only punt the cash crunch down the road.
Ontario and other provinces are urging older MDs to come out of retirement to assist, knowing that those over 65 cannot qualify for disability insurance, and due to their age, they are also at high risk of a severe or even fatal infection from the coronavirus. Ontario – in a mean-spirited move – has refused to compensate physicians should they develop COVID-19 or be forced to self-isolate. In contrast, British Columbia has a “Quarantine Income Replacement Benefit” for MDs not enrolled in the Physicians Disability Insurance Plan.
In June 2003, Ontario agreed to the “SARS Income Stabilization Program.” This paid 80-100 percent compensation to physicians quarantined or sick with SARS, whose hospital-based practices were affected by hospital actions (eg. cancellation of elective surgery), or who lost income due to reduced service volumes in the community-based practices because patients concerned about SARS cancelled appointments or avoided visiting doctors. Eventually $190 million was paid to physicians, nurses, and paramedics.
Finance Minister Morneau has pledged, “no cap on what we need to invest to solve the problem.” Justin Trudeau announced a $3 billion federal contribution to the provinces and territories to support essential workers. So far, the financial needs of MDs have been ignored.
Physicians in Quebec and across Canada should receive income stabilization benefits similar to that after SARS, and Ottawa should bear most of the cost, with targeted transfers to the provinces and territories.
Charles S. Shaver, MD