Newfoundland and Labrador's Doctor Decision

Everywhere around us Healthcare is front and centre. Whether here in Newfoundland and Labrador, or in a wealthy place like Alberta. Just yesterday the CBC reported that Alberta Emergency rooms were aiming for a success rate of 45% admitted within 8 hours of waiting. That is really sad, and in a place where most of us believe doctors are aplenty - atleast by Canadian standards. The causes are well known: aging populations; upside down demographic trends; shrinking tax bases; deficit budgets; sky rocketting intergovernmental debt; and of course a shortage of medical personel.

In Newfoundland and Labrador the boiling point has been reached between the government and doctors. The doctors claiming to be under paid compared to others in the region and country. The government claiming their offer is more than fair. Those are the essential battle lines. Issues such as quality of life, working conditions, and doctor shortages being implied symptoms of the primary cause - money or lack thereof. According to Canadian Medical Association Journal (CMAJ), figuring in all forms of income for doctors, whether salary or fee for service, doctors in this province are 6.78% less than the national average of $224,875 (2008/09 numbers). Dr. Lewis, President of the Newfoundland and Labrador Medical Association, states the doctor's offer would result in an eighty million dollar increase to the existing three hundred and thirty million dollars currently spent on physician's compensation - or a twenty five percent hike over all.

The problem with just throwing money at the problem is that it does nothing to fix the problem. If that were the case Alberta would have no problems - but they do. It seems the issue is not fixing the problems inherent within the health care system, but rather supplying enough funds to keep the bandaids in place. Not a good solution for anyone in the long run. Afterall, even doctors will one day need a doctor they can count on. If all things, even the medical field, are driven by financial reward, and if financial reward is determined not by what you make, but rather what you keep, then perhaps a thought outside the box is in order.

For starters, the cost of living in Newfoundland is far below that of most of the country. A home that would cost you $150,000 here will cost you easily $350,000 elsewhere in Canada. Consider that the cost of borrowing for a mortgage normally doubles the initial cost of the home and the dollars become even more significant. The costs for insurances, groceries, utilities, recreation and property taxes are either much less or competetive with the rest of the country. Certainly, personnel costs and salaries are much less. From a business point of view, the overhead here is very competitive. Then factor in the upcoming and ever growing industrial resource build up of Newfoundland and Labrador. One of the few, very few, provinces with a "boom" unfolding for atleast a generation. Sounds like a good place to be, and as good a place to do business.

Medicine is a business afterall. It is a calling - without doubt. However, strip all the warm and fuzzies away from it and healthcare is a business. Perhaps the solution to our current labour strife, and a very possible answer to some of our recruitment issues, lies in a business approach to the matter. Whether it be personal or business income the truth is the bottom line. Not so much necessarily in what we make, but rather in what we keep. In a word - taxes. Perhaps the solution lies in an outside the box approach to taxes - provincial income taxes to be precise. By way of example, Alberta has a flat income tax of ten percent. Whether your income is 30,000 or 300,000 it's 10%. So for a physician, who would normally make anywhere from 220,000 to 450,000, that is significant when compared to a place like right next door in Saskatchewan. In Saskatchewan that same doctor would be paying in the range of say 36 %.

Perhaps our government could pass legislation designating physicians a "strategic service" and offer them a break on their provincial income tax. Make their provincial tax even less than Alberta's - say 5% flat. That would save the average physician more money than the current raise request. It would entice other doctors from different jurisdictions to practise here. The people of Newfoundland and Labrador would likely view it as a necessary step to help retain and grow the essential service that doctors are. This approach emphasizes the business advantage to doing business here for doctors. More money thrown, simply to be clawed back by higher tax brackets, federally and provincially, does nothing to improve the doctors bottom line, and therefore their morale. Let's think outside of the box, and move forward, as we are in almost every other aspect of Newfoundland and Labrador society.