One evening I attended a dinner to hear the president of the Ontario Medical Association (OMA) announce an upcoming meeting with provincial health officials about the OMA fee schedule. The president gave the usual rally-the-troops speech but left immediately to catch a plane as she had to see patients in her office the next morning! Can you imagine the uproar from Canadian Auto Workers if their president was a part-time leader who couldn’t stay for an entire meeting?
Years ago I wrote a series of articles about prominent Canadians. I asked Shirley Carr, then president of the Canadian Labour Congress, why doctors continually lost battles with politicians. Her quick response: “You need good negotiators. Doctors are not trained to bargain.”
Without skilled negotiators to deal with politicians, it’s like sending a 98-pound weakling into the ring with Mohammed Ali. Rather, physicians desperately need a permanent Buzz Hargrove [former president of the Canadian Auto Workers] to fight for their interests. They should pay him a million dollars a year. Instead, they waste millions on part-time, rotating presidents and committees of doctors to look after the financial interests of the country’s medical professionals.
The result is a fee schedule that would make Hargrove blush. Like a grocery list, it’s $15.75 for this service, $12.80 for that service, and so on. These ridiculous fees compel today’s rapid, assembly-line office visits to cover the ever-increasing cost of running a medical practice.
Faced with escalating costs and a fee schedule like a grocery list, Hargrove would demand pensions for family doctors. Since family doctors are in effect socialized, why shouldn’t they be treated the same as teachers and others who enjoy escalating pensions?
Elementary school teachers are asking for $93,000 a year with zero overhead!
Don’t blame family doctors for this one-problem approach. I sympathize with them, as I used to be one of them. The fault lies with the colleagues themselves who believe part-time, short-term presidents can be effective. It’s unbelievable that the president of the OMA only has to be available 150 days of the year, when the annual budget is in the millions.
Dentists have been smarter. So have lawyers. The more problems you bring to them, the more they like it, and the more they charge. But not doctors. They can’t.
What does having a one-problem doctor mean to patients? This decision threatens anything from simple annoyance and inconvenience to the waste of time of having to return to the doctor for several symptoms. Not to mention inefficient medical care. But there’s a much more hazardous side to this approach. I’d predict that one-problem doctors are going to miss serious and life-threatening diseases.
What about the patient who is suffering from an attack of sciatica, the type that shoots knife-like pain down the leg and makes grown men cry? You can bet that not being able to stand due to incapacitating pain is a more urgent problem than painless rectal bleeding. So faced with a one-problem office visit, the rectal bleeding symptom can be postponed. Then the patient may decide the bleeding is due to common hemorrhoids and never see the doctor again, until colon cancer has spread beyond hope of cure.
The CMA journal says the one-problem-per-visit will take many years to address. It’s probably right because I’m not aware of any major effort to solve the doctor shortage in this country. But there are ways to start removing these signs.
Why don’t we use foreign-trained doctors who have been granted permission to enter this country? Some are driving taxis or employed in an assortment of jobs while trying to get a medical license. There’s no reason why these physicians couldn’t act alongside other doctors until they’ve satisfied Canadian standards.
Hell will freeze over before this happens. But if there’s a clone of Buzz Hargrove around, doctors should offer him whatever he asks to look after their financial affairs. Then their fees won’t look like a Loblaws grocery list. And the one-problem-per-visit signs will gradually disappear.
Dr. Gifford-Jones is a medical journalist with a private medical practice in Toronto.
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