Happy at work delivering babes in Kenya – I absolutely love what I do!
Today I’m switching gears a bit – instead of my usual work/life/training discourse, I want to talk about the Ontario government’s proposed cuts to health care. For my newer readers, I’m set to graduate from medical school this May. For my out of province and international friends, here’s a quick run down of how health care is paid for:
In Canada, we have universal health care, which means that people can access clinics and hospitals for free, as long as the services they need are “medically necessary” (i.e. no free Botox here, sorry). Doctors bill the government a certain amount of money for each patient they see, based on how complex the patient is. Each province is responsible for its own doctors, and each has slightly different agreements that outline how much they pay for different services.
This year, the Ontario government has proposed a significant cutback of 5% to healthcare spending, and as an “MD-to-be” I feel like this is really important to talk about. The Ontario Medical Association just accepted a 4% cutback in 2012, which is estimated to have saved the government more than $850M.
This article is a pretty good overview of what your family doctor bills when he or she sees you in the office in Ontario, and the costs associated with running that family practice. To summarize it here, quite bluntly, a doctor needs to see 4 patients per hour to cover the lowest average overhead of a clinic and earn a yearly salary of $138,000. This calculation was done assuming that the doctor takes 4 weeks of vacation and actually sees patients for 40 hours/week – it does not include lunch breaks, phone calls, reviewing labs/xrays, coordinating patient care, or any of the countless other things that I have to do in a day.
Now, I’m sure you’ve all been to see the doctor at some point in the last year. Would you be happy if she spent 15 minutes with you? What if you were elderly, with complex medical history and on lots of medications? What if you were struggling with mental health issues and needed someone to talk to? Suddenly, only spending 15 minutes with a patient seems ridiculous. Actually, I could argue that in some ways, it’s not safe.
So if I can’t see so many patients in a week, and my overhead is as low as possible, that leaves me with a decrease in my salary. I know that $138k is a lot of money, but I’d also like to look at what it took to get me there. In Ontario, you are required to do at least 3 years of undergraduate school before you can go to medical school (I did 4, but we’ll leave that last year out). The total cost of tuition was $7,000 per year ($21,000). I’ll also exclude textbooks, extra resources, exam fees and the cost of actually living. Then, I went to a three-year medical school (the fastest you can earn an MD in these parts). That cost me just under $75,000 in tuition alone. The program is full-time for three years, so there is no opportunity for summer work to offset these costs. I also paid for living expenses, transportation, textbooks, medical equipment, administrative fees, and parking, all of which were mandatory. I would estimate that the cost of my education thus far is in excess of $110,000 in textbooks and tuition alone. In fact, there is lots of data to support this: the average medical student graduating in Ontario carries $121,000 dollars in debt.
If this scares you, you’re not alone. Even banks, which traditionally provide market-rate lending to professional students, have noted that the fees to go to medical school are climbing faster than doctors’ salaries. In response, they have capped the amount of money they’re willing to lend to students, for fear of their inability to pay it back.
Setting aside the issue of the sheer monetary cost, let’s consider for a moment the personal cost required to become a physician. While my peers graduated from university and went on to find jobs, I had to relocate to continue to study. This delayed my earning, and separated me from my family and friends. Throughout medical school I have not been able to take vacation except for a few days over Christmas, so I have not been able to travel, relax or even sleep as much as the average adult. Going to university for 9 years (4 undergrad + 3 MD + 2 (minimum) residency) means that I have delayed any reasonable lifestyle or income by a decade.
Now, Ontario wants me to work overtime, rush my patients along, carry impossibly high debt, and somehow start a family/life 10 years late to the game, on a salary of $138,000 before taxes. No way.
For more commentary from medical students and residents about cuts, see this article. If you’d like to talk to your Ontario MP about cuts, please find the OMA’s advice about doing so here! Thanks so much for taking the time if you’ve read this far! If you’re curious about a much more complex overview of how physicians are paid in Ontario, you can tackle that issue here.