CANADA

A dollar a day keeps the doctors away

Shona McKay April 26 1982
CANADA

A dollar a day keeps the doctors away

Shona McKay April 26 1982

A dollar a day keeps the doctors away

CANADA

Shona McKay

In Scarborough, Ont., Dr. Derek Murphy, a mild-mannered 54-year-old family practitioner, hung up his stethoscope last week and joined hundreds of colleagues at a noisy protest meeting. In Ottawa, Jean Craig, director of nursing at the Salvation Army Grace General Hospital, sent 10 of her nurses on holidays or leaves of absence when sterile operating rooms fell silent. Kenneth Rowe, assistant administrator of the Hospital for Sick Children in Toronto, found himself explaining to anxious parents that their children’s tonsillectomies would have to be put off. As part and parcel of an unprecedented Canada-wide militancy among doctors in search of higher pay, Phase 2 of the Ontario Medical Association’s (OMA) war on the provincial government had begun.

The OMA, sole bargaining unit for Ontario’s 15,000 doctors, began negotiating last December with the provincial government over its members’ 1981 contract, which expired March 31. The doctors wanted a 20-per-cent increase in their salaries, which average $61,000 a year; the government offered 10 per cent. When negotiations floundered into February and the OMA called on its members to stop work for a day and attend “study sessions,” Health Minis-

ter Larry Grossman brought in Paul Weiler, a Harvard University professor, to act as an “independent fact finder.” Weiler waded through the data, then sent the doctors’ blood pressure soaring by recommending an increase well below the government offer. His prescription: a seven-per-cent raise over nine months. Retaliating, the doctors stopped giving free advice, refused to renew prescriptions over the phone, boycotted most hospital committees and declined even to sign patients’ records.

As a result, last week’s walkouts came as no surprise. And during the next four weeks, about one-fifth of the province’s doctors plan to walk out in different areas of the province each day. Offices will be closed and elective surgery cancelled. “We know we are inconveniencing our patients,” said Gene O’Keefe, spokesman for the OMA. “But we are not jeopardizing them. What other way do we have to protest?” Premier Bill Davis was not alone among Ontario politicians from all parties who denounced the OMA’s actions as “irresponsible.”

The Ontario dispute is of more than passing or provincial interest. It is the latest and most fevered development in the hostile relationship between the

philosophy of medicare and the priorities of Canadian doctors since Saskatchewan physicians went on strike in 1962, protesting the advent of state medicine on Canadian soil. When the Medicare Act was introduced nationally in 1968 by Lester Pearson’s Liberal government, Ontario Premier John Robarts described it as a “Machiavellian scheme.” But the grumbling did not become a roar until Emmett Hall, the man known as the father of medicare, issued a royal commission report in 1980 recommending that doctors be denied the right to bill patients over and above government rates.

That suggestion produced rumbles of discontent in doctors’ offices throughout the land. Last year alone, physicians bent on protecting their autonomy walked off the job in British Columbia, Alberta and Manitoba in an attempt to gain higher fees and the right to charge above the government rates. In British Columbia, where doctors were granted a 40-per-cent increase over two years, the medical association is nevertheless suing the provincial government for the right to extra-bill.

For their part, Manitoba’s 1,770 doctors are currently participating in rotating strikes, trying to persuade the provincial government to agree to contract arbitration. But doctor power, or

the quest for it, is nowhere more radiant than in Ontario, where almost half of Canada’s 35,000 physicians practise. The 102-year-old OMA, which formerly emphasized such creditable concerns as health promotion and public safety, underwent radical self-surgery shortly after the Hall report. Working from a $4-million annual budget and guarding a “war chest” planned to exceed another million, the OMA has become a dedicated and sophisticated selfpromoter. To publicize present contract disputes, full-page ads have appeared in every Ontario daily newspaper urging readers to “think about it.” “The anger has been building up,” says Gene O’Keefe. “Government has been pushing doctors around for 10 years. Now those doctors are angry and frustrated.”

The anger clearly has a dollar value. Weiler reported: “My bottom-line estimate is that the average full-time general practitioner in the province will net about $70,000 from his practice this year; the average specialist, $101,000.” Dr. Murphy calls such figures “exaggerated.” Murphy, who works about 60 hours a week and sees about 50 patients a day, netted $42,000 last year. “I would be perfectly happy to sign anything that gavp me a $70,000-a-year salary after expenses and taxes,” he notes wryly. The OMA claims that a doctor’s real salary has been eroded by 33 per cent over the past 10 inflationary years.

OMA polls indicate that more than 90 per cent of the doctors are complying with the master plan. But some doctors __ are in open disagreement with its tactics. Dr. Philip Berger, who works out of the South Riverdale Community Health Centre in Toronto, for one, practised business as usual last week. Berger, a

member of the Medical Reform Group, says he is “embarrassed” by his colleagues. “When 10 per cent of the population is unemployed,” he says, “it is difficult to sympathize with people who are not willing to accept a $12,000-ayear increase.” Berger, who is paid $40,000 a year, has still another concern. “The dispute is with the government, not with the patients,” he says. “But they are the ones who will suffer.”

As the walkouts gathered momentum (in spite of previous assurances by Grossman that most doctors would defy the OMA’s call to strike), patients’ rights became an emotional cause célèbre at the Ontario legislature. When it seemed imminent that doctors would cancel elective surgery at the Hospital for Sick Children, Grossman told the legislature that he found it “hard to believe that there is a situation in which surgery is being cancelled where a child’s emotional well-being or health is not threatened.” The minister said that he expected the College of Physicians and Surgeons, Ontario’s medical licensing body, to review every case in which surgery was cancelled at the hospital.

The medical community promptly accused Grossman of overreacting. “Operations are postponed every day,” says Dr. David Steward, chief of anesthesiology at Sick Kids. “If a child has a cold, we have to reschedule him.” By week’s end, the college had received dozens of complaints from patients—mostly about prescription renewals. Hospital administrators around the province, interviewed by Maclean's, seemed confident that no one’s health had been threatened by the work stoppage. “The hospitals are the real pawns,” says Alfred Story, head of the Etobicoke General Hospital.“We are vulnerable to criticism, but we are also confident that our patients will still be properly cared for.” Negotiators for the government and the OMA agreed to go back to the bargaining table this week, but whether new life can be infused into the ailing body remains to be seen. With protests of bad faith being bandied about by both sides, recovery is bound to be slow. Meanwhile, the OMA is preparing for Phase 3: an escalation in its campaign, with dark threats of a province-wide walkout in mid-May. Already demands from 12 of the 65 OMA branch groups have voted to move the date forward. As healers move from bedsides to picket lines, ailing Canadians could at least seek solace in Swedish and American studies that show that in times of suspended medical care, the death israte drops significantly.