A Doctor’s Worth: Thoughts on Value in Uncertain Times

November 5, 2018

As we try to reconcile claims of fiscal responsibility with promises of support to improve healthcare, the question remains: What’s a doctor worth?

With unsustainable healthcare costs, frighteningly high rates of physician burnout and suicide, and a societal trend towards anti-science and anti-authority, it’s no wonder that many doctors feel uneasy about the future. Add in the number of doctors in other provinces who are working without an agreement, while others prepare for negotiations, and the forecast becomes cloudier still.

Canada’s doctors stand at these crossroads: some asking for collaboration, while others prepare for the worst. In some areas of the country governments threaten to renege on agreements or claw back fees, yet there are growing crises of patient access to care and attachment. As we try to reconcile these claims of fiscal responsibility with promises of support to improve healthcare, the question remains: What’s a doctor worth?

Looking at others

Although it has been said that comparison is the thief of joy, we are presented with free market costs in many aspects of our lives. Anyone who has hired a lawyer knows that even the most junior associate bills hundreds of dollars an hour – a number that jumps exponentially when the lawyer’s name is on the letterhead. Having recently survived the effective contraceptive method known as renovations, I happily paid plumbers, tilers, dry wallers, and electricians to provide services to my family, while wondering the best way to convince our four-year-old daughter to consider getting her red seal. As well, the rates charged and benefits received by dentists, physiotherapists, chiropractors, and naturopaths, not to mention nurses and nurse practitioners, are clear, reasonable, and commensurate with experience. Given the length of our training, the need of our services, the overall responsibility of having the buck stop with us, and the whole saving life thing, one can argue that relatively speaking we should be highly valued.

Looking at ourselves
Perhaps the easiest thing would be to look at our incomes as a whole, including fee-for-service. But it’s not as simple as looking at a doctor’s billings in BC’s Blue Book. Most recognize that gross billings do not take into account overhead and opportunity costs, let alone historical inequities within our profession.

Looking beyond

All of these discussions equate value with price. While there are certainly personal and professional costs that need to be considered, many challenges go beyond the bottom line. Our morale is inversely proportional to our patients’ wait times for consultations and imaging. The onslaught of administrative tasks – many of which are not related to direct patient care – and time spent with our EMRs take us not only away from our patients, but our families, friends and activities that are so important to our own health.

Looking ahead

So as we advocate for fair economic reward we must also work together to create a more sustainable future. Funded, region-specific team-based care can allow us to practice to our scope and wrap needed care around our patients. Paid sick, parental, education, and vacation leave would help us be our best at and outside work. Improved IT tools, networks of care, and stream-lined referral processes are some examples of many possible solutions to improve efficiency and decrease burnout. Because anything that helps keep our patients, our communities, and ourselves healthy will be well worth it.

- Dr Eric Cadesky

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