ARMCHAIR ARCHIVES – Doctors’ closed-door strategy has its flaws

Concerns over the healthcare system aren’t new. Twenty-five years ago, B.C.’s doctors took a day off over a money issue. This column was originally published on Saturday, March 7, 1998.

THE DOCTORS weren’t in on Friday. They shut down their offices in protest over a money dispute with the B.C. government. They didn’t use the word protest, but that’s what it was, of course.

They called it a “reduced activity day.” They went golfing, if they could find a course that was open. Or they did spring cleaning or went for a drive out to their cabin at the lake or whatever else doctors do on a day off.

Emergency services were still provided at the hospital, but if you wanted a routine office visit, you were out of luck.

The dispute, as explained by the doctors, isn’t about fees. That is to say, they aren’t complaining about the levels of fees they are paid. Their beef is over a shortfall in the amount of money made available by the government to pay for the billings submitted by doctors for surgery, office visits, checkups, etc.

Doctors worry about the perception that they’re just greedy. They point out that a $70-million shortfall between the cost of services and the money available to pay for them equates to 15 days without pay this year. Next year, they claim, it will stretch to 24 days.

Their rationale for reduced activity days, or RADs, is that by shutting down their offices they save the system money and don’t have to work for nothing. It’s not a bad rationale, though slightly flawed.

It assumes that none of the people who would have made an appointment yesterday will simply have had to postpone that appointment until next week, or gone to the hospital emergency ward yesterday, or will overload the no-appointment street clinics today.

Of course, some people will have gotten over whatever ails them by next week and will, indeed, cancel their appointments. But many won’t. They will simply have been inconvenienced, at no savings to the system.

In a way, if the doctors do save a bundle of money for the system with the three RADs they plan for this month, they will have assisted the argument against them that says they bill for too many services. Then-health minister Joy MacPhail remarked recently that a large percentage of billings by B.C. doctors is unnecessary.

So, if a majority of the people who made office appointments yesterday didn’t need them badly enough to reschedule, it would seem to suggest there’s something to MacPhail’s comment.

Still, we shouldn’t be totally unsympathetic to doctors. Without them, we’d be in some trouble. As they point out, they go to university for an average of 10 years for a general practitioner, and 14 years for a specialist. That’s a long time to spend money on education instead of being in the workforce making a salary.

The average doctor now leaves medical school $100,000 in debt. The B.C. Medical Association claims the average GP makes only $84,000 before taxes. That bears some scrutiny, and I’d like more details.

If you look over the totals for doctors’ billings as they’re published each year, you’ll find that many specialists bill in the $300,000 to $500,000 range, but that GPs bill much lower — many around $100,000, from which they have to subtract their office overhead before they take anything home for themselves.

But it’s also true that quite a number of GPs work on little more than a part-time basis, three or four days a week. That would tend to skew the average gross salary downward.

But whichever way you look at it, doctors aren’t highly paid considering the training that’s required of them, and the skills they must have. Throughout their careers, they must constantly upgrade that training and those skills in a world of rapidly changing medicine and technology.

Those changes, they say, are one of the reasons — along with a growing and aging population — that healthcare is getting so expensive. All those wonderful new machines that are used for diagnosing and correcting illnesses cost huge dollars.

Though doctors so far, as a whole, are holding back on embracing a two-tiered system (they quietly insist we already have one anyway), it probably won’t be long before they bite the bullet, risk public outrage, and officially proclaim their support for it. Because they see it as the only way to preserve quality health care and anything approaching the kind of system we currently enjoy.

Doctors use a quote from independent mediator Irwin Nathanson to reflect their position in the battle with the B.C. government over money: “The burden of increasing health-care costs should be borne by society as a whole, not by the medical practitioners.”

Mel Rothenburger is a former mayor of Kamloops, alternate TNRD director and a retired newspaper editor. He is a regular contributor to CFJC Today, publishes the ArmchairMayor.ca opinion website, and is a recipient of the Jack Webster Foundation Lifetime Achievement Award. He has been writing columns about Kamloops since 1970. He can be reached at mrothenburger@armchairmayor.ca.