MDS may be exploring once unthinkable move

There was an uncomfortableness in the conversation between the patient, his wife and their doctor beyond the usual reasons for uncomfortableness in such settings.

This wasn't news about a potential bad health outcome — one of the many things that makes being a doctor practising anywhere difficult.

Instead, it was the doctor outlining to his patients his current difficulties in practising medicine in Saskatchewan, including having to lay off staff he could no longer afford under the province's public health-care and fee/billing system.

He wanted his patients to know about potential changes he was seriously exploring — remedies many would see as inconceivable here.

Since the 1962 implementation of medicare in this province, doctors have usually subscribed to the same tried and trusted solutions to be properly compensated.

The options have always been to: see more patients, spending less quality time with each; work even more hours in hospitals; demand more public health money for specific procedures; or move somewhere that is paying more for some procedures.

Sadly, Saskatchewan doctors opting to leave is what's now wrong with our health-care system — why we now can't seem to find a GP or specialist.

What's even more sad is many doctors here would prefer to stay — preferably, without working ridiculous hours or rushing through as many patients in a day as is humanly possible.

For some specialists, there are often even fewer options if they work in rural areas outside the cities where most of the surgical procedures are done.

That leaves the option of negotiating higher fees for visits or specific procedures, but there is a huge impediment with this alternative as well.

Here in Saskatchewan, the government through the Ministry of Health negotiates with the Saskatchewan Medical Association (SMA) representing doctors on what is the appropriate lump sum to be collectively paid to all our doctors in any given year.

What isn't part of these contract negotiations, however, is negotiations for specific fees. The SMA works these out later with the approval of the government health authority.

One might think that doctors having this much authority over how much they get paid and for what would be a good thing. But it's optimal for everyone — specialists in particular.

With a majority of Saskatchewan doctors being general practitioners, they exercise considerable influence in the SMA'S priorities, meaning smaller numbers of specialists don't have the same clout on fee payment schedules.

Now, other provinces are offering better working conditions or better fees for some specialists, which is perhaps why Saskatchewan is struggling to keep some specialists like pediatric gastroenterologists.

But what are the options for Saskatchewan doctors who want to keep their practices — essentially private businesses — here, and don't or can't see more patients or take hospital shifts?

Well, there's one other option no has even talked about until now — an option perhaps unthinkable in the birthplace of medicare.

Under the Saskatoon Agreement in the original 1962 medicare contract, doctors here have always had the right to opt out of medicare and directly bill patients.

It would mean forfeiting their rights to bill the government (doctors can't bill both the government and patients). However, this is already happening in Quebec.

Nobody has ever done this in Saskatchewan, but all it would take is one request to the College of Physicians and Surgeons to do so.

And there are now rumblings — as per the aforementioned conversation at least one Saskatchewan doctor is now having with his patients, informing them he might be exploring private billing options that could affect them. (The patient asked not to be identified.)

To be clear, private doctor billing is not happening yet and may never happen. There are other solutions.

But it's fascinating, in a province where one's view of medicare is akin to a religious belief, that it's even being discussed.

It's even more fascinating that it is being discussed not for philosophical reasons, but because, in Saskatchewan, we just can't seem to get health-care funding right.