Thread: Is the sky the limit for doctors' salaries? (Vancouver Sun)

http://www.canada.com/vancouver/vanc...e-fc8bc5656484

Is the sky the limit for doctors' salaries?
Doctors are already pampered, but the answer is to train more, says columnist

Daphne Bramham
Vancouver Sun


Saturday, January 31, 2004





The Canadian medical profession is the largest sheltered workshop in the country.

From the time doctors enter medical school until they retire, they are among the most pampered and protected groups in our society.

Medical students pay the smallest proportion of the true cost of their education compared to students in all other programs, including other professional programs. The subsidy is about $70,000 a year per student.

Interns get paid to work while they do their training. Engineers don't. Dentists don't. Teachers don't. Nurses used to, but they got cut off years ago.

Doctors have guaranteed jobs when they graduate. As lobbyists for the medical profession keep telling us, doctors can go anywhere because there is a global shortage.

The most expensive tools of their trade are paid for by taxpayers, from hospitals to surgical suites to diagnostic equipment.

Doctors, unlike all other small business operators, never have to worry that their fees will be paid. They have a single payer -- the government.

Doctors are allowed to limit their competition. The provincial colleges of physicians and surgeons are the licensing bodies and it's up to them to decide whether foreign-trained doctors can join the club. What a union boss wouldn't do for similar powers.

For some reason, successive governments -- and citizens fearful about doctors going on strike -- have allowed this to happen.

The average B.C. physician earns $300,000 a year. The fees here are second in Canada only to Alberta. The majority of doctors, who practise in Ontario, make far less.

That $300,000 average is more than six times the average income for a Canadian with a university education, which Statistics Canada says is $48,648. The average, of course, masks the fact that there are plenty of family physicians earning closer to $100,000 a year; that at least 10 specialists were paid more than $1 million by the B.C. Medical Services Plan last year; and that most physicians have office overhead of 50 per cent or more of their salary.

The question we need to ask is: What are we willing to pay them?

Certainly, we can't get by without them. But are they so valuable that we are willing to pay more taxes or have services cut so that they can have higher wages at a cost the government figures might be as high as $1.3 billion over three years?

To put $1.3 billion into perspective, Ottawa will give the provinces $2 billion more this year in health care transfers. The $250 million earmarked for B.C. would be entirely eaten up by doctors if they had their way.

Another way to look at it is that the doctors' fee demands would negate all the savings the regional health authorities have squeezed out of their budgets in the past two years by closing hospitals, shutting acute-care beds and nursing homes, and firing $19-an-hour kitchen staff and replacing them with $12-an-hour contract workers.

If the government were to agree to the doctors' demands, patients would get no improvements in services. There would be no cuts to long waiting lists, no enhanced treatments, no increase in emergency room doctors or beds.

It's worth noting, though, that if there is no increase for doctors' fees as Premier Gordon Campbell is now threatening, there will be no money to cover the estimated increased demand for physicians' services of 2.5 per cent. That increased demand is a direct result of population growth coupled with technology advances and an aging population.

The other risk to declaring war on the doctors is that B.C. will lose some doctors and might find it more difficult to recruit replacements.

It might be a risk worth taking. But only if the government commits to reversing the historical trend of failing to train enough of our own doctors. The fact is, physicians are only able to demand so much because there is a shortage.

Victoria has committed to doubling the number of spaces in medical schools to 256 by 2010 by increasing the number of seats at the University of British Columbia and adding distance learning for first- and second-year students at the University of Victoria and at the University of Northern British Columbia.

But there's no magic to either 256 spots or 2010. In fact, even that is far short of the estimates that between 300 and 400 additional doctors are needed each year just to match the number leaving or retiring.

Certainly there is no shortage of people wanting to be doctors. The University of British Columbia already has 1,314 applicants for 200 spots this fall and the deadline is still weeks away.

But even if B.C. doesn't dramatically increase the number of spaces in medical school, it should at the very least require graduates to work here for a set period of time. The Canadian Armed Forces does it, so why shouldn't the province do so as well to offset the $280,000 subsidy doctors receive as students?

The high cost of training doctors could also be partially offset by higher tuition fees for medical students, moving them at least to a par with other schools in the country.

Nobody wants doctors withdrawing their services and driving the health-care system into greater chaos. But nobody wants to risk losing medicare if doctors' fees alone make it unsustainable.

dbramham@png.canwest.com

Well....I've stared at this article for a couple of weeks now...and I'm still speachless. Just as a Vancouverite...I'd like to say I'm embarrassed.

Originally Posted by geoff

Well....I've stared at this article for a couple of weeks now...and I'm still speachless. Just as a Vancouverite...I'd like to say I'm embarrassed.

well, as a Canadian it says that you have problems getting a spot to go to school there. Until the system in Canada is friendly to IMGs we in the US are going to benefit from your doctors more than Canada.

az skeptic

Wow, that's craziness for BC. Is this the future for Canadian docs?

Ouch.

IndianBabu

I heard that in Ontario, the opposite situation exists, doctors there aren't being paid enough. Most GPs in Ontario make the equivalent of $50,000US after expenses and many struggle to pay their medical school loans. This really pales in comparison to an IM in the US who averages $150,000US or even a Family Practioner who makes $120,000US. This is the reason why many high achieving Canadians move to the US.

Well it's just not Ontario physicians that are underpaid....that's why I'm so embarrassed.... the article is so entirely anit-doc and backwards...it's pretty much insulting. Currently I thought that RAD days were still being done all over Canada.. Reduced activity days. Because of procedure capping...and the lack of the government funding procedures after 'x' numbers of them....essentially, depending on your client base...doctors were/are forced to work for free. So they decided they were being treated like a union...so they'd act like one...and strike. So they all get together and take off days they figure they're not getting paid for anyway. Just a year or two ago all of Newfoundland/Novia scotia doctor's were on strike...and the amount of times I heard BC doctors were limiting services to 'essential services'...... I don't even know how many. So it's just somebody saying...because docs get paid more than average they don't deserve it..which is rediculous...there are many other jobs out there that can make absurdly more for one ten the educational requirements....think about it.... 3 years undergrad....4 years **....3-7 years more and hundred of thousands in debt....anyhoo. whatever.... lets just not complain about the brokers that have 13 million in their RRSP's...that took a 6 month Canadian Securities Course.... and let's support the brain drain. Cda has been opening up new spots in med school now for a couple of years...and in BC they're training them now in smaller(or would like to) universities...and sending them back to Vcr for clinicals.. I think UNBC and Univ of Victoria..which is all responsive and good...but because of the system...I think I read 21% of Canadian trained docs are finding work in the States.... so they're defeating their own efforts...anyhooo.....
Geoff

Oh boy...

While your article brings up some valid points there are certain things I have to say are WAY out of line.

You can't compare a doctor to an engineer, or a teacher, or a university graduate. When you are making a living by "healing" people, putting yourself on the line every day for others, not to mention risking law suits, having to study and train yourself every day of your life so you stay in touch with the evolving field...the profession should not be compared to other professions.

An intern *should* get paid to do what he does! The issue isn't that a doctor gets paid while the others don't, the issue is that those others SHOULD get paid.

Regardless...for the sacrifices a doctor has to make by choosing his profession , i believe they deserve the benefits they get. And some really special ones will go in under-serviced areas, or needy countries without a dime to their name.

Hello again, just wanted to express some concerns here in Canada, some of my dear frineds were practicing in Ontario, Canada, however because of the Medical Social System....the cap method, they gave up and moved to the states........I guess in some cases it is well worth it to pay extra liability. One friend a GP moved to Florida and opened a chelation threapy business and he is now Multi-Millionaire......Can never do that in Canada.........other an orthopedic surgeon, moved from Toronto, where he was maxed at 300,000$ per year, before 60% taxes plus, moved to Texas and he is now making at least double and paying 20% Taxes, as a corporation........(Since in Ontario you can not incoroporate as a medical doctor.........)
IMG's Can not practice in Canada, Ontario specifically makes it HELL for IMGs to try and even think about practicing........Regardless of your education and experience...............
Now, you wonder why there is a physician shortage in CANADA....?
The good MDs leave and the new MDs leave also.......The ones that stay work like DOGS !!!!

Sad but True............I would never considering working as an MD in Canada, not worth the headache.....

Regards,

Originally Posted by IMG X-Files

.other an orthopedic surgeon, moved from Toronto, where he was maxed at 300,000$ per year, before 60% taxes plus, moved to Texas and he is now making at least double and paying 20% Taxes, as a corporation........(Since in Ontario you can not incoroporate as a medical doctor.........)

IMG's Can not practice in Canada, Ontario specifically makes it HELL for IMGs to try and even think about practicing........Regardless of your education and experience...............
Now, you wonder why there is a physician shortage in CANADA....?
The good MDs leave and the new MDs leave also.......The ones that stay work like DOGS !!!!

,

Hmmm..... 60% in taxes? this is a mild exaggeration. Either his accountant was embezzling, or someone isn't telling the complete truth. NOBODY pays this much tax in Canada.

An ortho capped at $300 000? perhaps this was what he made AFTER taxes. almost all physicians in Ontario are capped at around $500 000.

IMGs can't practise in Canada? Hardly true - Saskatchewan has around 50% of its doctors being foreign trained.

Ontario is VERY hard to practice in as a foreigner just starting out - but a IMG who has practised elsewhere in Canada for several years (ie 5+) has many more options open to them than simply going through the standard OIMG program.

A foreigner who has already completed specialty training also bears special consideration in almost all provinces.

I felt the need to address some exaggerations here. While it is difficult as an IMG to initially practice in Canada, it isn't impossible - and for many people it is WELL worth the effort.

Cheers,

Silenthunder

ah yeah i am pampered. When I saw the med school loans I weed myself.