Health-care system pushed to breaking point with recent cuts, proposed tax changes

Posted on September 25, 2017 in Health Debates – Full Comment – A new survey paints a grim picture of the effect of the government’s recent actions on Ontario doctors
September 25, 2017.   Dr. Kulvinder Gill and Dr. Mark D’Souza

A survey conducted this month by Concerned Ontario Doctors paints a grim picture of the effect of the Ontario government’s ongoing unilateral cuts to physician services, the governments’ mistreatment of physicians, and the federal government’s proposed taxation changes on Ontario doctors and medical trainees.

Of the 5,000 survey respondents, 63 per cent reported burnout—which can very quickly lead to compassion fatigue, anxiety, substance abuse, depression and suicide. Given that doctors are already twice as likely to commit suicide as members of the general population, this finding points to an alarming public health risk. An astonishing 81 per cent of doctors reported feeling attacked or vilified by the Ontario government (and 70 per cent by the Canadian government). And 55 per cent reported that their practices are being influenced by government-driven policies rather than evidence-based clinical medicine.

Ontario’s doctors are into their fourth year without a contract and, since 2015, the provincial government has unilaterally cut more than $3.5-billion from the patient services that physicians provide. These cuts to frontline care have left more than a million patients in Ontario without a family doctor, created unprecedented emergency room gridlock, and caused wait-times to explode (a patient can wait for up to three years to see a specialist). Faced with the largest debt of any sub-sovereign borrower in the world, the Ontario Liberals have resorted to rationing patient care. Combine these changes with multiple draconian pieces of provincial health-care legislation passed this year that hurt patients and strip doctors of their autonomy and human rights, and you have the making of a health-care system in crisis.

A majority of survey respondents reported burnout

Finance Minister Bill Morneau’s recently announced tax proposals could push many doctors to their breaking point. In 2000, Ontario granted physicians the ability to incorporate in lieu of fee increases. The government even encouraged doctors to use incorporation as a vehicle to save for their retirement. Although physicians bill the government for the patient services they provide, physicians are self-employed and have no pensions or benefits. Physicians cover all of their own overhead expenses (an average of 30 to 60 per cent of their fees fund health-care infrastructure), and must generally service an average student debt of $250,000 (accumulated from the 10 to 16 years of university training they are required to undergo). Physicians are unique small business owners in that they are not able to pass their increasing overhead expenses onto patients, as their fees are fixed by the government.

The vast majority (85 per cent) of survey respondents reported that Morneau’s proposed tax changes will force them to change how they practice medicine: 11 per cent plan to leave Ontario, 21 per cent plan to leave Canada, 26 per cent plan to retire earlier, and a shocking 11 per cent plan to leave medicine entirely and re-train for a new career. An alarming 35 per cent of medical students and residents plan to leave Canada. If doctors follow through on these plans, it will likely exacerbate burnout rates: currently, there are 88,000 physicians in Canada, more than half of which report burnout.

It is alarming that of the 31 per cent of Ontario doctors who plan to remain in Canada following Morneau’s proposed tax changes, an overwhelming number plan to reduce working hours (75 per cent), reduce patient services (55 per cent), reduce OHIP services (68 per cent) and lay-off staff (39 per cent). Since the taxation proposals were announced, a quarter of all doctors also report having already cancelled plans to expand their clinic services, expand their clinic hours, or hire new staff. The end result will be frightening: more patients suffering and dying on waitlists.

An overwhelming number of doctors plan to change how they practice medicine

The last mass exodus of physicians from Canada was during the “brain drain” to the United States in the 1990s, when one-quarter of all graduating physicians left Canada. The effect was to leave 1.2 million patients orphaned. It took Canada more than a decade to recover, which it only achieved by investing heavily in training and recruitment.

The strains on Canada’s health-care system today are far greater than those that existed prior to the exodus in the 1990s, and we are entering unchartered territory with our senior population projected to grow by 68 per cent over the next 20 years. When you combine more than five million patients in Canada without a family doctor, unprecedented wait-times for specialists, a growing aging population, and a likely mass exodus of doctors, you have a recipe for the collapse of our health-care system.

More than 50,000 Canadians have already signed a petition against the proposed tax changes. Concerned Ontario Doctors is holding a public rally on October 1, 2017, at 1:00 p.m. outside of Morneau’s office in Toronto (430 Parliament Street). We are fighting for our health care and all small businesses. Join us, Canada.

National Post

Dr. Kulvinder Gill is a physician practicing in the Greater Toronto Area (GTA), the President and Co-Founder of Concerned Ontario Doctors, and a former Chair of District 5 (GTA, Dufferin, Simcoe and Muskoka) of the Ontario Medical Association. Twitter: @dockaurG

Note: The survey referred to herein will be available on Concerned Ontario Doctors’ Facebook page on September 26, 2017.

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