How to keep older doctors working

Canada needs to find ways to get ‘all hands on deck’ in order to deal with health-care crisis

Recently, a two-year-old child died unexpectedly in an emergency department at Lakeridge Health Ajax Pickering Hospital. Several adults have died in emergency departments in New Brunswick.

Due to burnout and income constraints from Bill 124, many health professionals have retired prematurely. Emergency departments across Canada have been forced to close for days at a time. Meanwhile 1.8 million Ontarians and 5 million Canadians do not have a family physician. Even Jagmeet Singh warned, “If we don’t see action on health care, we absolutely reserve the right to withdraw our support.”

No wonder health care has now surpassed inflation and jobs as the top national issue of concern.

Sadly, the politicians are still mired in the chronic debate over funding. A Vancouver health ministers meeting ended in an impasse. At a virtual meeting on Dec. 9, the premiers demanded that the Canada Health Transfer be increased from 22 per cent to 35 per cent and that Justin Trudeau meet with them early in the new year.

Federal Health minister Jean-Yves Duclos declined to commit to such a meeting and stated that funding would come only with “strings attached” to insure improved health outcomes. Ottawa also claims that it has already transferred “tax points” to the provinces which should have gone to health funding. Ontario Premier Doug Ford insists that the provinces want “flexibility to move those funds around where they’re needed.”

Duclos has called for the premiers to focus on recruiting and retaining health professionals. Thus, a first step in resolving this impasse might be financial support to existing older physicians.

A decade ago, 10 per cent of physicians were age 65 and over; now it is over 15 per cent. Yet like their patients, these physicians may need to be off for a few weeks or months due to a heart attack, severe infection such as COVID-19 or other ailments.. Private disability insurance usually has a two- to four-week waiting period, and is difficult to obtain after age 65. It would be unfortunate if such an illness or surgery therefore resulted in permanent retirement.

Consider as a precedent the maternity benefits for doctors across Canada. Benefits are generally paid for 17 weeks, and vary from $1,000 in British Columbia and New Brunswick to $1300 in Ontarioto $1500 in Nova Scotia.

All provinces provide these benefits, for once a provincial medical association negotiates a benefit with its own province, the others quickly follow so as not to face an exodus of many physicians. Also, unlike fee increases, which can and have been cancelled or even rolled back with little opposition from the public, it would seem most unfair for governments to cancel a benefit once it had been given.

I therefore propose, as in my earlier article (Oct. 11, 2022) that Ontario and all provinces and territories provide coverage to practicing MDs from age 65 to at least 80 with no waiting period at a rate of 70 to 80 per cent of their previous average billings for 60 or preferably 90 days.

If Ottawa were to subsidize this program, it would be targeted and should be agreeable to Duclos and most provinces. Quebec might claim “exclusive jurisdiction” over health, and protest indirect federal funding of MDs. Ottawa could simply pay them directly. Recall that the Interim Federal Health Program pays physicians treating refugees directly.

During our current crisis, we need “all hands on deck.” While waiting for increases in medical school enrolment, possible portable national licensure, and fast-tracking of licensure of foreign MDs to have an impact, we must retain our older physicians. Government-funded short-term income stabilization will help to do just that.