Who pays for MD training?

The Annals, Royal College of Physicians and Surgeons of Canada, 2001;34(3), has reached a new editorial low in its article “A Point of View/Laser Eye Surgery” by Gordon H. Guyatt, professor of clinical epidemiology and biostatics, McMaster University. It is obvious he belongs to the University milieu and knows little about private practice when he makes a statement, correctly, that medicine and medicare impose a stronger obligation for public service than any other profession. However, he continues with a commandment directly from the Holy Grail saying the public pays most of the cost of a doctor’s medical training which should strengthen that duty. He carries this absurdity further by suggesting physicians who leave the system for money making private activities might be subjected to: 1. Exclusion from public reimbursement. 2. A demand to repay the money the public has spent on their medical education. 3. A surtax on profits for delivery of private medical care.

Welcome to the new millennium. Let us start with a few observations.

Was it the doctors and ophthalmologists who decided years ago to restrict the number in training? Small wonder the system should now be strained.

How much money has the public lost in training physicians of any sort? I have 35 years of income tax receipts which indicate doctors are a great public investment. There are how many doctors in Canada? 57,000 perhaps? This capsizes any statement about the public paying the cost of training and the absurdity which followed.

It is true doctors escape some taxation by incorporation, but keep in mind, while physicians may have actively sought this taxation wrinkle, without fee adjustment, it was the politicians who authorized it.

When I consider physicians who are obligated by law to medicare, and receive no praise but only further procrastinations about their performance and obligations, it is time to ask what about the dentists and lawyers, and to acknowledge physician persecution is now over. My suggestion is to re-invent the wheel. Any physician completing 30 years of private practice should receive recognition. While Governor General accolades, by way of Order of Canada, are not feasible, some thought should be directed toward federal government recognition with a Good Citizen Award which would also include limited disability insurance. It would be well earned to say the least.

—G.F. Roseborough, MD 
Victoria