Dr. Shawn Whatley is the president of the Ontario Medical Association.
Finance Minister Bill Morneau wants people to think that his new taxes will only mean a little less champagne for small-business owners; no one else will notice any difference. But Mr. Morneau’s tax proposal will decrease access to medical care and make Canada an undesirable place to practice.
Government cannot attack doctors without harming patient care. Patients will first notice the change in doctors’ offices. The tax that Mr. Morneau plans to grab from doctors would otherwise stay as retained capital in medical corporations. Doctors use retained capital to upgrade offices, purchase equipment and hire staff. If the capital goes to taxes, patients will be seen in older clinical facilities, have less access to medical technology and have fewer staff caring for them.
When doctors cut spending on clinics, the community feels the impact, too. My rural clinic supports the tiny pharmacy in town. Without it, seniors would have to take a 2 1/2-hour round trip bus ride into a larger town to get their medications.
When doctors cannot buy technology – such as ECG machines – patients have to bear the cost of travelling to a lab or hospital for simple tests. Hospitals or public labs have to fund the staff and equipment that doctors would have otherwise funded, in their own clinics. Government-run clinics cost more than private offices. So, patients will have less access and the access that remains will cost the system more overall.
The second impact of Mr. Morneau’s taxes on medical care will take longer for patients to feel but causes more damage. In Ontario, the 1990s provide a 10-year test case about what happens to patient care when governments attack doctors. The Ontario government made deep cuts to medical funding and human resources, as politicians pursued their “social contract” agenda. Lower-paid doctors, such as those in family practice, struggled to pay office overhead. Medical students avoided training in family practice and residency spots went unfilled.
Family doctors chose focused practices in emergency medicine, sports medicine or as hospitalists. New doctors avoided the risk of starting a private practice. Doctors scrambled for salaried positions in community health centres, workers’ compensation or with the coroner’s office. Some doctors took extra training in non-medicare work, such as cosmetics and spa medicine.
Tax hikes and fee cuts have similar effects: They encourage doctors to adjust the care they provide. Years ago, I lamented about fee cuts to an older orthopedic surgeon. He shrugged and said, “I’ve got long wait lists for worker’s compensation and military work. I will just spend more time there. OHIP patients will have to wait longer.”
The 1990s left 1.2 million patients without a family doctor. Communities mounted massive recruitment campaigns. A former municipal politician from Belleville, Ont., said recently, “We were able to sign 15 docs. We paid them a bundle. I felt sorry for the smaller communities. There was no way they could compete.”
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