I am a physician, and I love practicing medicine. There is no question that, as in all professions, there are ups and downs, joys and frustrations, but I would have no hesitation in recommending this as a career choice. This is why it has been so disheartening to see my colleagues and leaders of medical associations promote a narrative that doctors should not encourage their children to go into medicine, or that new graduates should seek their fortune in countries other than Canada.
Medical associations have an obligation to advocate on behalf of their members. The need for this advocacy has become increasingly apparent as governments have made unilateral fee cuts and proposed tax changes that will impact physicians' incomes. However, the advocacy has taken a dark turn, with threats to leave Canada and stop providing patient care and accusations that Prime Minister Justin Trudeau has declared "open season on doctors."
Hyperbole in negotiations and politics is nothing new, but what is it that these doctors are hoping to achieve through these tactics? Maintenance of the status quo? New government that is more sympathetic to doctors? Guaranteed pension that reflects doctors' earnings? Regardless, the government probably isn't going to change their mind unless the public does, so it may be worth having this debate while considering the average Canadian who earns approximately $34,000 per year likely doesn't have a pension and would be thrilled if their child went to medical school.
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The argument that the public should rally behind doctors because they won't be able to save for retirement or their children's education — or because they will move to the United States, or that because the government is calling them names — is unlikely to work, and is why the prime minister and Finance Minister Bill Morneau are sticking to their plan. Doctors don't deserve to pay more than their fair share of taxes through a progressive tax system, but they are certainly a group that, in aggregate, can pay more tax.
Advocate for better policy
In order to be effective, doctors should rally behind policy changes that are good for both doctors and society as a whole. Governments want to be re-elected, and if doctors can get behind policies that improve the health of Canadians and their access to health services, these are policies that government will support. Here are a few examples of priorities that are already on the books and, in fact, speak to many of the concerns that are being raised.
1. Reduce medical school tuition
After deregulation, medical school tuition skyrocketed, making medical school inaccessible for many and leaving new doctors with significant debt. This is a government that is focused on equity, and making medical school accessible to students from all socioeconomic backgrounds is sure to speak to this agenda.
2. Address the issue of under- and unemployed physicians
Despite waiting lists, there is a well recognized phenomenon that Canadian-trained physicians, particularly those who need to work in a hospital, simply cannot find a job. If established physicians were to retire or move to the United States, these un- and underemployed doctors would be the first to pop champagne corks. Their lack of employment is a waste of their publicly funded education. Bringing this workforce to bear to reduce wait times can only be a win for a government that campaigned on this issue.
If we can bring the public with us with forward-looking ideas, they will surely bring governments along with them.
3. Increase socioeconomic and geographic diversity in medicine
Health care in rural, remote and First Nations communities remains inadequate. We should continue to increase recruitment from these regions and ensure that well-supported training opportunities are available in these communities. Minister of Indigenous Services Jane Philpott highlighted our shared societal and professional responsibility to these communities and it is clear that a focus here will align with the government agenda.
4. Promote and value generalism in medicine
There remains a strong culture that values specialists over generalists in training and in practice. Compounding this is the increasing drive for physicians to have more credentials on their CV as a condition of employment. A strong primary care foundation and core of generalists is needed to help improve outcomes for our patients and drive down costs. Allowing physicians to enter practice on time and without artificial delays will help address the issues of waiting lists for patients and debt for new physicians.
5. Create a system that provides extended health benefits, maternity and paternity leave, pharmacare and pension plans for all Canadians.
This was identified in an open letter signed by hundreds of physicians as one of the mechanisms that will help support a just and healthy society and I couldn't agree more. No one should be penalized for starting a family, be bankrupted by a dental emergency or be unable to afford basic living expenses as an older adult. For a government that campaigned on fairness, this seems right up their alley.
Focus on solutions
Do physicians have legitimate reasons to be angry with government? Clearly, yes. Should their associations advocate on their behalf to mitigate the impact of government actions? Certainly. However, we are far more likely to achieve our goals if we are seen as providing real solutions to real Canadian health system challenges rather than setting ourselves up as objects of pity. I want to encourage all of our health-care leaders and physicians who are active on this issue to prioritize being solutions focused, firm advocates but capable partners and, most importantly, to be kind to one another. If we can bring the public with us with forward-looking ideas, they will surely bring governments along with them.
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