May 15, 2020
Attention: The Honourable Jason Kenney, Premier of Alberta.
Dear Premier Kenney,
Thank you for making me feel young again.
Your press conference last Friday “triggered” me. I felt like a millennial.
Calgary Herald columnist Licia Corbella—a staunch supporter of physicians—asked you whether Health Minister Tyler Shandro would be shuffled out of his portfolio. You responded with this gem:
“I think he’s been doing an extraordinary job under the most trying circumstances probably for any health minister in modern Alberta history.”
On that we agree, Mr. Premier.
What is extraordinary, however, is the breath-taking incompetence Minister Shandro has displayed in the short time he has held his portfolio.
What is extraordinary is the degree of rancour the Minister has managed to generate between himself and the doctors of Alberta.
What is extraordinary is the complete and utter collapse of trust between doctors and your government—and during a pandemic, for crying out loud.
We know perfectly well, of course, that Mr. Shandro is simply doing your bidding.
But we’ve have had it—up to our collective eyeballs—with politicians constantly smearing the medical profession.
We’ve had it with being painted as money-grubbing parasites.
We’ve tired of being lampooned as greedy, grasping Ebenezer Scrooges—wealthy beyond description but too tight-fisted to give up a solitary dime as Alberta teeters on the edge of financial apocalypse.
We’re fed up with being portrayed as over-stuffed pigs slurping greedily from the public trough while constantly squealing that our generous swill isn’t enough.
I have news for you, Mr. Kenney: we’re not pigs, but we’ve had our fill.
We’ve had our fill of you trying to turn the public against us by twisting the facts.
Speaking of twisted: there’s an old Twisted Sister song that captures perfectly the zeitgeist of the slandered doctors of Alberta at the moment—We’re not gonna take it anymore.
I’m dating myself a bit by trotting out that golden oldie, I suppose. Whatever. I’ve been around. This isn’t my first rodeo. I’ve endured politicians of your stripe before.
I will admit to being caught off guard, however, by your assault on doctors. You fooled me.
I met you in October 2017 at the Calgary Leadership Prayer Breakfast, when you were still plotting your way to the pinnacle of Albertan politics. Preston Manning was the keynote speaker. Licia Corbella was there too.
You won’t remember me, but I shook your hand that day. I knew you would become premier. At the time I thought you would make a good one.
Sixteen months later I watched you sign a giant placard—the “Public Health Guarantee”—as leader of the newly formed United Conservative Party. I listened as you vowed to protect health care spending in Alberta.
Then I voted for you to become the premier of Alberta.
I voted for you because you talked a good game.
I voted for you because you stood up for the energy industry in Alberta, because you understood the energy sector’s critical importance to restoring a prosperous economy—an economy that allows all Albertans to thrive, an economy that supports intelligent spending on infrastructure, education, and health care.
I voted for you because you’re a fiscal conservative.
I’m a fiscal conservative too. But I’m also a doctor, and I understand that fiscal conservatism and robust public health care are inextricably linked: they’re “sisters”, if you will. A healthy population is a productive population—and that’s good for the economy.
But you’ve twisted those sisters against each other. That’s bad for Albertans—and bad for the economy.
And prayer will not fix it, Mr. Premier.
You threw out some eye-popping numbers last Friday.
You suggested, for instance, that the average Alberta doctor rakes in almost $400,000 per year. Then you said this:
And that’s OK. As I say all the time, we value enormously the work of our physicians… We think they should be compensated not only fairly but generously.
But… we cannot continue, particularly with the great fiscal reckoning that Alberta will face following the pandemic—we cannot continue to see annual increases in physician compensation that are typically three to four times higher than inflation.
Over the past five years, the average Alberta family has seen… their incomes decline after tax by about 10%. Over the same four to five-year period physician compensation went from $4.5 billion to $5.5 billion! So we saw, you know, an enormous increase in compensation for one segment of the population.
Let me get that straight: you value us enormously; on the other hand, we’re selfish bastards. That’s like embracing us so you can stab us properly in the back, Mr. Premier.
It was a masterful display. You sounded reasonable, measured, and thoughtful as you methodically demonized us. Any ordinary Albertan watching that press conference would have been outraged by the naked greed of physicians, and understandably so.
I would have been outraged, too, if I were an ordinary Albertan. I am pretty ordinary, but—again—I’m also a doctor: I understand a thing or two about the financial realities of being a doctor.
I’ll set aside for now, Mr. Premier, the falsehoods and shameless distortions contained in your response to Ms. Corbella. I’ll leave others to expose those lies for what they are.
But I do want to explain a few things to you about doctors and money.
It’s a difficult topic for us. Doctors don’t like to talk about money. We’re not good with money. What we’re good at it is taking care of patients.
But because we keep our focus on our patients, because we don’t speak up effectively around matters of money, we’ve permitted the false notion of rich, fat-cat doctors to crystallize as reality in the public mind—and in your mind as well, it would seem.
That notion isn’t easily dispelled. But I’m going to give it a shot. Perhaps your jaundiced view of doctors is based on honest misunderstanding. Perhaps you’re genuinely confused about the dollars and cents of doctorhood.
Consider this: You hired accounting firm Ernst and Young to conduct an audit of Alberta Health Services. You paid them two million bucks.
No logical person would suggest that all that cash landed in the firm’s bank account as pure profit. Much of the money went toward defraying the personnel and material costs of conducting the audit.
Only after all those expenses were paid was there money left over to line the pockets of the firm’s partners.
Just as accounting firms and other businesses have expenses, so, too, do doctors. It’s expensive to become a doctor, but it’s also expensive to be a doctor.
Most medical practices function as small businesses. They employ Albertans, pay taxes and participate in the economy. On average, 30% of physicians’ billings go to overhead expenses—rent, staff, equipment, continuing education, malpractice insurance, membership dues, licensing, and so on.
Yet you consistently mislead the public, Mr. Premier, by suggesting that doctors’ billings land in their bank accounts as pure profit.
In 2018 doctors in Alberta billed the government, on average, $380,000. Thirty percent off the top for expenses leaves pre-tax income of $266,000.
That’s still a lot of moolah—and with a lot of moolah comes a lot of tax. Taxes trim that number all the way down to $168,000.
Which is still a big chunk of change. According to Stats Canada, for non-senior families—where the highest income earner is under 65 years of age—the median after-tax income in 2018 was $91,000. Therefore, Alberta’s doctors took home $77,000 more than the median for Canadian families.
But that ignores the ten to fifteen years doctors spend in education and training, years in which they’re not earning $168,000 in after-tax income; nor are they earning the Canadian median of $91,000. They’re busy accumulating hundreds of thousands of dollars of debt instead as they slave away to master their craft.
You’re far from the first leader to take aim at physicians, Mr. Premier. We’re an easy target for unscrupulous and ill-informed politicians. In 2017, for instance, Prime Minister Justin Trudeau and Finance Minister Bill Morneau shamefully attacked doctors as money-hungry bloodsuckers—just as you are doing now.
I’ll share a snippet from a letter of protest I penned to Mr. Morneau in September of 2017:
After fourteen years in university and in training, I finally began practice as an emergency physician at Alberta Children’s Hospital in Calgary.
Fourteen years—years that my contemporaries used to develop careers, grow businesses, and start families; years in which they began building nest-eggs for their children’s education, and for their own retirements.
I built a nest-egg of a rather different variety during those fourteen years, composed of an enormous yolk of debt surrounded by an expanding egg-white of interest.
Most doctors “catch up” financially to their non-medical peers by their early to mid-40’s, assuming they work hard and have decent money habits, assuming they don’t become disabled or critically ill, and assuming they don’t take too many breaks to have children.
Albertans are well aware that doctors are paid with taxpayers’ dollars. But they are unaware that we receive no other benefits: no sick pay; no disability benefits; no paid maternity leave; no vacation pay; no health and dental benefits; no pension plan. All of these things we must provide for ourselves. We are public servants—but with none of the benefits that all other public servants enjoy.
A physician who wishes to retire at age 65 on an income of $60,000 per year must sock away $2 million dollars in retirement savings ($2 million at three percent return equals $60,000). Assuming a 35-year career, that’s $57,000 per year.
Subtract that from the $77,000 “advantage” calculated earlier, and one is left with twenty thousand bucks as the annual “bonus” for being a doctor—a bonus from which parental leaves, dental bills, sick leaves and so on must be paid. That’s the bonus for engaging in one of the most demanding and stressful occupations that exist.
(In the interests of remaining relatively calm I won’t discuss the platinum pensions that politicians enjoy, Mr. Premier. Let me just say that landing one of those bloated, taxpayer-funded, fully-indexed-for-life cash-dispensing beauties is akin to winning the lottery every year for the rest of your life.)
Medicine is an awesome, fulfilling career in many, many respects; but it’s not for the faint of heart. You may be surprised to learn that one in three physicians experience signs of depression; according to a 2018 literature review in the U.S., roughly 40 physicians per 100,000 die by suicide each year—the highest rate of suicide of any profession, and double the rate of the general population.
It’s no surprise, given the load physicians carry, that burnout and mental distress litter the landscape. Politicians who make a sport of smearing us as selfish jerks don’t make things any easier.
Doctors choose the profession for a variety of reasons. Some see it as a noble calling to serve others; some are attracted to endless intellectual challenge; some may simply desire a colourful way to fritter away their time on this planet.
But anyone who pursues a career in medicine “for the money” is in dire need of the profession’s most able psychiatrists.
I suspect you know all of this already, Mr. Premier. Yet you persist in attacking us.
You may be familiar with Hanlon’s razor: “Never attribute to malice that which is adequately explained by stupidity.”
I know you’re not stupid, sir. I know the opposite is true.
That leaves malice as the motivator for your continued assault on the doctors of Alberta.
But from whence does that malice arise? Why do you hate us so much?
In the legislature last Friday you remarked that your government must better “manage” physicians’ pay once the pandemic is over.
Oddly, you haven’t “managed” to inform the public that fee-for-service doctors presently manning the front lines of this pandemic are being “rewarded” for their service with steep reductions in pay. (Patient numbers—and therefore billings—have plummeted due to the unprecedented context of this pandemic and the attendant lockdown.)
Those doctors are going to work as always. People are still getting sick and injured; women are still going into labour; some folks still require urgent surgeries; some unlucky citizens are falling ill from COVID-19. But despite working with heightened stress and increased risk to themselves and their families, doctors’ pay has been cut, in some cases by 75% or more. If they become infected with COVID-19, they’re sent home to isolate for weeks—in which case they receive no pay whatsoever.
Doctors’ overhead expenses, I should emphasize, haven’t declined at all. Which means that many of the province’s doctors are serving during this pandemic for free, or at a loss. About that you’ve “managed” to say nothing at all.
Nor have you “managed” to tell the public what your government is doing with all the money it is saving by not paying intrepid doctors manning emergency rooms, clinics, and operating theatres.
You haven’t “managed” to articulate that no other essential workers on the front lines—or anywhere for that matter—have taken a pay cut to serve Albertans during the pandemic.
You have managed to do one thing, Mr. Premier, very well indeed: you’ve managed to disrespect us, over and over and over again.
I’ll close this long letter with another musical blast from the past. Twisted Sister, meet Linda Ronstadt:
I’ve been cheated, been mistreated
When will I be loved
I’ve been put down, I’ve been pushed ’round
When will I be loved
We don’t want your love, Mr. Premier.
But we’ve been cheated, mistreated, put down, and pushed ‘round for far too long.
We’ve had enough. We’re not gonna take it anymore.
We don’t need your love.
But we demand a little respect.
J. Edward Les, MD, FRCPC
cc The people of Alberta