Physicians facing financial difficulty, struggle to keep practices running

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While they may seem like improbable economic victims of the pandemic, physicians across the country are losing most of their income because of COVID-19 as elective surgeries are cancelled and fewer patients are visiting clinics.

Most doctors are not paid for showing up to work; they are compensated after they perform a service. Some with offices are worried about keeping the lights on and say that without government relief they will be forced to lay off staff. They have started consulting with their patients online or over the phone but have still seen a dramatic drop in case volumes.

Some provinces are helping physicians who find themselves in this position by partly supplementing their income based on previous billings.

Braedon Hendy, a family and emergency room physician in Windsor, Ont., said that since physical distancing measures have been in place, his office billings have dropped 80 per cent. He said he has some financial stability because he works in an emergency room twice a week, but maintaining an office and staff is a substantial expense.

“I may have a longer time to adjust, but for some of my colleagues, it's going to force them to close their doors,” he said.

Dr. Hendy said he is applying for the federal government’s small business relief loan but pointed out that it would be helpful if Ontario implemented an income stability mechanism.

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In Newfoundland and Labrador, for instance, physicians who work on a fee-for-service basis and commit to being available for “additional services” during the pandemic – and meet other criteria – will earn 80 per cent of what they previously billed. Physicians who are called on to provide “additional services" will get 100 per cent.

Dr. Hendy raised another issue unique to Ontario. Since the start of the pandemic, physicians have conducted appointments with patients online or over the phone. He said that because of an issue with billing codes in the computer system, doctors are facing lengthy delays getting paid, a problem that won’t be resolved for months.

The Ontario Medical Association has been urging the provincial government to find a solution that would support health care workers and quickly resolve the billing issue, said OMA president Sohail Gandhi.

“Over the past couple of weeks, we’ve been trying to let the ministry know that without some form of stabilization funding for health care infrastructure, the system is heading for a collapse, frankly, because our survey shows 49 per cent of all physicians are considering closing their clinics for a month or more," Dr. Gandhi said. “Our health care system cannot survive that many clinics closing.”

Hayley Chazan, a spokeswoman for Ontario Health Minister Christine Elliott, said in a statement on Monday that the provincial government will issue advance payments to physicians in May to be reconciled against future earnings, to ensure their services can continue. The province said it will pay up to 70 per cent of physicians’ average income, but they would be expected to pay the money back in the fall.

Dr. Gandhi said the proposal “shows a glaring lack of understanding” of how the health care system works because it assumes physicians can make up the work at a later date, but he said the infrastructure doesn’t allow it.

“So instead of not having enough money to pay your overhead in May and June, you won’t have enough to pay your overhead when this starts in November ... it’s a nonsensical approach,” he said, adding that the OMA has not agreed to it.

He said most physicians in Ontario do not qualify for federal relief programs because of complex funding mechanisms designed to assist their employees.

Bobby Yanagawa, the program director of the division of cardiac surgery at the University of Toronto, said his income has been reduced by about 80 per cent. He and his colleagues are focusing on patients who would die without operations.

“We’re worried about sort of keeping the lights on and keeping our secretaries and our nurse practitioners and our nurses employed," he said. "And we’re also worried about putting food on our tables and supporting our families … so, just like everyone else, we’re worried.”

Like Dr. Hendy, Dr. Yanagawa said he would like to see the provincial government implement an income stabilization mechanism. While other public employees are getting their full salaries, he said, physicians are in a different position.

“We’re high-income earners, I understand that, but we should get something to keep us afloat," he said. "The issue is, if we don’t do that, we’re going to close clinics. Clinics are already closing … and that’s going to decrease access to care.”

Physicians in Alberta and British Columbia are also feeling the financial burden of COVID-19.

Christine Molnar, president of the Alberta Medical Association, said most physicians in the province work on a fee-for-service basis and have seen significant drops in their workloads. She said the AMA, too, has proposed an income stabilization mechanism to the provincial government.

Some doctors in the province have taken advantage of the federal wage subsidy program for employees, she said, but even with that support, clinics are still scaling back.

“The whole population is suffering right now because of all of this, but I just want to point out that physicians are essential services and the population needs them to be there before, during and after COVID."

Morad Hameed, the head of the division of general surgery at Vancouver General Hospital and the University of British Columbia, said that while physicians are worried about overhead costs, he’s also witnessing better collaboration and openness to change at the hospital.

“I’ve never seen this much engagement or shared purpose," he said. “There’s this unprecedented level of collaboration that’s allowing us to be very agile in the way we respond to the pandemic, but I think this will have implications for health care moving forward as well.”

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