After 30 years in practice and 4 years working at a high level of health administration, I realize that our system of physician remuneration is out of touch with the realities of modern hospital-based practice. There is wide­spread frustration among specialist physicians as the increasing shortage of resources prevents them from working to their full potential and earning capacity. Future investments in health care will be in treating chronic disease, elder care, and health promotion—not acute care. This changing pattern of investment will particularly affect my surgical and anesthesia colleagues.

Furthermore, inequitable distribution of income resulting from a procedure-based fee schedule has resulted in serious shortages of manpower in some specialties. Tenfold differences in incomes cannot be justified by hours worked per week.

Canadian physicians urgently need to start a conversation around remuneration and, as a group, ap­proach governments for reasonable and predictable compensation.
—Peter Blair, MD
New Westminster