Doctors joining in the campaign to oppose proposed private corporation federal tax changes has caused some friction within the medical community.
Evidence of that is an open letter sent to federal Finance Minister William Morneau this month signed by more than 430 physicians and medical students from across Canada advocating for a comprehensive review of financial health care issues doctors face.
The letter downplays opposition to the tax changes, calling the reforms a first step in a comprehensive reassessment of tax policy in Canada, especially mechanisms that disproportionately benefit large corporations and the wealthiest Canadians.
A Salmon Arm family physician who supports the letter feels the majority of his counterparts have condemned the tax change proposals without an in-depth understanding of the bigger picture which the letter attempts to address, calling it an emotional reaction to seeing the potential loss of tax breaks impacting their income.
“The general reaction from the Canadian Medical Association and Doctors For B.C. has been to condemn the tax changes being proposed, but that reaction is divorced from any context,” said Dr. Warren Bell.
Bell is uncomfortable with doctors comparing themselves to small businesses because the two don’t exist on an even economic playing field.
“Unlike small businesses, we have reliable incomes and can work as much or as little as we want,” Bell explained.
Bell said most of his colleagues today have families and structure their working hours around their family or other personal demands. They are off work by a set time and unavailable beyond office hours.
And hospitalists are taking over looking after a family physician’s patients in the hospital as many are giving up hospital patient privileges to just focus on their practices.
“We don’t have to deal with market forces, competition or customer sales relations with our clients. A doctor probably has a two per cent accounts receivable aspect to their income, something any ordinary business would die for,” he said.
“If you want to look at people who might be vulnerable, look at farmers. Their financial plight is huge. Most of our food now is produced by larger agri-farm operations. People who do run their own farms often have to make a living off-farm in order to survive.
“If anyone deserves a break, it is them.”
Bell said the CMA and Doctors for BC are playing on outdated perceptions of the family doctor to drum up enthusiasm for opposing the tax policy—that doctors are overworked in a stressful profession and carry a huge debt load from medical school education loans.
While Bell agrees with the reliance of student loans, rather than access to student grants, as being a travesty in our current education system, he says the idea of the family doctor being on call 24/7 is not a widespread reality today.
“We have about 10 security blankets built into the health care funding system where most businesses have next to none,” he added.
Dr. Vanessa Brcic, a clinical assistant professor at UBC in Vancouver, is a leading force behind the letter writing initiative, saying it essentially advocates that doctors not be reliant on tax breaks to deal with specific drawbacks, financial or otherwise workplace related, to their livelihoods.
She acknowledged that younger physicians starting out don’t have access to the same tax benefits, such as sprinkling income among family members, that their more senior counterparts do.
She said while doctors have long training periods, incur significant student debt, enter the workforce later in life and have high rates of burnout, she said those issues shouldn’t be addressed with tax breaks.
“I often hear about time pressures and financial pressures that physicians face and I think these tax benefits are considered some form of recognition for that, yet I wonder about greater underlying issues within how are health care system functions that aren’t being addressed,” Brcic said.
“The reality is many others who oppose these tax regulation changes don’t have the income security that we do.”
Bell, one of only three doctors in the Okanagan-Thompson region to add their signatures to the letter so far, said while he would think twice about standing up among his Doctors of B.C. colleagues at a public forum and expressing his views on this issue, he feels the oath doctors take to practice medicine is about improving health care for everyone.
“I think advocating for social or tax change for our own benefit is a weakness. To be socially conscious is something we all strive for…but this tax policy opposition is an exercise in acting for our own special interests rather than working to achieve something with a broadly more applicable aim,” Bell said.