"Is the sky the limit for doctors' salaries?"

[Guest Ian Wong]

Here's an interesting article that I found in yesterday's Vancouver Sun. Basically, the article asserts that BC doctors are on average making $300,000 annually. That figure is derived from the fact that the BC MSP system pays out $2.4 billion to physicians annually, and there are 7,800 physicians actively billing the BC MSP system.

 

I think there's a lot of misguided information within this article, but it raises a lot of good points about the public's perception of doctors versus what physicians themselves think about doctors.

 

Ian

 

PS: Oh yeah, Carolina just scored to even the Superbowl at 7-7. Gotta go!

 

 

www.canada.com/vancouver/vancouversun/news/story.html?id=58453c88-a31c-4005-965e-fc8bc5656484

 

 

Is the sky the limit for doctors' salaries?

Doctors are already pampered, but the answer is to train more, says columnist

 

Daphne Bramham

Vancouver Sun

 

Saturday, January 31, 2004

 

The Canadian medical profession is the largest sheltered workshop in the country.

 

From the time doctors enter medical school until they retire, they are among the most pampered and protected groups in our society.

 

Medical students pay the smallest proportion of the true cost of their education compared to students in all other programs, including other professional programs. The subsidy is about $70,000 a year per student.

 

Interns get paid to work while they do their training. Engineers don't. Dentists don't. Teachers don't. Nurses used to, but they got cut off years ago.

 

Doctors have guaranteed jobs when they graduate. As lobbyists for the medical profession keep telling us, doctors can go anywhere because there is a global shortage.

 

The most expensive tools of their trade are paid for by taxpayers, from hospitals to surgical suites to diagnostic equipment.

 

Doctors, unlike all other small business operators, never have to worry that their fees will be paid. They have a single payer -- the government.

 

Doctors are allowed to limit their competition. The provincial colleges of physicians and surgeons are the licensing bodies and it's up to them to decide whether foreign-trained doctors can join the club. What a union boss wouldn't do for similar powers.

 

For some reason, successive governments -- and citizens fearful about doctors going on strike -- have allowed this to happen.

 

The average B.C. physician earns $300,000 a year. The fees here are second in Canada only to Alberta. The majority of doctors, who practise in Ontario, make far less.

 

That $300,000 average is more than six times the average income for a Canadian with a university education, which Statistics Canada says is $48,648. The average, of course, masks the fact that there are plenty of family physicians earning closer to $100,000 a year; that at least 10 specialists were paid more than $1 million by the B.C. Medical Services Plan last year; and that most physicians have office overhead of 50 per cent or more of their salary.

 

The question we need to ask is: What are we willing to pay them?

 

Certainly, we can't get by without them. But are they so valuable that we are willing to pay more taxes or have services cut so that they can have higher wages at a cost the government figures might be as high as $1.3 billion over three years?

 

To put $1.3 billion into perspective, Ottawa will give the provinces $2 billion more this year in health care transfers. The $250 million earmarked for B.C. would be entirely eaten up by doctors if they had their way.

 

Another way to look at it is that the doctors' fee demands would negate all the savings the regional health authorities have squeezed out of their budgets in the past two years by closing hospitals, shutting acute-care beds and nursing homes, and firing $19-an-hour kitchen staff and replacing them with $12-an-hour contract workers.

 

If the government were to agree to the doctors' demands, patients would get no improvements in services. There would be no cuts to long waiting lists, no enhanced treatments, no increase in emergency room doctors or beds.

 

It's worth noting, though, that if there is no increase for doctors' fees as Premier Gordon Campbell is now threatening, there will be no money to cover the estimated increased demand for physicians' services of 2.5 per cent. That increased demand is a direct result of population growth coupled with technology advances and an aging population.

 

The other risk to declaring war on the doctors is that B.C. will lose some doctors and might find it more difficult to recruit replacements.

 

It might be a risk worth taking. But only if the government commits to reversing the historical trend of failing to train enough of our own doctors. The fact is, physicians are only able to demand so much because there is a shortage.

 

Victoria has committed to doubling the number of spaces in medical schools to 256 by 2010 by increasing the number of seats at the University of British Columbia and adding distance learning for first- and second-year students at the University of Victoria and at the University of Northern British Columbia.

 

But there's no magic to either 256 spots or 2010. In fact, even that is far short of the estimates that between 300 and 400 additional doctors are needed each year just to match the number leaving or retiring.

 

Certainly there is no shortage of people wanting to be doctors. The University of British Columbia already has 1,314 applicants for 200 spots this fall and the deadline is still weeks away.

 

But even if B.C. doesn't dramatically increase the number of spaces in medical school, it should at the very least require graduates to work here for a set period of time. The Canadian Armed Forces does it, so why shouldn't the province do so as well to offset the $280,000 subsidy doctors receive as students?

 

The high cost of training doctors could also be partially offset by higher tuition fees for medical students, moving them at least to a par with other schools in the country.

 

Nobody wants doctors withdrawing their services and driving the health-care system into greater chaos. But nobody wants to risk losing medicare if doctors' fees alone make it unsustainable.

[Guest coastal79]

Thanks Ian, interesting article. I especially liked the part suggesting that doctors work in the province they are trained in for a set amount of time to "pay-back" their highly subsidized educations. To be fair then, since all post-secondary education is highly subsidized, philosophy majors and everyone else should have to work in-province for a set time as "philosophers" or whatever.

[Guest strider2004]

Interns get paid to work while they do their training. Engineers don't. Dentists don't. Teachers don't. Nurses used to, but they got cut off years ago.

 

Is the author serious? Since when do dentists NOT get paid to do specialist training? Engineers don't get paid when they graduate until they get their professional cert?

 

It's funny that she states that it costs $70,000 extra /medical student and then expects the gov't dramatically increase the number of spots but fails to account for this in the budget. She also expects graduates to work for the gov't for a set period of time. They do. It's called residency.

[Guest cracked30]

Someone in Government fed her that info. BC has decided to use the media to undermine doctors.

 

Get used to it.

[Guest moo]

C'mon this is BC you're talking about, where instead of money going into health care, it's going to buy heroin for addicts.

[Guest Ollie]

Umm, do you have an example of when addicts have had heroin bought for them? If you are referring to the safe injection site, the addicts that use it do not have drugs provided for them.

 

Sorry I am not trying to hijack this thread. I think that the column is really interesting, and worthy of discussion. I just would like a clarification of the above point.

[Guest coastal79]

Which is a heck of alot better than having them shoot up in the street. A study was released awhile ago that stated that there were almost no ODs in the safe needle clinics. That saves HC money cause they don't have to go to emerg. Safe needles also save money because they decrease the spread of HIV/Hep C etc, which also have high social and healthcare costs. Finally, safe injection sites put users in an environment where help is available to them.

[Guest moo]

It's not just a simple "safe injection site." This was in the Vancouver Sun back in December. A Christian group (and I'm not Christian) who had been providing food and shelter to the people down in the downtown Eastside for years was displaced because of this new plan. I believe it is a study sponsored by UBC, and funded by the government, and the first in North America. There was an update a few weeks ago, I believe that said that not a lot of the addicts were actually going there because the heroin was not of sufficient quality or something. The gov't can't even do this right!

 

The debate of these actual safe injection sites and what not goes in another thread, so I'm not going to say any more about it. My point is that the government does not have its priorities straight in BC.

[Guest Ian Wong]

I just figured I'd toss in my few cents worth regarding why I really got irritated at this article. At first glance, it really puts doctors in a bad light, but I think the viewpoints expressed in this article are seriously one-sided. Here are a few of my thoughts on the other side of the coin.

Medical students pay the smallest proportion of the true cost of their education compared to students in all other programs, including other professional programs.

Even if our education costs are massively subsidized, medical students still pay some of the highest tuitions at any university, far exceeding most other undergraduate and graduate programs, and equalled only by other professional programs such as law, dentistry or MBA programs. Student debtload among medical students is at an all-time high, with many medical students carrying debtloads well into the six-figure range upon graduation. The upshot of this is that it introduces significant pressures among medical students to enter into lucrative high-paying specialties, and to shun lower-paid primary care fields. This has a hugely detrimental effect on the health care system.

 

As a reference point, this last year was the WORST year in Canadian history for the recruitment of medical students into Family Medicine programs, with only 24% of medical students choosing Family Medicine as their #1 career choice. Add to that the lure of medical students leaving Canada to practise in the US for higher reimbursements, or the deterrent effect of high tuitions on applicants coming from rural communities, and charging huge tuitions doesn't look like such a good idea any more.

 

When you charge med students a few thousand more, and then lose that $280,000 investment to a US physician recruiter, or else wonder why your $280,000 investment doesn't want to become a family doctor, or doesn't want to practice in a remote underserved community (where they are most needed), you might well agree that while raising med school tuition looks good at first glance, you'll end up paying higher costs later on.

Interns get paid to work while they do their training.

Quite frankly, those university teaching hospitals could not run without residents. And considering that each resident is making roughly $40,000 annually in exchange for working anywhere from 80-100 hours a week, while continuing to pay off interest from that 6-figure debtload, then paying your resident physicians the equivalent of $8 per hour to treat patients doesn't really seem so generous after all.

Doctors have guaranteed jobs when they graduate. As lobbyists for the medical profession keep telling us, doctors can go anywhere because there is a global shortage.

The fact that health planners screwed up big-time over the last decade, and slashed medical school enrollment in anticipation of a huge physician surplus (that never materialized) isn't the physician's fault. Yes, there is a huge physician's shortage right now, and the public is taking the brunt of the effects of that shortage. Still, the blame for the fact that a physician can just about walk into any Canadian city and start practising belongs to the government and those health planners, not physicians.

The most expensive tools of their trade are paid for by taxpayers, from hospitals to surgical suites to diagnostic equipment.

I suppose that each MP in the Parliament pays for his/her own office and office supplies as well as all flights and other expenses while performing his or her job then? The irony here is that many surgeons would buy into private surgical clinics to have more OR time (just as radiologists are willing to buy into private MRI clinics), yet these private ventures are deemed in contravention of the Canada Health Act. So, you forbid physicians from purchasing and using private funds to buy equipment, and then accuse them of relying on taxpayer funds for "the most expensive tools of their trade"??? Is that the friggin' limit or what?

Doctors are allowed to limit their competition. The provincial colleges of physicians and surgeons are the licensing bodies and it's up to them to decide whether foreign-trained doctors can join the club.

I would agree here that there has been foot-dragging and bureaucracy in getting foreign-trained doctors into Canadian practice. However, there are incredible nuances here at work. A physician trained in Australia has different credentials than one trained in the US, or one trained in the UK, or in India, or China, etc, etc, etc. Much of the documentation for these physicians may not/do not meet the national certification standards. Quality control is important, and being treated by an incompetant physician is just as bad as being treated by no physician at all. I welcome all foreign-trained physicians and hope that they can help alleviate some of the current physician shortage, provided that their training can be adequately assessed as meeting our Canadian standards.

That $300,000 average is more than six times the average income for a Canadian with a university education, which Statistics Canada says is $48,648.

Once you hack off huge costs for overhead in paying your office staff, rent, office supplies, equipment repair and upgrade costs, malpractice insurance, CME expenses, association dues, having no medical or dental benefits nor paid vacations, factor in on call time and the fact that most physicians work anywhere from 50-60 hours weekly, and the plain fact that each physician has in general trained for at least 10 years after high school (make that 14+ years for a fellowship-trained subspecialist, who is actually likely to be grossing $300,000) and that $300,000 gets whittled down pretty fast. One GP I worked with literally pocketed $5-7 dollars for each 15 minute patient visit. I hardly doubt that she is living the big life, despite the huge levels of responsibility and stress that go along with being a physician.

The other risk to declaring war on the doctors is that B.C. will lose some doctors and might find it more difficult to recruit replacements.

 

It might be a risk worth taking. But only if the government commits to reversing the historical trend of failing to train enough of our own doctors.

As noted later in the article, BC and Canada in general need to train more physicians. However, you also need to retain those physicians that you curently have (or else who is going to be left to train the next generation of doctors?) The trouble is that the US is after all, a very viable option for Canadian physicians, and certainly hundreds of Canadian physicians head south of the border each year to practise. If you piss off doctors enough, they will leave. Physicians are attracted to practising in BC in large part due to the lifestyle and geography, and traditionally have lower incomes than physicians in our next-door neighbor Alberta, but if the practise environment is hostile enough, people will certainly pick up and move. Right now, Alberta is receiving a large number of physicians from the rest of Canada due to higher wages and access to health care resources.

But there's no magic to either 256 spots or 2010. In fact, even that is far short of the estimates that between 300 and 400 additional doctors are needed each year just to match the number leaving or retiring.

Given that there is a HUGE population of physicians in their late 50's and early 60's out there who will all be retiring en masse as the baby boomers age, the fact that we still don't train enough doctors as we lose each year is a trend that can only worsen in the future. Once again, this underscores why we have to work harder to keep the physicians that we have already.

But even if B.C. doesn't dramatically increase the number of spaces in medical school, it should at the very least require graduates to work here for a set period of time.

As noted already, that's called residency. The amount of work each resident generates is far in excess of the $8 per hour monetary compensation that they receive. The ironic thing is that, last I checked (a couple years ago), BC still had fewer residency spots than there are graduating UBC medical students. This means that by definition, some BC medical school graduates needed to leave BC in order to pursue residency training, simply because there were not enough spots to accomodate them all. How ridiculous a situation is that? In the same vein, there was a court ruling in BC a few years back stating that the government could not restrict billing numbers in urban areas to new graduates (essentially forcing them to practise in more rural areas) as it was a discriminatory policy. If physicians had to compulsorily provide return of service, then the question of whether or not they can provide that service anywhere in BC (at a place of their choosing, and not the government's choosing) rears its ugly head.

The high cost of training doctors could also be partially offset by higher tuition fees for medical students, moving them at least to a par with other schools in the country.

I don't know what crack this author is smoking, but current tuition costs for this current year's applicants is $14,000 annually, and that goes up to $20,000 annually including textbooks and other educational costs. That doesn't even touch housing and living expenses, which are obviously very high in Vancouver relative to the rest of Canada. Certainly, the tuition costs in BC are higher than any other province in Canada except for Ontario, and when you factor in Vancouver's cost of living, probably are higher than some of the schools in Ontario as well.

 

In summary, this article was really poorly researched, and really only scratched the surface of the discussion. The unfortunate thing is that this sort of superficial understanding of these issues is all that you see in the media, and doesn't help the general population at all with gaining a truly informed opinion on the problems with physicians in our health care system.

 

Ian

[Guest Ollie]

Hi Ian,

 

When I first read this article in the Sun, I had pretty much the same feelings you have just expressed. When she suggests raising tuition so that it's on par with the rest of the country, I was shocked. Did she even bother to check what tuition is elsewhere in Canada?? Also the fact that she states that UBC has received 1300+ applicants this year and the deadline is still weeks away???? Um, that's funny, because I'm pretty sure that it was October 1 2003, or at least that's what I was told. This just underscores the poor research in this article.

 

I have been looking in the Sun the last two days for responses to this article, but haven't seen any yet. You should write a letter to the editor. I would have written one, but signing myself "med school applicant", just doesn't seem to carry much weight.

[Guest moo]

Hey Ian, didn't know you were so conservative. But, as Churchill once said, "If you're not a liberal in your 20s, you don't have a heart. If you're not a conservative in your 30s, you don't have a brain."

 

I agree with almost everything you said. I don't want to bust my ass for 10-15 years post secondary just to be making something that someone with a lot less training would make. Not to mention that I will be starting out with a lot more debt than most other people, and that's without even having a mortgage! Yeah, I can be compassionate and all that but in the end, I have to take care of myself and my family first. What good is it if I default on my loans, can't buy a house, etc. I don't even mind working 80 hours a week during residency for peanuts, but I expect some sort of compensation in the end. You can call me greedy or whatever, but I'll bet you most doctors feel this way. Why do you think FP is in such shortage right now? People don't want to have worked so hard just so they can make slightly more than someone with a bachelors degree. Well, you can say that they shouldn't have gone into medicine in the first place. But I would argue that there are other reasons why people go into medicine other than money. You have to love what you do, and if you don't, even if you make a lot then it doesn't matter. You can't be all altruistic and want to save the world. There are things in this world that you just can't avoid, such as paying the bills.

 

You know, things in the US aren't all that rosy either. When you add in malpractice and the cost of living in some of the major cities (SF, NY) you won't be making more than what you would be in Canada. Not to mention I pay A LOT more in tuition than what you in Canada pay. (Well I think it turns out that by the time I graduate I'll owe about 150k CAD in loans, which I guess is about double most schools in Ontario.)

[Guest aneliz]

Excellent points Ian...I hope that you also submitted the above post to the newspaper as a letter to the editor...that article deserves a response!

[Guest kosmo14]

I agree this does deserve a response. It would be nice to see a large response from many med students, physicians, and residents. It is this kind of misinformation that makes it hard to resolve many of the human resource problems the health care system faces today. I am going to drum up a reply to this article, maybe get some classmates to sign it as well.

[Guest Makunouchi]

Excellent responses Ian.

 

Using the word "pampered" in the subtitle really does summarize the author's tone towards physicians.

 

---------------

The average, of course, masks the fact that there are plenty of family physicians earning closer to $100,000 a year; that at least 10 specialists were paid more than $1 million by the B.C. Medical Services Plan last year; and that most physicians have office overhead of 50 per cent or more of their salary.

---------------

 

This is the only part of the article that explains that the $300,000 amount is quite misleading.

 

I recall seeing a letter from a Nanaimo family physician in the Province(?) (yes, yes, the Province) responding to the $300,000 amount quoted by others. Basically saying... where's my $300,000?

[Guest me maniac]

so that makes me very sorry to change the subject. The project where heroin is SUPPLIED to the addicts to inject is called the NAOMI project (North America Opiate Medication Initiative something or other). Yes, heroin is supplied free to long time addicts in an effort to reduce use (only three injections per day!).

 

Now, back to the original and very enlightening topic. I agree with the others, Ian, I think you should send a letter to the editor of that newspaper.

 

me

 

PS. sorry, I just saw this stated in another thread.

[Guest Ian Wong]

Just to further the discussion a little, the Vancouver Sun posted a letter written by Dr. Kevin McLeod, a graduate of UBC medical school. I've actually worked with Kev before, and he's a pretty politically motivated guy, as evidenced by the fact that he's now president of PAR-BC, the organization which represents all resident physicians in British Columbia. Anyway, here's his reply regarding the letter. Unfortunately, it only addresses the comments made by the author regarding residents being paid while they work their 80 hours a week. The best comment by far is:

we will focus on her statement that "interns," [...] are paid to work while they complete their training. As if this is a wrong that must somehow be righted.

Here's the rest of the article:

 

www.canada.com/vancouver/vancouversun/news/story.html?id=d0cfdc45-0322-4ebb-ab88-e849c09b66f8

 

Resident doctors provide bulk of patient care

 

Vancouver Sun

February 7, 2004

 

Re: Is the sky the limit for doctors' salaries?, Daphne Bramham, Jan. 31

 

Although we take exception to much of what Daphne Bramham wrote, we will focus on her statement that "interns," unlike dentists, nurses, engineers and teachers, are paid to work while they complete their training. As if this is a wrong that must somehow be righted.

 

Upon receiving their academic degree, the MD degree, medical students must complete an additional two years of training before they are eligible for independent practice. During this period, they are collectively referred to as resident physicians or house staff. The internship (and along with it "interns") is a thing of the past, abolished in 1993 when the training program for general practitioners became a two-year family practice residency.

 

Resident physicians train within the hospital in an apprenticeship format. There are no classrooms and few lectures. Residents provide the bulk of primary care for most patients.

 

They also carry the responsibility for in-hospital care on nights and weekends. Approximately 75 per cent of a resident's training consists of service with the remaining 25 per cent split between teaching and education.

 

The average work day is nine or 10 hours. There are no formal arrangements for meals or breaks. In addition, a resident will spend every third or fourth night in the hospital.

 

Although the number of hours worked per week varies, the average is 90 hours and totals exceeding 100 hours are not unusual. Residents are paid a fixed salary, which calculates out to between $9 and $15 an hour based on a 90-hour work week. There is no overtime pay.

 

The Professional Association of Residents of B.C. and its members are committed to working toward solutions. Unfortunately, Ms. Bramham's column is a disservice to the public and our members in its simplistic solutions based on poorly conducted research.

 

Kevin McLeod, MD

 

President

 

Professional Association of Residents of B.C.

[Guest Winwip]

I just have a couple of comments to add to this thread, moreso for the purpose of discussion than anything else. The first one regards foreign medical graduates. I honestly do not think the reason we make it difficult for IMG to work in Canada is because of the quality of health care. If it was, we would let them do the same standardized exams that we do, then allow them to practice if they did well, and let them in our matching system so that the top candidates get the top residencies. I think it's because we would like to secure jobs for ourselves, and someday our children, who grew up here in Canada instead of providing the best patient care.

 

The bottom line is that there are not enough doctors in Canada and patient care is suffering. The politicians, (and in some part the general population) blame the "overpaid" doctors, and we, as doctors (or future doctors), blame the system and claim that we can't "save the world". (which we can't, it's ridiculous to expect someone who's spending 60 hours a week in clinics to lobby for better management of funds).

 

If the quality of patient care can be assured and the IMGs have adequate skills, why not allow IMGs into the system, instead of making them go through much more rigorous screening criteria than we would ever face.

 

(and we all know that once you get into medical school, if you work hard, you become a doctor, at least I hope)

 

And also, I think that we forget that we are very fortunate to be in this profession. Even though we have a lot of schooling, a lot of debt, we are guaranteed to make at least 6 figures for the rest of our life. (I realize there are some flaws with that statement, and I didn't take into account the 1/4 of a million dollar debt)

 

I don't like the tone of the article, and I was happy to see they printed Dr. Mcleod's reply. (although there were many other comments that deserved to be criticized). But I do think it brings up some things that deserve thought. No matter how much we make ourselves the victim, we will always have a job somewhere, we will always be helping people, and we will always be respected (except by certain specialists if we're GPs). In a time when so many other graduates cannot find jobs, it's not necessarily a bad thing.

 

 

 

 

(and the GP comment was a joke)