Thursday, February 5, 2015

A Doctor for a Daddy: The Politics of Healthcare

Hi Friends,

I just want to start off by saying that this post may get a little political (read: completely political), so if that makes you squeamish, please feel free to stop reading here (I will not be offended, I promise).

As most of you know I am married to a Resident Doctor, and more specifically a Family Medicine Resident Doctor. For those of you who may not know, a resident doctor is someone who has completed their medical school training (and thus holds the title of Doctor), and is in the process of completing 2-6+ years of specialized training in their area of choice (in D's case, that would be Family Medicine).

At practice the other night, one of the girls I coach asked me, "how many years does it take to be a doctor?". I answered, "well, in D's case, 4 years of undergrad, 4 years of medical school and 2 years of residency, so I guess 10 beyond high school". Her reply? "Holy shit, I'm crossing that off my list of things I want to be when I finish high school".

Her response, while slightly amusing, made me stop and think. It really does take a special kind of person to decide in their teens that they are willing to commit the next 10 years (at minimum) of their life training for a career.

However, I will say, having been with D every step of the way, that you never really have that 10 year milestone in mind. It's more like working toward the completion of different phases.
Phase 1: Completing an Undergrad degree
Phase 2: Applying and interviewing for medical school
Phase 3: Being accepted and completing all 4 years of medical school
Phase 4: Applying and interviewing for residency, and
Phase 5: Being accepted and completing residency.

Then when all is said and done, you look back and say, "Holy shit, where did 10 years go?".

Now that we are working on Phase 5 and the end is in sight, we are gearing up for D's career in medicine. Contrary to popular belief, there will be no time for, "I'm a doctor, now I can go relax and bask in my doctor-ness". Rather, if the last 10 years have taught us anything it's that doctors train hard for 10+ years, so that they are able to work even harder for the next 50 or so!

I'm not going to lie, as the wife of a doctor, this makes me a little nervous.

All that being said, following the most recent breakdown of talks between doctors and the province, the Ontario Government has decided to impose a new "deal", ridden with health care cuts, on Ontario's doctors. I will admit, I am not the most well-versed in Politics, nor do I profess to be an expert on balancing budgets or even critiquing government for that matter. However, I do hold a perspective on this particular matter that I would like to share with you all.

I find it difficult to respect a government that not only abandons contract negotiations, but also slanders an entire profession by attempting to paint them all as money-hungry and greed-driven men and woman. The province would have you believe that doctors prioritize their desire to line their (white coat) pockets over both the financial and physical well-being of Ontario taxpayers. While I recognize that there are greedy and money hungry doctors in Ontario, I also think it's safe to assume that you can find greedy and money hungry, politicians, insurance brokers, farmers, bankers, franchise operators, taxi-cab drivers, teachers, dentists, retail executives, small business owners... and any other profession you can imagine. But like those other professions, the majority of doctors are hard-working, humble, genuinely caring individuals who want nothing more than financial, physical, mental and social well-being for the people of Ontario (Ds "dream car" is a Subaru Outback for crying out loud).

The cuts imposed on Ontario's doctors, while not earth shattering or career ending, send out a couple of strong messages. The first being that quality health care is not a priority for the government, which should scare us all, and the second being that the financial and overall well-being of Ontario's new doctors is not a priority, which is particularly scary for me (and my small family).

The "deal" encompasses a shift away from patient-centred (salary-based) Family Health Teams (FHT: by reducing the number of positions available in FHTs by 50%) and towards Fee-For-Service (FFS: think walk-in clinic) model, coupled with a 2.65% reduction in all fees for medical services and the abolition of the New Graduate Income Stabilization Program (which assisted new family docs by removing some of the financial risk associated with setting up a new practice).

So in a nutshell, the government is forcing new family doctors into walk-in style practices (where they will be billing a reduced rate for their services) by eliminating FHT positions and increasing the financial risk of starting up (or purchasing) a rostered practice. While this won't necessarily have a huge impact on those doctors with established practices (other than the 2.65% decreased income from billings) these cuts are monumental for those just starting out. The reason being, $200,000+ of debt that accompanies most new docs into their new career.

Now some people will just say, "too bad, so sad, the new doctors will just have to work harder". To that I will say, "that's a very real possibility, assuming you can provide a 30-hr day".

As a resident, rarely a day goes by that D doesn't stay late at clinic. Whether he's following up with Mr. A's lab work, ensuring Mrs. B gets called with the results from Little Man's chest x-ray in a timely fashion, double-checking that Mr. C's narcotic prescription gets renewed before he has to come face to face with the reality of his chronic pain, the list of ways most residents go above and beyond goes on and on. He could easily wash his hands for the day, turn off the office light and go home when the clock strikes 5:30, but he doesn't. He doesn't, at the expense of ultrasound appointments, birthdays, family dinners, promised trips to the pool, bath times, bedtimes and everything else in between. What is more, is that these unpaid hours are put in just so that they can reach an baseline standard of care. They are not getting special recognition from their patients, in fact, nine times out of ten Mrs. B is upset that it's already 6:30 by the time she gets the call.

We would be naive to believe that these long hours will end with residency, in fact, if anything the hours will get longer. As a wife of a doctor, I've come to accept that my husband will have a special amount of passion and dedication for people I will never know. However, I will not accept his not being compensated for the work he does. If I know D, he will continue to work tirelessly to ensure his patients receive nothing but the best of health care, and he while he would likely do it for free, there's no way in hell I would ever let him. Fortunately for us, Ontario is the only province to have shown such blatant disregard for the financial and overall well-being of new family doctors and their families. Which means that there are 9 other provinces that would be happy to have the dedication and quality health care that comes with these fresh-faced family docs. I'm glad that our small family has the flexibility to make the decision to go elsewhere if and when the time comes.

The most recent deal imposed on Ontario doctors is really just a big ole' slap in the face to new doctors (and their families). We (myself, D, his resident colleagues and their families) have dedicated the better part of our 20's making social, financial and emotional sacrifices to ensure the people of Ontario are greeted with doctors who can provide them with exceptional care, it's unfortunate that the Government is choosing not to acknowledge or value that.

Until next time friends,


"Ooooh mummy's gone political, Snap!"

For anyone interested in specifics, you can check out Dr. Shawn Whatley's website, as he does a great job crunching numbers, and providing stakeholder perspective.

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