I wrote this back in 2004 and published in the London Free Press in response to a columnist’s suggestion that Doctors are “milking the system”… It has some relevance now with the unilateral moves by the Ontario Government to decrease doctors’ fees. I should state that I am in support of some fees being reduced in light of technical advances made that have enabled physicians to treat more patients. Having said that, it is abundantly clear that the Ontario government pays physicians considerably less than what individual patients would be willing to pay if this was a free market economy.

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[…] thinks I am overpaid. Well, he did not mention me specifically, but he thinks physicians’ incomes represent an enormous burden to the taxpayers.

Funny that. While few physicians I know are poor, most are not exactly wallowing in cash. The point most physicians take issue with when we read criticisms of this sort is the value people seem to attach to their health compared to other commodities.

The present set up – where the government is the single payer tends to ensure that physicians are paid less that what the population at large would be willing to pay. Consider the following example: A physician is on call at a hospital. At 3am, a 58 year old male patient experiences what the Government of Ontario’s Ministry of Health and Long Term Care euphemistically calls a “Life Threatening Emergency Situation.” In lay terms, that means that his heart or his breathing have stopped. (We used to call this death until we realized that it could be reversible and death was supposed to be irreversible). A sequence of events is activated, culminating in a number of overpaid health care professionals, including the physician, responding to this emergency in an attempt to resuscitate the patient.

It is difficult to explain what it really means to be at a dying person’s bedside at 3 in the morning, knowing that you have only a few minutes to take very specific actions that may mean the difference between life and death. We break down the process into individual components to which we give sanitized terms like “securing the airway” or “obtaining intravenous access.” In the meantime, you’re furiously drawing upon every last bit of knowledge and experience you have accumulated to understand why this man is dying and how to stop this from becoming permanent. When it’s all over, someone has either just died in front you, or, if they have survived, you’re still going over the events in your mind hours and days later.

The big question, of course, is how much […] would pay for the performance of this service. I haven’t asked him, but I am certain that most people would pay more than what the government pays. The “system that has paid off handsomely for health care workers”; the government that has “caved in” to the demands of physicians will pay roughly $120 for an average resuscitation attempt.

If the physician attending to the patient is the intensive care physician and the patient actually survives, that physician receives no remuneration for his or her efforts.

What else can you get for $120 these days? Ironically enough, two tickets to the upcoming Melissa Etheridge concert at the John Labatt Center cost $122. The concert could very well sell out. Some people may complain, but most understand that this is the cost of bringing a big ticket item to town.

As I mentioned in the beginning, most physicians are hardly poor. However, the vast majority of physicians I know are not practising their profession for the money either. For the same amount of training and education – the current minimum is 8 years, the average is closer to 12 years – most would make more money doing other things.  Many consider their practice of medicine to be a privilege – the privilege of being able to attend at a sick person’s side and provide help in their time of need.

And if you are the person dying in a hospital bed at 3am you had better hope that the physician resuscitating you is not doing it for the money, because, frankly, the money is not worth it.

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Addendum: Since 2004, the amount paid for an average resuscitation attempt is around $165.75 – this represents an increase of $25 dollars in real terms (after adjusting for inflation) ie a raise of ~2% per year. The question does remain, though: in 2012: What can you buy for $165.75?