SOCIETY TODAY
Medicine
Doctors who never had it so good
Gethin James
An intriguing international comparison has arisen between the recent action of the British General Medical Council and the Ontario College of Physicians and Surgeons (OCPS) in Canada. Shortly after the GMC made the headlines in the British press with its investigation of the charges of unethical conduct brought against a GP by the matron of a nursing home, the OCPS took 'disciplinary action' in the light of similar charges of unethical conduct brought against members of the Ontario medical profession by members of the Ontario Legislature. Herein lies the contrast: whereas the. GMC sought maximum publicity in an overzealous investigation of a trivial matter, the OCPS, for their part, enacted an incredible cover-up of palpably unethical conduct by numerous Ontario doctors — conduct that amounted to the embezzlement of hundreds of thousands of public dollars. While the GMC washed its smalls in public, the■OCPS furtively turned its dirty linen into an apple-pie bed.
Of course the comparison involves groups that operate before vastly different political backdrops; the differences in socioeconomic climates are staggering. The sky-high economics of Canadian medicine never fail to surprise newcomers on the Canadian scene. What purports to be the same, however, is the professed resolve of doctors on both sides of the Atlantic to serve the sick and the infirm; it is this pre-supposition that makes the present comparison so fascinating. The crisis in Ontario medicine has served to dispel the myth that was around before the doctors joined the Province's 'Medicare' scheme in 1969 that there would be a mass exodus of doctors from Ontario in the face of 'State Medicine.' In fact, what happened under 'Medicare', was a rise of 35 per cent in three years for doctors' incomes. The average doctor in Ontario made $15,000 per annum in 1958, by 1969 this figure was $31,000 per annum; today it is $41,000 per annum. Doctors' incomes, which were five times the average person's income in Canada in 1961, have now risen to seven times that average.
The figures were brought dras
tically into focus early this year when Morton Schulman, NDP, MPP disclosed his firm estimation that one doctor in ten was abusing the Provincial Medicare system. He revealed the instance of one doctor in particular who had billed the Ontario Hospital Insurance Plan (OHIP) for $18,161 for the month of April alone. The doctor's records claimed that on one day in that month he had seen 115 patients in his office, he had made twenty-six house calls and that he had made 114 hospital visits.
The total costs to OHIP for April gave weight to Schulman's accusations. The doctors billed for $574 million — $50 million more than was anticipated. Naturally, the public response to this new awareness was to raise the question as to whether the remaining 75 per cent of Ontario's 6,000 doctors be put on salary like the British counterparts.
The suggestion struck terror into every GP's breast; for, last year, the doctors had the lead over all the other professions in Ontario. Their average income was $7,000 more per annum than lawyers and $9,000 per annum more than dentists. (The average incomes of ear, nose and throat specialists, surgeons and opthalmologists are presently as much as 40 per cent higher than GP's average.) The reason, of course, for these inflated figures, is in the continuing use of a 'fee scale' that predates the inception of 'Medicare' in Ontario. The fee scale represents 'Robin Hood' medicare of yesteryear when the rich paid more than the poor. But now everybody pays the same into Ontario's Medicare — Yet the fee system remained. Why the fee schedules remained is no mystery. The schedules are so blurred as to make it very difficult to distinguish between 'a surgery visit' for $6 and 'a general assess ment' at $15. Again, there are many tasks, such as kidney dialyses, which doctors hand over to technicians, yet get paid for under the fee system. There is the ever recurrent double temptation to doctors to 'over service' patients in asking them to return to the surgery for treatment when this is no longer really needed and, also to bill OHIP for casual advice.
It was before such temptation that the un-named doctor in Schulman's accusation bowed. The doctors themselves spoke out against their critics and quoted capitalist maxims about working hard and being well paid, the expenses of running surgeries, the temptation for salaried doctors to sit at home, and the like.
Seeing that there was a possibility of the provincial government taking the reins out of its hands, the OCPS decided that it would take the necessary steps to curb Ontario surgical hi-flyers before the Tories did. The action that the august body took would surprise only the novitiates and the naive in Ontario's bastion of advanced capitalism. Firstly the GPs got their fingers rapped. The OCPS stipulated that from now on Ontario's 6,000 doctors may collect no more than $77,760 for a 48week year.
This limits taxable income to $51,321 per annum. One complaining GM admitted that although such measures were severe, at least it gave the profession $6,000 more than the estimated average doctor's income for last year. Doctors are now limited to seeing 300 patients a week and their claims must not exceed $1,800 per week. ,By far, the worst shrieks of agony came from the ranks of the surgeons, who may now perform no more than twelve operations a week, and thereby, have to exist on a mere $67,414 per annum.
Gethin James is at present doing background research for current affairs programmes on Canadian television.
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