Playing chicken

There are few people who would disagree with the statement that doctors right across this country have difficult jobs with particular skill sets, and that they deserve to be paid well for their expertise and time.

At the same time, there are few people who should be surprised by the fact that provincial health departments are feeling a tremendous fiscal pinch.

Ontario was the first to blink. Citing technological changes that make some procedures faster and easier, that province rolled back a series of fees that will see it trim $338 million from what it pays doctors. The Coalition of Family Physicians and Specialists of Ontario immediately invoked its biggest threat: that doctors should move to greener pastures, saying physicians “should explore options in more hospitable practice jurisdictions.”

The translation? Find other provinces willing to pay top dollar. It’s the kind of message that has regularly seen provinces right across the country paying more and more to keep doctors at home.

But what if, this time, no province is willing to pay?

Buried at the end of the Newfoundland auditor general’s report this year was an interesting table — it lists everyone who billed the province for more than $600,000 in the last year for professional services.

On that list? A total of 80 physicians or physicians’ practices billing everything from $600,000 a year to a whopping $1.44 million. That’s not take-home pay — it’s simply what the province paid the doctors for services before expenses.

More interesting, perhaps, is the year-over-year increase in those billings.

Out of those 80 physicians, 68 had a single-year increase in billings of more than $100,000. Within that 80, 47 had single-year increases in billings of more than $150,000. Thirty-one saw single-year increases of more than $200,000, and a subset of those, 17, had single-year increases in billings of more than $300,000.

These are very rough numbers, and are not meant as a criticism of any particular doctor or their billing practices: what they show, though, is a little sliver of the dramatic increase in costs provinces have borne as they bid against each other to try and keep skilled medical professionals in their jurisdictions.

It’s an increase, though, that will continue for as long as the provinces are willing to keep competing.

With Ontario, and now Alberta, looking at rolling back millions of dollars in payments for physicians’ services, the water may well be changing on the beans. British Columbia, Nova Scotia and Manitoba are also looking at changes, and once that ball starts rolling, it’s hard not to imagine that the provinces and territories won’t wind up working to find a level playing field.

It’s like playing chicken, but this time, in reverse.

Doctors are skilled professionals who deserve the returns that the market will bear for their skills; what seems to be changing is the market itself.

No one — particularly doctors — should be surprised if the province decides the ground is going to change here as well.