Saturday, June 13, 2009

Canadian Pay Doc'd

We have taken several swipes at our neighbors to the north with regard to their health care system. Queue's, lack of proper facilities, limited choices . . .

But I don't think we have ever addressed the way doc's in Canada are paid.

To be honest, the Canadian health care system is not one system but 10. One for each province. Some may be better managed than others but from our perspective, if you have seen one you have seen them all.

So how are Canadian doc's paid?

They are on a salary as determined by the Health Minister (or similar title) in each province. In the case of New Brunswick, just north of Maine for those who are geographically challenged, it seems the Health Minister wants to freeze wages and return to the bargaining table.


Yes, that is correct.

Having just negotiated a 4 year wage agreement in December, 2008, apparently the H.M. has decided they are paying too much for medical services and wants to take a Mulligan.
The wage-freeze bill, introduced by Health Minister Mike Murphy, passed second reading Wednesday afternoon. Alward likened the bill to a gun to the head of the medical community.

He said (H.M.) Murphy hasn't shown he's serious about finding a solution to the crisis over the doctors' contract dispute.

"We believe if he is truly serious about finding solutions it makes sense to take the legislation off the table."

The Tory leader said the Liberal government has to do something to regain the trust of doctors.
"Liberal" government.

That would equate to the Democratic party here I suppose.
In December 2008, the New Brunswick Medical Society and a government negotiating team reached a tentative agreement on a new four-year contract.

The doctors ratified it in February.

But by March, the ruling Liberals were privately telling the doctors they couldn't afford the deal because of the collapsing world economy and falling government revenues.

Murphy introduced legislation last week to freeze doctors' wages for two years.
So the wage agreement has been in place less than 5 months and already the government wants a do-over due to the falling economy. Why don't they just do what Washington does? Increase taxes on the wealthy?

Maybe they are already on the wrong side of the Laffer curve and have realized more taxes will be counter-productive.
Murphy said he knows the wage freeze will leave a stain on the government's relationship with doctors and he doesn't want to proceed with it.

"But it is there for the protection of the fiscal realities of the province and all of the people of the province," he said.
While we don't (yet) have a government run health care program, and we don't (yet) have our doctors working on a salary that is "negotiated" with the government, perhaps we can peer into the future a bit and see what is in store.

Keep in mind that doc's who treat Medicare and Medicaid patients have their income on these patients capped. Most doc's who do accept M/M patients limit the number of M/M patients in order to maximize revenue. Most would like to keep their M/M patient load to less than 10% and few will allow their patient load to exceed 20% of total patients.

Some, due to the nature of their practice don't have that luxury and may have 50% or more of their patient on M/M.

So what happens if we have "Medicare for all" as some in Congress envision? Or we find ourselves with Medicare, Medicaid, SCHIP and a "Public Plan".

Doc's may not be on salary but as the government role in providing and managing health care increases doc's will find their income squeezed more and more.

I don't know what doc's in Canada do to compensate for a wage freeze. They have bills to pay just like the rest of us.

Maybe they take a second or third job to stay current on bills or perhaps even get ahead. Imagine walking into McDonald's and seeing your pediatrician there, asking if you want fries with that.

Yeah, that's comforting.
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