Doctors need income-stabilization benefits, too
Recently, a clinic in Orleans, east of Ottawa, announced that it was closing permanently, leaving 9,000 orphaned patients. I work in a group of 12 clinics, over half are temporarily closed. Similar closures are occurring across Canada, all related to the COVID-19 pandemic.
Physicians might appear to be unlikely economic victims of the pandemic and do not qualify for current federal relief programs. Yet most doctors are not directly involved in treating COVID-19 patients in hospitals and have suffered a major drop in income as routine office visits, diagnostic and surgical procedures are postponed, and non-COVID-19 emergency department visits have declined by half. By mid-June, nearly 400,000 elective surgeries across Canada will have been affected. In recent weeks, these operations have slowly resumed in all provinces except Quebec and Nova Scotia.
Most physicians have ongoing overhead costs during the pandemic. In addition, nearly half of Canadian medical school graduates had debts of at least $120,000. Over the past few years, provincial governments have broken contracts, clawed back billings, and slashed fees. These cuts have caused many older physicians to delay any thought of retirement until well into their 70s.
British Columbia is still working on an optional contract to remunerate MDs anticipating lower patient volumes. 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 additional income for COVID-19 redeployment work. Newfoundland and Labrador have agreed to pay 80 per cent of the average previous billings to doctors who agree to carry on normal services and commit to be available to provide “additional services” with no requirement for payback. Saskatchewan and P.E.I. have also limited agreements to compensate physicians financially during the pandemic. Quebec Premier Francois Legault urged his physicians to assist in understaffed chronic care facilities, and about 2,000 MDs agreed to do so. Yet this does not really meet the needs of most Quebec physicians.
Ontario has offered only an interest-free loan, which merely punts 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.
Most provinces have encouraged older MDs to assist, while knowing that they are at high risk of developing severe or even fatal disease and usually cannot obtain adequate disability insurance past age 65. British Columbia now provides a Quarantine Income Replacement Benefit that covers MDs not enrolled in the government-funded Physicians Disability Insurance Plan.
Ontario and most other provinces give absolutely no disability or death benefits. In contrast, with nearly 40 soldiers testing positive for COVID19, Ottawa has agreed to provide “hazard pay” to CAF persons working in long-term care facilities.
New York Gov. Andrew Cuomo has also called on the U.S. government to provide hazard pay to frontline workers and required all New York state and municipal governments to pay death benefits to families if they died of COVID-19. Can we not treat our physicians as well?
A gold standard might be the 2003 Ontario SARS Income Stabilization Program. This paid at least 80-percent compensation to physicians who were quarantined or were sick with SARS, whose hospital-based practices were affected by hospital actions (for example, cancellation of elective surgery), or who lost income due to reduced service volumes in the community-based practices because patients cancelled appointments or avoided visiting doctors because of concerns about SARS.
In addition to greatly increasing funding for long-term care, Ottawa should provide income stabilization benefits to all Canadian physicians with targeted transfers to the provinces and territories.
After all, Finance Minister Bill Morneau did pledge, “We have not put a cap on what we might need to solve the problem.” Because of a greater number of cases, Ontario and Quebec physicians may require income stabilization for longer than colleagues in British Columbia and other provinces. Legault and the other premiers should not protest intrusion into an area of provincial jurisdiction. After all, when Ottawa was asked, CAF personnel were promptly sent to assist in understaffed nursing homes in Quebec and Ontario, demonstrating one of the many advantages of being part of Canada.
Ottawa physician Dr. Charles Shaver was born in Montreal and 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.