“What the older ones see while sitting, the younger ones, standing on two legs, will not see. — African proverb
Across Canada, emergency departments have been temporarily closed and doctors and nurses have retired prematurely. The nurses are “beyond exhausted,” according to Rachel Muir, president of the ONA bargaining unit at The Ottawa Hospital. Some reduce their working hours, others go through private agencies to obtain a better salary and more flexible hours; when hospitals are then forced to rehire them, it drives up costs.
In many provinces, 20% of people do not have a family doctor. Fewer medical school graduates are choosing family medicine as their specialty, and existing physicians are moving away from primary care and into other specialty areas.
What can we do ? It is true that enrollment in medical and nursing schools is increasing and the licensing of foreign graduates is accelerated. Newfoundland and Labrador is even offering $100,000 to doctors (and $50,000 to nurses) born, trained or who have practiced in the province if they return to work for at least five years.
The DD Nancy Whitmore, CEO of the College of Physicians and Surgeons of Ontario (CPSO) announced in mid-August that the College of Physicians and Surgeons of Ontario was encouraging recently retired physicians to reactivate their license and to return to practice. I wrote to him and suggested that he drastically reduce the annual licensing fees for older doctors, just like the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada are doing. Annual license fees are nearly $2,000 in Quebec and most other provinces. When an older doctor receives a bill for this amount, it may well cause a retirement.
Be creative
However, we need another incentive to keep older doctors working as long as possible. I propose government-funded short-term income stabilization.
Physicians may need to be off work for a few weeks or months due to a heart attack, serious infection such as COVID-19, resection of a malignant intestinal tumor, heart surgery, depression, knee or hip arthroplasty, etc. Especially if they incur fixed indirect costs, this illness or surgery could lead to permanent retirement. Private disability insurance is usually unavailable after age 65.
There are precedents. Recall that in 2003, the Ontario government implemented a SARS-related income stabilization program that paid up to 80% of doctors’ average monthly bills if they were quarantined, had SARS or if their hospital or office practice was affected.
Maternity benefits offered across Canada set a more important precedent. In Quebec, benefits are payable for 12 weeks. These include a lump sum of 33% of previous weekly income, up to $802 for family physicians and $1000 for medical specialists/surgeons, as well as 67% of previous weekly income, up to competition of $1809 per week for family physicians and $2400 for other specialists.
Ontario has a maternity and parental leave benefit policy that covers the pregnancy of an eligible physician (and often the partner), adoption of a child, or surrogacy arrangement. . All provinces have similar plans. Benefits are usually paid for 17 weeks, are taxable and range from $1,000 in British Columbia to $1,500 in Nova Scotia. They are $1300 per week in Ontario.
Concrete measures
Therefore, I propose that Quebec, Ontario and other provinces and territories, if they are serious about using older physicians as much as possible, provide the following support:
Physicians and surgeons in practice would be covered for ages 65 to 80, with no waiting period. Physicians would receive 70-80% of their average monthly bills over a period of 60 days, or preferably 90 days.
In Canada, more than 15% of family physicians and 16% of medical specialists are 65 years of age or older. A decade ago, they were only 10%.
Karl Blackburn, president of the Conseil du patronat du Québec, points out that with his new mandate, Premier Legault should focus on the economy. Quebec is experiencing a major labor shortage that affects all sectors, from finance to health care. This is mainly due to the aging of the population.
We are now in the third year of the “Decade of Healthy Aging” under the aegis of the United Nations. About 25% of Canadians will be 65 or older by the year 2026. As Helen Hirsh Spence writes, “there is already a talent shortage in every industry, and there will never be enough births or immigrants to Canada to fill the talent pool for this century.
Therefore, we need to be creative and do whatever it takes to retain older healthcare professionals. As Ontario NDP health critic France Gelinas recently said, “we need to financially support health care workers and treat them with the respect they deserve.”
Like nurses, doctors have been dubbed “health care heroes” by politicians. It is time for all provincial governments and all colleges of physicians and surgeons to translate such platitudes into financial benefits, such as short-term income stabilization and reduced annual licensing fees. This will help keep older physicians in the workplace, even on a part-time basis. They can thus continue to offer their patients the indispensable expertise that only decades of experience can provide. This will reduce the burden on emergency services.
As Chinua Achebe wrote, “When we old people speak, it’s not to feel the sweetness of the words in our mouths, it’s to express something you can’t see.”