In Canada as here, the government is in the saddle
Back in medical school, a classmate who had just signed up with the army asked me (knowing I was a vet) what I thought of the military, and whether he would get the residency of his choice. I asked whether he had any residency promise in writing, and he said no, but the recruiter said… When I finished laughing, I summed it up thusly: “All you need to know about the military is 1) they make all of the rules, and 2) they can change them anytime they like. If you’re okay with that, you’ll be fine.”
There probably significant philosophical commonality between being in the military, and being a Canadian physician. Generally, the Canadian government owns all of their doctors, and apparently can change the rules anytime they like. It also appears that even organizations in the hearty Great White North are coveys of cowards if gathered under the acronym “AMA.”
Health Minister Tyler Shandro is limiting the “current physician services budget at the 2018-19 level and (will) allow the government to withhold payments from doctors if overspending is expected.” What a brilliant idea! If the government spends too much, just cheat the people who do the actual work. Our timid U.S. Medicare / Medicaid apparatus fiddles on the edges with this stuff, but the brave Canadians are showing how to kick ass and take names, eh?
Sure, it may scrape the cheddar off the poutine when doctors see fewer patients, cherry pick more profitable cases, or close up shop for longer periods. But the Alberta Medical Association is fighting for their members and patients:“If the AMA does not agree with those budget-balancing strategies, or the government refuses an AMA request to adjust the physician services budget, it can take the matter to a mediator.”
But…but…
In the finest international tradition of folding like a cheap fur parka, their AMA surrendered as quickly as our does: “A letter signed by both Health Minister Tyler Shandro and AMA president Dr. Paul Boucher says a condition of the agreement would be the AMA discontinuing its $250 million lawsuit against the province that sought binding arbitration.”
So their AMA agreed to a cut in pay, and agreed not to fight it if the government decides to alter the deal. But the Canadians have not lost their tongue-in-cheek ways. “The agreement appears ‘quite favourable’ to the government, according to University of Calgary health law professor Lorian Hardcastle.”
“An AMA spokesperson said doctors are declining comment during the ratification period.” I’ll bet they are. They can save it all for when their masters lift COVID restrictions enough to enjoy a big convention in Montreal, where they can invite some of their U.S. cousins to debate homelessness, racism, and climate change. The patients in Alberta will doubtless be grateful.
Well, I’m not surprised. Canada has done far worse to physicians.
Anybody remember 2002, when Quebec FORCED community doctors to physically cover rural emergency departments? I mean simply draft and coerce a community doc, with or without emergency medicine experience, to physically go to a rural hospital and physically cover an emergency department that could not be staffed.
I mean, send mounties to the doc’s house. Fines and penalties for refusal. Forget about cutting the doc’s pay, how about forcing them to work.
https://www.cbc.ca/news/canada/quebec-government-to-force-doctors-to-work-in-emergency-rooms-1.344971
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC121991/
Pennsylvania flirted with this over a decade ago, and I think there will be more of a push for drafting. Worse days ahead.
You know what really kills me? Examples are all around us showing us what NOT to do–in medicine, in society. And yet, we Americans just stumble down the bad path, gleefully proclaiming “we’re gonna do this better”! We NEVER learn from history nor from lessons on vivid display of rot around us. I wish we could burn it all down and start over in caves.
There seems to be some change in physicians who become administrators at any level–almost like they underwent a brain transplant. Perhaps it is because they see what easy money and lifestyle are to be had wearing the hat of administrator physician instead of a doctor who actually works for a living.