Thank you. I would like to thank the committee for allowing me the opportunity to participate in your study.
My recommendation, and it's one I've worked on for a number of years now, is that to retain physicians and to protect our investment in the doctors we train, Canada should change federal tax laws to allow provinces to negotiate pensions for physicians. No physician in Canada presently can receive pensions.
There's a shortage of physicians, as you know. The two crucial facts about this shortage are, first, it's getting worse, and second, it's dangerous for patients. If we compare where Canada stood in 2004, when we had three million Canadians without family physicians, to today, we now have five million Canadians without family physicians. Or if we compare our OECD ranking for physician numbers, it has moved down from 16th to 26th.
Second, the shortage is dangerous for patients. An OECD study of 21 countries over 25 years showed that decreasing physician numbers increases premature mortality, infant mortality, perinatal mortality, and decreases life expectancy.
The problem for the federal government is that the federal government provides health funding for the provinces, but the federal government has a limited ability to ensure that this funding will successfully increase physician numbers.
There are migration pressures in the recent economic downturn. The average age of physicians in Canada is about 50, and many have lost 30% to 40% of their retirement savings in the present financial downturn. And the U.S. is expecting a 200,000 shortfall of its physician force by 2020. Further, President Obama is making it more financially rewarding to practise in the U.S. by initiatives such as decreasing malpractice and overhead costs and increasing reimbursement rates for primary care physicians. This combination of increased U.S. physician shortages and incomes with the reduction in Canadian physicians' savings has a potential to result in a tsunami of physician shortages in Canada.
Historical analysis shows that recessions are correlated with the exodus of physicians from Canada. I just want to make sure you have the chart in front of you. Perfect. If we take a look at these recessionary periods in the past and place them on a migration chart of Canadian physicians--this is the pie chart--we see a perfect correlation and a definite and unmistakable pattern. Recessions cause a serious exodus of physicians from Canada.
The solution is to act proactively with a solution that only the federal government can provide. It is time to make an historic change and allow physicians to obtain pensions. What is needed to implement this solution? My research shows that Canada is the only country that does not allow its publicly funded physician force to contribute to pensions. The federal government must change tax laws and deem physicians eligible for pensions. I've been told that by deeming physicians eligible for pensions, provincial agreements remain in place.
An overwhelming majority of Canadian physicians support pensions. In 2005 the general council of the Canadian Medical Association passed my motion to request that the federal government change tax laws to allow self-employed physicians to contribute to pensions.
A previous Medical Post poll found that 91% of physicians wanted pensions. Moreover, 76% considered it to be the most important negotiation strategy. A February 2009 Medical Post poll showed that 88% of physicians across Canada support pensions. The Medical Post is also starting an old-fashioned newspaper campaign to get pensions for physicians.
In summary, altering federal tax law to allow physicians to negotiate for pensions is a retention initiative that is strongly supported by physicians and protects the investments Canada has made in training physicians by reversing the historical trend of physician losses as a result of recessions.
For those of us who believe that access to health care is a basic human right, ensuring Canadians have access to physicians by retaining them with pensions is the right thing to do.
I hope this committee will act on this recommendation and coordinate with the CMA and myself to change federal tax laws, and do so in a way that provincial agreements are not impacted.
I thank you.