Overworked and underpaid
About noon one day in 1978 our household clothes washer stopped. Cloth diapers and drooly bibs don't retain their just-washed freshness if your washer is broken, so we called the repairman. He came while I was away at the hospital and was gone before I returned. For the 20 minutes he charged $46: $8 for the part, $38 for the visit. I was off giving anesthetic so a distressed baby could be born by section. I earned $37 for my two hours.
Last weekend I dropped off a vacuum cleaner that had stopped working. The fee for an assessment was $52, not including parts or labour over one hour. Today I made a house call to a woman in her late 40s with terminal breast cancer. We talked about how chemotherapy had failed and how the aim of further therapy would be to relieve symptoms rather than obtain a cure. We talked about her teen-aged son, her parents, how her sisters were laying the guilt trip on her about not trying hard enough to get better. I examined her and left a prescription. Total bill $28.60.
I leave for work at 7:30 a.m. and return at 6 p.m. five days a week. Each year I'm on first call 61 days and back-up call 121 days, including 26 weekends. Still, compared to my rural family medicine counterparts, I've got it easy. I no longer administer anesthetics or deliver babies or work in the emergency room, but I do have hospital wards full of sick people to be seen and I do clinics daily. I supervise family medicine residents and I teach medical students. When there is time I do research and write tripe such as this. Yet, compared with my rural colleagues I've got it easy.
"Make sure your doctor explains the pro's and con's of hormone replacement therapy in the treatment of chronic tiredness." Great idea but who pays the doctor for the half-hour? Who looks at the remaining sick people in the waiting room? Who needs to see these remaining people so they won't overwhelm the emergency room staff who, in the rush, might miss a seriously ill patient?
The newspaper headlines accuse, "Family Doctors Prescribe Too Many Antibiotics." Okay, let's look at this. A sick person goes to the doctor, the doctor diagnoses a cold, probably the same one the doctor had to work through last week. The doctor says that no antibiotics are needed and explains the self-limiting nature of viral illnesses. The doctor then listens to how an important event is up coming and if the patient can't attend this event because of illness the doctor will be blamed. Not sued, just blamed. This acrimonious discussion takes six minutes. To write Amoxil 500 t.i.d. X 5/7 takes 30 seconds. For $16.50 a visit you get what you pay for.
Here in Newfoundland we endure the lowest fee schedule of any jurisdiction in North America. We see more patients per day, spend more time on call, and work more days per year than any doctors west of Europe. Canadians want a top-notch health care system but have decided, through their political parties, to pay bottom-rung salaries.
The government bureaucrats and cabinet ministers who make the laws and draw up the fee schedules have no trouble with access to medical care. Such persons always live near large medical facilities - never, like those who elected them, in rural or remote areas. So the decision-makers feel everything is fine and any problems that come their way arrive second hand. No wonder we, the doctors, feel that concerning our patients we're being told by such administrators to say, "Let them eat cake."
One young surgeon told me she wasn't going to work too hard. No sir! She wasn't going to kill herself like so many before her. No way! "I hardly ever get to the hospital before 7 a.m. and I'm mostly always home before 7 p.m., unless I'm on call. Weekends, I'm usually home before 2 p.m. No sir, I'm not going to over-work myself." Eighty hours a week to take somebody's gallbladder in her hands for less money than the cost of half a semester at a cheap gym.
Although trained to do a good job we are so underpaid that we must constantly cut corners. The patients lose the time of their doctors while the doctors lose themselves.