Tuesday, January 23, 2018

BC Health Authority mismanagement of long term strategy

In this article the Vancouver Sun identifies a looming problem. Specifically our province seems to face an imminent physician shortage. I suspect the reader would agree that they have not recently had an experience which suggests that we currently have enough physicians, or that their services are available more or less on demand. Here are some bullet points to consider, I have no statistics for you and speak only from personal experience:
  • Health authorities are constantly looking to decrease doctors' pay.
  • Any time physician compensation issue arise, it is never in the nature of 'maybe we should change our approach, which is antiquated and wasteful.'
  • Also, it is important to note that it is almost never doctors saying 'we demand more' but rather doctors reacting to health authority actions and saying 'please do not give us less.'
  • The doctors (who I feel compelled to emphasize are the people charged with the task of saving our lives) draw very little public support when such an argument becomes public. See the comments sections on any physician compensation news story if you do not believe me.
See my recent article on that latter topic for more. Often doctors are thought of as rich people whereas empirical evidence does not bear out that stereotype. Here is a breakdown suggesting that what doctors make is hard to know, but is likely not higher than $225,000 on average in Canada. That sounds like a pretty good wage, and it is, but a Rockefeller it does not make.

Just using rough hypothetical numbers, assuming we all make our decision about our career path at age 20 and we all retire at age 65, and assuming doctors go to school for ten years, the wage set out above is far less appealing. In order to get there, you start working at age 30, having missed a good portion of your best working years and with a massive student debt. Conversely, if you had taken a well-paid job requiring less or no education, you may well have bought a house and accumulated some serious equity by age 30. Further, if $225,000 is the average, it is fair to assume that the average entry level physician earns less.

Add to this factors like long hours, labyrinthian bureaucracy and constantly facing downward pressure on your earnings from the only employer for whom you can work (let us recall it is a single payer system).

Further, and again to invoke my previous article, Justin Trudeau seems bent on taking even more away from our doctors. I will pause to note the inherent irony in this. You plan to pay doctors less in an effort to collect taxes geared toward (among other things) the creation of a better health care system.

Two general principles I think people could agree upon in principle are as follows:
  1. Attracting and retaining more and better doctors is desirable.
  2. Key to attracting and retaining people generally to any job is treating them well.
I see this problem as a reflection of the perennial tension between politicians with short term appointments and a burning desire to save money versus the need to make plans for both the present and the future.

I encourage any readers to consider my paradigm. Doctors are highly-educated, hard-working life savers. They are financially comfortable as a group, but not rich as a rule. Even if they were rich, however, I think that would be fair given the job they do. I do not support downward pressure on their remuneration. Like many other professions (teachers come to mind) I feel as though these public jobs are invaluable to us. If anything they should pay better.

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