The current tension between the Government of Ontario and its doctors over what is or isn’t a fair “wage” is yet another chapter in a long saga documenting the political truth that when government is the paymaster, it has the right to call the tune.
But the melody is wearing thin. To refresh myself on this long narrative, I revisited my own files to stories I wrote in the ’70s, ’80s, and ’90s, for the Canadian Medical Association Journal and The Medical Post on the protracted fee schedule negotiation between not only the Ontario Ministry of Health and the Ontario Medical Association but also similar combatants in most other provinces. And the story line then, as it is now, was that the more money the province (that’s you) paid doctors, the less it had to pay for other key health care services—new hospitals, more beds, newer technology, more technicians, and so on an so forth.
You would have thought that since the 1970s both sides would have achieved some kind of balance. But they haven’t, and they probably never will. Why? Because although there’s only one paymaster, doctors don’t have much leverage to challenge the government’s assertions that they are just another group of civil servants—even though most are actually individual businesses. Most are small businesses with overhead, continuing education obligations, set-asides for their own self-funded pensions, medical school education debts, and all the taxes most Canadians are heir to. Add to that workloads that most autoworkers wouldn’t even attempt, and the picture begins to focus.
So when we hear that the average physician in Ontario bills roughly $350,000 a year , the bureaucrat or politician may seem like a guardian of your tax dollar.
And then you think of the average USD $2.75 million annual salaries of NHL players, many of whom are not college-educated, and some perspective creeps in.
I know that whenever I have been in a hospital for urgent care (and whenever it’s you in the hospital, it’s always urgent), I have never thought of asking for the second-best cardiologist or GI specialist. And I never cared how high on the salary ladder he or she stood. Just give me your best, and they always did. There’s no price you can put on that.
And then the bureaucrats might say, “But doctors are paid out of taxes, hockey players are not.”
To get granular about it, taxes are paid by you. So are hockey players.
In 2013, Andre Picard, health columnist at The Globe and Mail, wrote a provocative article showing that if you thought the average $307,000 paid to Canadians doctors at that time was exorbitant, those same docs—especially family practitioners—might argue that their take-home pay was less than that of many plumbers and autoworkers.
He calculated that once you account for overhead (average about 26 per cent of billings), Canadian doctors had average annual incomes of a little more than $225,000 (before taxes) in 2013. Good salary? No doubt. But “high flyers?” Not really. Not for the great majority.
I’m not mounting a defense of doctors vis-à-vis provincial bureaucrats (well, maybe I am), but provincial and federal governments have been singing to same old song for 40-plus years, and the burden of health care costs in one of the world’s most prosperous and technologically advanced countries only continues to climb, unabated and unresolved. In the meantime, there’s a lot of government spending that could benefit from a trim—spending that’s not as visible as health care professionals’ incomes.
Frankly, I would have no problem being attended to in the emergency room by a million-dollar-a-year earner. I know I’d rather have them at my side than a hockey player—any hockey player.