Paying MDs more won’t help
Re Physician incomes at heart of dispute with province: Opinion, Feb. 10 Dr. Philip Berger argues that improving the health of Ontario’s citizens requires a “redistribution of wealth in the form of far more robust social programs,” rather than raising physician incomes to the levels the new OMA powers seem to be aiming for. I couldn’t agree more. Every day we see clients whose health will never improve because of poverty.
Within the health-care system, the wages most in need of improvement are not those of doctors, but all the other professionals who work for your health. This includes a lot of people — and they should be paid professionally appropriate wages. The next time you are turned in your hospital bed, or need someone to take you to the toilet at the nursing home, how badly paid do you want that person to be? Dr. Wendell Block, Toronto Philip Berger minced no words in his refutation of the positions voiced by Dr. Nadia Alam. I am quite disturbed by the reactionary response to his views. Some of them implied that, as an academic physician, he has no right to suggest independent practitioners such as Dr. Alam running business practices are overly preoccupied with their bottom lines. Their response completely misses Dr. Berger’s point: physicians are a privileged, entitled group of professionals, whose livelihoods are funded by Ontario taxpayers.
While it is true that income growth has slowed in recent years, we are still obscenely wealthy when viewed against the backdrop of the vast majority of Ontario citizens, struggling against the ravages of neoliberalism and austerity. I am an inner-city physician whose practice includes comprehensive home care, palliative care, chronic mental health, immigrants and refugees. Most of my wonderful patients struggle with poverty. Close to half of my income comprises overhead and coverage of services for the non-insured. Yet, at age 62, I have never been more enthused about my work, which is challenging, rewarding and rich in ways that transcend remuneration.
I think Dr. Alam and her colleagues in the coalition may be well served in remembering their privilege as well-paid civil servants, and perhaps checking their entitlement. Dr. Berger embodies a rare, endangered type of physician, whose legacy will live well beyond the self-serving rhetoric of the coalition as represented by Dr. Alam. Dr. Jim Sugiyama, Toronto Dr. Philip Berger hit the nail on the head in his opinion piece. It is disingenuous to say that the dispute between doctors and the province is about patient care, when it is clearly about protecting and optimizing our incomes. We need a more honest dialogue and less fractious politics within the Ontario Medical Association about what is reasonable and equitable for the whole of our professional group. Last summer’s rejection of an adequate tentative agreement tells me we need more mutual trust, unity and perhaps good faith before we can get back to the negotiation table with the province.
But, rather dishearteningly, we see things heading in the opposite direction. A non-confidence vote in the OMA executive late January further destabilized the organization, and now there is increased discussion about what “job actions” physicians could take to pressure the government.
Let’s instead show that patient care is our priority and demonstrate our professionalism by providing full health care and continuing in our administrative and leadership roles within the health-care system during these difficult times. Ashley Raeside, Toronto Re More proof the province’s health-care system is broken, Feb. 8 We agree with Dr. Nadia Alam that Ontario has the worst RN-to-patient ratios in the country, and that is not good for Ontarians. However, Alam’s assessment that our system is broken is inaccurate. In fact, we have never been closer to the kind of reforms that are needed to ensure our system moves forward.
Nurses have long advocated that services must be focused around patients and not health professionals. We have also called for more timely access to health services and anchoring these services in primary care.
The good news is that Ontario’s registered nurses, nurse practitioners and nursing students have solutions that will put patients first: give RNs the authority to prescribe medications independently (something RNs do in several jurisdictions around the world); allow NPs to prescribe controlled substances; and ensure there are thousands of RN care co-ordinators working in primary care.
These changes, when enacted, will provide people with faster and more co-ordinated access to care and will improve people’s experience with our health system.
With RNs having a four-year university degree and most NPs having graduate degrees, our contribution to the province’s health system can and should be expanded. We are ready for it and committed to serving Ontarians in health and illness. Doris Grinspun, Registered Nurses’ Association of Ontario, Toronto
“Within the health-care system, the wages most in need of improvement are not those of doctors, but all the other professionals who work for your health. This includes a lot of people — and they should be paid professionally appropriate wages.” DR. WENDELL BLOCK TORONTO
As a retired health-care professional in Ontario, I am heartbroken and worried about the negative impasse not only among our MD practitioners but Ontarians.
It is not simple or easy to provide the health care we have developed. It will always take great wisdom, strength and compassionate communication and co-operation to serve patient-guided care while remunerating all doctors who participate in our $52-billion health-care system equitably. The loud, dissenting 25 doctors who bullied their view onto the Ontario Medical Association are frightening. Marguerite Langley, Toronto The OMA casts itself as saviour and guardian of our health-care system. It decries waits for cancer diagnosis, surgery, longterm placement, palliative and home care. This list continues from the 1980s, when many of our physicians went on strike for higher fees and more control over healthcare spending.
Some access and wait-times are better since the 1980s, but not because there are more physicians getting higher fees. Success has mainly come through common-sense reorganization and by replacing physician-centred models of medical care with patient-centred models, often involving fewer physicians but other more appropriate professionals.
Thirty years later we know with even more certainty how other factors matter more to our health than the quality of our health care: security in housing and food, good education, adequate income. These issues, which are critical to patients’ health, are not on the OMA’s agenda.
Acceding to the organization’s demands will not remedy what ails patients or our health-care system. Dr. Debby Copes, Toronto