Is medicine as bad for doctors as nurses? Are doctors the next to be attacked?

[whatdoido]

preface: this might be a bit Ontario-centric; unsure how bad things are for the rest of Canada.

No secret that things are extremely bad right now for nurses in Ontario; Bill 124 is nauseating and flat-out insulting, and we are apparently looking at an unprecedented shortage of nurses in the coming months/years due to them quite rightfully transitioning to other careers/less stressful nursing positions or just plain out quitting. It is disgusting how the conservative government is treating nurses, especially during a pandemic in an already fragile and stressed healthcare system.

It got me thinking, though- no one seems to bring up physicians in these conversations. How have they been treated by the gov during the pandemic? What is the general rhetoric towards physicians? Have we ever seen the govnmt attempt something like Bill 124? I know they love to mention how much of the yearly fiscal budget healthcare/doctors eats up...

I have to say, seeing how nurses are being treated makes me of course quite sympathetic towards them and also nervous for my future as a physician. I do intuitively feel that physicians have some more innate protection against this sort of treatment (there's less of us so we're more "in demand," there's always the risk of brain drain), but then I remember what happened in Alberta and other provinces...

Also, there's a lot of speculation that these attacks/the underfunded healthcare system in general is some sort of "starve the beast" plan by the conservatives to try and establish a privatized system. Anyone know if this is plausible? What does that look like for doctors? Is it better or worse for us? What about the general population?

Kind of a disorganized post, but I've just been thinking a lot lately as this has been in the news and i'm procrastinating studying for my summative haha.

[zoxy]

On 1/7/2022 at 2:15 PM, whatdoido said:

What is the general rhetoric towards physicians?

They're overpaid, greedy, and don't care about patients because they won't spend 45 minutes with each patient.

On 1/7/2022 at 2:15 PM, whatdoido said:

Have we ever seen the govnmt attempt something like Bill 124?

Yes, many times. Ontario doctors were without contracts from 2014-2019. The government imposed unilateral fee cuts.

https://www.cbc.ca/news/canada/toronto/ontario-doctors-take-province-to-court-over-fee-cuts-1.1134985

https://www.cbc.ca/news/canada/toronto/doctors-vote-not-to-accept-ontario-s-proposed-fee-agreement-1.3722071

https://www.cbc.ca/news/canada/toronto/ontario-doctors-awarded-new-contract-arbitrated-settlement-1.5025350

There were also fee cuts in the 1990's in Ontario when Canada was the Sick Man of the Western World. I don't explicitly know about physician fee cuts in other provinces during the 90's but considering Saskatchewan was a hair away from bankrupt at the time, I'd imagine that other provinces were also imposing cuts in the 90's.

 

In Alberta Kenney is waging war over physician fees as well, I think they're currently without a contract:

https://www.cbc.ca/news/canada/calgary/road-ahead-alberta-medical-association-doctors-agreement-rejected-1.5971133

https://www.cbc.ca/news/canada/calgary/alberta-kenney-doctors-government-1.5653948

 

Legault campaigned on brutal cuts to specialist pay but flip flopped a bit on it. He did end cutting specialist pay after all but by not as much as he initially said:

https://globalnews.ca/news/6285029/quebec-medical-specialists-deal-provincial-government/

On 1/7/2022 at 2:15 PM, whatdoido said:

more innate protection against this sort of treatment (there's less of us so we're more "in demand," there's always the risk of brain drain)

I'm not sure they do have more protection. Nurses are actually eligible for TN visas while doctors are not. The Canadian government made sure not to include doctors in NAFTA or USMCA negotiations because they want to forestall a doctor brain drain but probably weren't too worried about nurses at the time. An H1B is a much tougher visa to get and requires all three USMLEs and an employer to sponsor you. The regulatory barrier to Canadian doctors working in the US, is bigger than for nurses.

On 1/7/2022 at 2:15 PM, whatdoido said:

Also, there's a lot of speculation that these attacks/the underfunded healthcare system in general is some sort of "starve the beast" plan by the conservatives to try and establish a privatized system. Anyone know if this is plausible?

It's not a conspiracy to establish a private system. Provincial governments are just dead broke,  and they are the ones responsible for healthcare. NL is essentially bankrupt, the Maritimes are geriatric and dependent on transfer payments, Ontario's finances are a shambles, Quebec is aging and not much better off, and Alberta was hemorrhaging money with low oil prices. Only BC and Saskatchewan are in decent fiscal shape while Manitoba is treading water but on a downward trajectory.

The public will not tolerate tax increases with the rising cost of living. Meanwhile the Canadian economy remains stagnant and unproductive compared to the US.

Another issue is that the burden of healthcare falls on the provinces while the feds collect the majority of the taxes and do not transfer enough back to the provinces. When the public system was set up in the 60's and 70's, the provinces and the Feds split the cost 50/50. Nowadays 75ish percent of the burden falls on the provinces and the Fed's Canada Health Transfer is only 25ish percent. Meanwhile, the Feds will use the Canada Health Act to ban the provinces from privatizing anything. They say that if there is any privatization, they will withhold the equivalent amount of money from the Canada Health transfer. And This is today with low interest rates. God forbid what will happen with rising interest payments on the mountain of government debt when interest rates invariably go up. J-Pow recently said that the US Fed is increasing rate in March.

https://www.pbo-dpb.gc.ca/web/default/files/Documents/Reports/RP-2021-020-S/RP-2021-020-S_en.pdf

https://cwf.ca/research/publications/what-now-canada-health-transfer-background-and-future/

On 1/7/2022 at 2:15 PM, whatdoido said:

a privatized system.

The Canada health act won't allow and changing it to allow privatization would be political suicide by whichever federal parties support it, regardless of how much the provinces might want and need privatization. The Feds will just tell the provinces to suck it up without increasing transfer payments, and the provinces will have no recourse because taxes are already pretty high.

https://www.theglobeandmail.com/news/national/saskatchewan-asked-to-end-two-for-one-mri-program/article33085495/

https://globalnews.ca/news/6630331/federally-imposed-deadline-approaching-for-saskatchewan-to-stop-private-mris/

Combined Federal and Provincial Marginal Tax Rate in Ontario for 100,000 is already 36 percent with an HST of 13 percent. You can then add in property taxes, gas taxes, the carbon tax, liquor taxes, marijuana taxes, CPP premium, EI premium, and tobacco taxes. There literally isn't anything else to tax beyond higher income taxes and wealth tax. I'm not sure the public will bear anymore taxation.

[shikimate]

have realistic, pragmatic expectations for the bureaucratic, political and the healthcare system. try not to let your worry hinder your path to residency. Pay attention to these political and economic issues, but don't dwell on them if they're outside your control.

[Pakoon]

8 hours ago, whatdoido said:

preface: this might be a bit Ontario-centric; unsure how bad things are for the rest of Canada.

No secret that things are extremely bad right now for nurses in Ontario; Bill 124 is nauseating and flat-out insulting, and we are apparently looking at an unprecedented shortage of nurses in the coming months/years due to them quite rightfully transitioning to other careers/less stressful nursing positions or just plain out quitting. It is disgusting how the conservative government is treating nurses, especially during a pandemic in an already fragile and stressed healthcare system.

It got me thinking, though- no one seems to bring up physicians in these conversations. How have they been treated by the gov during the pandemic? What is the general rhetoric towards physicians? Have we ever seen the govnmt attempt something like Bill 124? I know they love to mention how much of the yearly fiscal budget healthcare/doctors eats up...

I have to say, seeing how nurses are being treated makes me of course quite sympathetic towards them and also nervous for my future as a physician. I do intuitively feel that physicians have some more innate protection against this sort of treatment (there's less of us so we're more "in demand," there's always the risk of brain drain), but then I remember what happened in Alberta and other provinces...

Also, there's a lot of speculation that these attacks/the underfunded healthcare system in general is some sort of "starve the beast" plan by the conservatives to try and establish a privatized system. Anyone know if this is plausible? What does that look like for doctors? Is it better or worse for us? What about the general population?

Kind of a disorganized post, but I've just been thinking a lot lately as this has been in the news and i'm procrastinating studying for my summative haha.

Everything above has already been said, and I couldn't agree more. I'd also like to add that what's happening to the Nurses now has basically been physicians situation for the last I'm not even sure how many years. Burnout, absurd hours, government pay cuts, physicians have seen it all. 

The difference here is that if physicians complain about their situation they are seen as evil and greedy, where as the nurses are not. I do think our nurses deserve better, but I sometimes find it hard to sympathize when their own unions are the ones perpetuating scope creep and pushing their own out of bedside nursing.