Canada’s doctors are losing income during pandemic, too

During the pandemic, doctors might seem improbable economic victims. Yet many physicians remain available for unexpected emergencies, but have suffered a major drop in income as routine office visits, diagnostic and surgical procedures are postponed.

Most MDs are small businessmen and women with ongoing overhead costs. In addition, 42 per cent of Canadian medical school graduates had debts of at least $120,000 and 13.1 per cent of over $200,000. Because of fee cut in Ontario of up to 30-50 per cent and billing clawbacks over several years, many older physicians have been forced to delay any thought of retirement until well into their 70s.

Since March 15, Ontario hospitals have cancelled 52,700 elective operations and nearly 190,000 have been postponed across Canada. Yet there appears to be some hope. Ontario plans to resume elective surgery in a few weeks.

Meanwhile, surgery resumed in PEI, Alberta, Manitoba and will do so in British Columbia on May 18, in Saskatchewan on May 19, and in New Brunswick in mid-May. Nova Scotia and Quebec have announced no plans.

Surgeons whose elective OR time has been slashed, palliative care and other MDs making house calls, and officebased family physician and internists have seen marked drops in income. A recent Ontario Medical Association Survey found half of physicians were considering closing their clinics for a month or more.

Some provinces have shown respect and appreciation to their physicians. Doctors Nova Scotia recently reached an agreement to stabilize the physician workforce by offering fee-for-service MDs the option of participating in an income stability program. This would pay 80 per cent of their 2019 billings plus extra income for COVID redeployment work.

Sadly, Ontario is offering only an interest-free loan, which will merely punt the cash crunch down the road. It will “top up” billings to 70 per cent of the average during May, June, and July, but will then take back all of the money from November to March. Former OMA President Sohail Gandi asserted that the proposal showed a “glaring lack of understanding” because it assumes that MDs can make up the work later which is not feasible with current infrastructure.

Not only that, but Ontario and many other provincial governments and hospitals are urging older MDs to come out of retirement to assist in the pandemic, while knowing full well that those over age 65 are unable to qualify for disability insurance, and due to their age, they are also at high risk of suffering a severe or even fatal infection. Ontario has refused to even consider compensating physicians should they develop COVID-19 or be forced to self-isolate.

Recall that in June 2003, Ontario agreed to the “SARS Income Stabilization Program.” Eventually some $190 million was paid to physicians, nurses, and paramedics.

Finance Minister Bill Morneau pledged, “We have not put a cap on what we might need to invest to solve the problem.” Justin Trudeau just announced a $3-billion federal contribution to the provinces and territories to support essential workers. Yet so far, MDs have been ignored.

Physicians across Canada should receive income stabilization benefits similar to that after SARS, Ottawa should bear most of the cost, with targeted transfers to provinces and territories. Ottawa physician Dr. Charles S. Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine. He is past-chair of the Section on General Internal Medicine of the Ontario Medical Association. The views here are his own.