Saturday, October 14, 2017

Going to bat for physicians (and why Justin should too)

Once again, I find myself posting on a topic that pits my emotions against my professional instincts. I voted for Justin Trudeau in the last election for reasons I do not intend to get into in this article, but broadly speaking I thought he could make Canada better even while knowing I was going to have to pay more. Halfway through his mandate, I am still evaluating whether he is delivering and have by no means made up my mind regarding where my vote will go in the next Federal election. I provide the foregoing synopsis only to lend credibility to the idea that I am not simply protesting tax reform that hurt me. I am one of the few suckers who is ready to pay more if it means moving our country forward.

Please believe then, that this article is not about personal interest. It is about respect for our doctors, something I think is woefully absent in a lot of media coverage. Mr. Trudeau recently chose to invoke a ridiculous and unfounded populist stereotype about doctors to justify his position on tax reform. Herein, I decry the stereotype. Tax reform is a personal issue for me, whereas going to bat for doctors is a large part of the job I do.

In a recent parliamentary debate, Andrew Scheer pressed Justin Trudeau on tax reform.A good summary of the exchange can be found here. This took on a predictable tone very quickly with Scheer attempting to cite a sympathetic example of how the reforms would impact Canada. He chose the mechanic.

Well played Mr. Scheer. Everyone can get behind mechanics because the public perception is that they are not rich.

Also predictably, Mr. Trudeau went with what he thought was an unsympathetic counter-example. He chose a doctor.

I would say 'well played Mr. Trudeau' if his goal was to pander to populist nonsense without reference to facts. I hope that was not our leader's intent, here too I reserve my judgment.

The public would do well to disabuse themselves of this notion that doctors are invariably rich. In fact, doctors in Canada face a very difficult working environment. The majority of them are employed by bureaucratic health authorities with mandates to trim their bloated budgets. Often this translates into, to cite a hypothetical example, finding a group of 90 doctors and short-changing each of them by $25,000. $2,250,000 saved and the public loves it, not a bad day at work.

But put yourself in the shoes of one of these doctors. You have mortgage payments, student loans to repay, kids in school etc. You have planned for these expenses based on the status quo and now you have to conjur the means to support yourself with less or to forego some of the privileges associated with being an educated professional in a wealthy nation. Understand further that the doctors in this example do not have options that are available to most employees whose employer chooses to act unfairly. Often they cannot quit or even take job action without risking lives. Meanwhile (and unlike virtually any other working Canadian) there is usually no other employer and especially not one who will treat them better. The health authority is, without many realistic exceptions, the only potential employer for any doctor who does not wish to move to a new city altogether. Even with a move, the physician is likely to find that the health authority in the new locale bears more similarities to the old employer than differences.

Tevlin Gleadle Curtis Employment Law Strategies acts for physicians and physician groups in a number of matters including contract negotiations and workplace disputes. I have had a number of fights with a number of health authorities across Canada. They do not act very differently in my experience.

Here is where it gets particularly nasty. In any substantial fight against a health authority the public seems to line up against the doctors every time. The focus of their anger appears to always center around what kind of car the doctor drives, or how nice their house happens to be.
To anyone reading this who holds that view, I would like to ask: would it not be fundamentally wrong if we lived in a country where a doctor does not have a nice house? Would that not place us closer to the North Korea end of the spectrum than we wish to be? I have yet to see an article about a doctor with a yacht or a private jet, because that is not the kind of money we are discussing. Doctors tend to be stable, but not wildly rich.

From the link above, Mr. Trudeau's words were "Mr. Speaker, the member opposite, and indeed the entire opposition, has been going around the country, telling every doctor that they meet that they stand with them[.]"

Justin: think carefully about how to follow that up. You just said your opposition supports our doctors, a group who I would posit might be behind only the military in terms of deserving the country's united support. They deliver our babies, cure our parents of cancer and ensure proper palliative care for us when there are no better options.

Justin continued: "That they will defend their rights to pay lower taxes than nurses that work alongside those doctors," Trudeau continued. "We don't think that's fair."

Swing and a miss Mr. Trudeau. At least for this voting taxpayer.

First of all, I do not for a second believe that doctors are habitually paying less tax than nurses.
I would also be remiss if I did not comment upon the irony that physicians' employers (who are after all essentially governmental arms) are constantly chipping away at how much they will pay in the first instance. So these doctors are being asked to fight a war on two fronts.

Now I do not intend to get into the rabbit hole of debating how much should everyone pay. There is plenty to read on that topic written by people better-versed in it than I. Generally it strikes me as fair that those who earn more should pay more and from personal experience my impression is that that happens in this country. Despite the best tax advice money can buy, I can assure you that I am in a position where I pay more tax in a given year than a nurse likely does.

But again, this article is not about me, and realistically not about tax. My problem with Mr. Trudeau's words is that our leader has disrespected our doctors. Shame on him.

In my work I have met a lot of doctors often in very tough situations. My impression is almost invariably that they are hard working professionals with an astonishing commitment to healing people, often in circumstances where they are not being paid properly or sometimes at all.

Mr. Trudeau too eagerly plays into the stereotype of a well-established physician without a mortgage who does not need any more 'favours.' I have another stereotype for you Mr. Trudeau. How about a 30 year-old who has spent eight years qualifying for one of society's most important professions, working as hard as one has to in order to run the gauntlet of medical school. Our hypothetical physician recently graduated with six figures of student debt and no assets to her name. She started medical school when the deal was that the health authority will give doctors x, y and z and on that basis she has a plan to retire comfortably, but not wealthy, at age 65. Within a month of graduating the health authority for whom she is forced to work announces she gets a different deal, and it is worse. Make no mistake, I have yet to see a health authority announce a change in the nature of 'we have determined these doctors need better hours, or more pay.' No, health authorities seem to only ever take away. I say that is unfair, but in any event it is demoralizing.

That is perhaps the worst part of the situation doctors face in Canada. Most people would agree that a respectful working environment is one of the privileges one should expect in a developed nation. Too often, a health authority uses the fact that doctors have no realistic alternatives as justification for not fostering a positive working environment.

At the end of the day, if one person reads this article and re-thinks this media stereotype of a rich, greedy doctor then I will have accomplished something. But I cannot possibly offset the sweeping influence of the words our Prime Minister chooses to speak in Parliament, and I wish he would stick to facts rather than unwarranted stereotypes about physicians. The medical profession has earned (and deserves) more respect than that.

Anyone who will join me and go to bat for our doctors, please share this article. Either way, thank you for taking the time to read it.

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