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DR. CHARLES SHAVER • Guest Opinion

Ottawa physician Dr. Charles Shaver is past-chair of the section on general internal medicine of the Ontario Medical Association. The views here are his own.

Across Canada, there is a critical shortage of health-care staff. Emergency departments have closed temporarily due to a lack of nurses and MDs, physicians have closed their offices, surgery has been postponed or cancelled, and wait times for patients have increased. As of Aug. 1, 105,000 residents of Nova Scotia had signed up with the Need a Family Practice registry.

Clearly, we must use all tools in the toolbox to correct this problem.

These include increasing enrollment at Canadian medical schools, fast-tracking licencing of foreign graduates, but importantly, also doing whatever is required to retain existing physicians and nurses.

On Aug. 19, Dr. Nancy Whitmore, registrar of the College of Physicians and Surgeons of Ontario, in an e-mail announced the college would encourage the recently retired to reactivate their licences with no application fee and a flexible approach to re-entry. I applaud her efforts, but have one further suggestion — a major reduction in annual fees for all older physicians. I have outlined this in a letter to her.

Across Canada, due to burnout, COVID-19, and income constraints, many nurses and doctors are retiring prematurely.

A recent Angus Reid poll found that only 14 per cent of people have a doctor and can get an appointment quickly. There is also a shortage of medical and surgical specialists, with long wait times to be seen them. We need to provide various incentives to retain senior nurses and physicians. As the saying goes, “It is difficult to fill a bathtub with the drain open.”

Older physicians are working fewer hours and paying a much higher portion of gross income on overhead, and in Ontario, like nurses, have received only a sub-inflationary one-per-cent fee increase.

If provinces cannot or will not give realistic pay increases to physicians and nurses, they can at least look for ways to reduce their expenses.

The annual renewal fee for a licence is $1,950 in Nova Scotia, $1,850 in Newfoundland and Labrador, $1,950 in P.E.I, and about the same in most provinces, with currently no discount for older MDs. If an older physician receives an invoice for this amount, this may be the “last straw” that causes premature retirement.

Certainly, precedents exist in other professional organizations to give discounted fees to senior MDs.

The Royal College of Physicians and Surgeons of Canada, with 47,000 members, offers a reduced fee to “long-term fellows,” i.e., active fellows with at least 40 years of membership. Currently, this is $247, compared with the regular annual fee of $990.

Also, the College of Family Physicians of Canada, with 38,000 members, discounts the national portion of annual fees, from $823 to $559 for MDs age 65 and over; the Ontario chapter discounts their fees from $246 to $126. Those aged 70 and older can become “life members” with no annual fees.

Younger physicians, especially general internists, derive much of their income from work in hospitals, where there is little or no overhead. Most older family physicians, internists, and surgeons have a predominately office-based practice. Many incur overhead charges of 40 to 50 per cent of gross income. At the same time, many only work part-time.

Across Canada, over 15 per cent of family physicians and 16 per cent of medical and surgical specialists are aged 65 or over. In Nova Scotia, over 10 per cent of MDs are over age 65 and 4.1 per cent over 70. In Newfoundland and Labrador, 18 per cent of family physicians are over age 60.

Hopefully, Nova Scotia, P.E.I., and Newfoundland and Labrador, plus all other provinces and territories, will significantly reduce annual fees for older physicians, nurses, and other health professionals. We need their knowledge and experience more than ever and should do whatever it takes to keep them in the workforce.

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