Federal Government & Politics II

[Truenorth00]

^ We'll see. I do think this is wish casting. Trump's only ideology was Trump. That's what allowed him to be flexible. Poilievre is not like that at all. He's literally never had a job outside politics. He's rabidly ideological to the core and he's about to be rewarded for being that way with the keys to the kingdom. And he's backed by a strong base that even has a bit of a nihilist streak. I don't see why he wouldn't do things to really go after not just Trudeau's policies but the broader LPC legacy in Canada.

[Truenorth00]

I was in High School when Mike Harris ran against Bob Rae. And I remember a whole lot of teachers quietly wishing Harris would win. They particularly despised the "Rae days" of extra unpaid days off.
"He's a teacher. He'll understand us. Sure, he's talking about cuts. But they won't apply to us." Boy did their views on him flip quite soon after the election. I was a kid and I still couldn't fathom the depths of their naivete at the time. Seemed strange to me that they would support a politician pledging to cut government and then somehow expect their own paycheques to be exempt from the cuts. I see a lot of similar wish casting here.

[thewave46]

At least Mikey was honest.

Plainly said what he was going to do.

And he did it, awful as it was.

The current CPC doesn't strike me as so intellectually honest. Which is disappointing and probably an indictment of politics in general at this juncture.

I just want an honest adult conversation, mostly. What do we want and what are we willing to pay for it.

Sadly, I expect an external shock to dictate our course in Canada. I make my plans accordingly.

[Marshsparrow]

Originally Posted by thewave46

At least Mikey was honest.

Plainly said what he was going to do.

And he did it, awful as it was.

The current CPC doesn't strike me as so intellectually honest. Which is disappointing and probably an indictment of politics in general at this juncture.

I just want an honest adult conversation, mostly. What do we want and what are we willing to pay for it.

Sadly, I expect an external shock to dictate our course in Canada. I make my plans accordingly.

Parties don't put out platforms with enough time to have good debate. The election is nothing but soundbites. Running for party leader you can buy your way out of appearing in debates. And then they wonder why cynicism is high and participation is so low... the change in government will be just the same as the current one except with a bunch of science deniers, religious zealots and Harrison Butker/Trump wannabes.

[YOWetal]

Originally Posted by Truenorth00

I was in High School when Mike Harris ran against Bob Rae. And I remember a whole lot of teachers quietly wishing Harris would win. They particularly despised the "Rae days" of extra unpaid days off.
"He's a teacher. He'll understand us. Sure, he's talking about cuts. But they won't apply to us." Boy did their views on him flip quite soon after the election. I was a kid and I still couldn't fathom the depths of their naivete at the time. Seemed strange to me that they would support a politician pledging to cut government and then somehow expect their own paycheques to be exempt from the cuts. I see a lot of similar wish casting here.

Interesting. A friend's mother who is a teacher told a similar story (she characterized it as a few foolish (male) teachers) at an Easter event as several civil servants professed their plan to vote for PP. I don't think any said he won't cut civil servants but more the he will cut the lazy ones or the recently hired or the.... I honestly don't know how even a Realtor or other small business owner sitting in Ottawa could not see the danger. to their livelihoods. And I say all that as someone very decided to vote Conservative. Wish casting indeed!

[Dartguard]

Originally Posted by Truenorth00

^ And if two tier is inevitable then so is flooding the job market with FMGs. No more quotas. Just a licensing exam. Like the US MLE. Maybe quotas for those who get paid directly, like those employed in the public system or in certain specialities. But beyond that, it's going to be hard to argue that the profession should be substantially protected as it is now.

I suspect eventually we'll evolve to a system like the NHS in the UK. And I see that British GPs average £90-100k with that two tier system. That's certainly less than most Canadian GPs after conversation, and they live in a country with a higher cost of living.

GP's in the NHS however get pensions and just ask Moncton Rad what Canadian doctors get. Higher salaries but the expenses of everything.

[Truenorth00]

Originally Posted by Dartguard

GP's in the NHS however get pensions and just ask Moncton Rad what Canadian doctors get. Higher salaries but the expenses of everything.

Pay data was the average for all GPs. Not just NHS. Do their private sector GPs get pensions too? NHS GPs are supposedly between £69-105k. So their pension is not putting them higher than the average Canadian physician.

[casper]

Originally Posted by YOWetal

Absolutely. There is always a lot of fear mongering with Conservative governments and secret agendas. But having nearly universally Conservative premiers (BC 50-50 to make it a nearly clean sweep) a huge deficit, a landslide and an rabidly ideological prime minister really is the perfect storm.
They don't even need to cancel the Canada Health Act just continue the lack of enforcement.

All that said Polievre doesn't seem like he wants to do thankless hard work and he talks like he wants to be a populist conservative so a lot of his base would be hit hardest by almost all of these cuts and benefit only marginally from tax cuts. It's possible we get something more like Trump blowing up the budget pushing tough decisions off for someone else.

I think balancing the budget is core to the conservatives DNA in this case. They are not going to come in with a rational plan that shows the budget balanced in a a decade. They will fast-track whatever changes need to happen to achieve it.

There are some easy targets for them, e.g., the CBC, foreign aid, external affairs, de-carbonisation.

Health care is a easy one for them. They simply stop increasing the budget and turn it into the provinces problem.

On the defence side, I see them playing games. Take existing programs and simply delay delivery so it pushes expenses out into future years.

[YOWetal]

Originally Posted by Truenorth00

Pay data was the average for all GPs. Not just NHS. Do their private sector GPs get pensions too? NHS GPs are supposedly between £69-105k. So their pension is not putting them higher than the average Canadian physician.

It's clearly dramatically less than in Canada. We could easily bring in many doctors from France and UK with almost no effort. They'd need a little bit of training as we are bit more reliant on tech/advanced depending on how you view it. NHS style two tier healthcare seems risky in the Canadian context where we pay doctors so well.

[theman23]

Originally Posted by Truenorth00

Pay data was the average for all GPs. Not just NHS. Do their private sector GPs get pensions too? NHS GPs are supposedly between £69-105k. So their pension is not putting them higher than the average Canadian physician.

This is not an apples-apples comparison. The NHS pays very well once you've made it past being a junior doctor, in most cases better than Canada. Salaries doctors make less on paper in the NHS, but have actual benefits including a pension and do not have to run a business. For the most part, this is not an option in Canada. With that being said, the majority of GPs in the UK are not salaried and make more than their Canadian counterparts.

The GP salary you quoted of 70k GBP (120k CAD) in the NHS is base pay for employed GPs working 37.5 hours a week, which includes time for administrative duties. They typically only spend 3 days a week seeing patients during that time. Most Canadian physicians would consider this part-time work. Obviously most GPs in the NHS work more than 37.5 hours, and their income increases because of this. The average earnings of a salaried GP in the NHS was 101k GBP, which is 175k CAD. They receive benefits on top of this, including a pension. They also do not have the responsibilities of operating a business. Regardless, the majority of GPs do not work under this model in the UK.
Source.

Almost all Canadian GPs are self employed contractors that operate their own small businesses. They average about 48 hours/week (55hours/week when including on-call duties ) and earn $308k CAD before overhead expenses (which amount to around 27%). Take home is $220k but with no benefits and they also have to allocate time and energy to running a business.

A better comparison to Canada would be a contractor GP in the UK, who operate as self employed physicians in a similar manner to Canadian doctors. Their gross pay is around 500k GBP (867 CAD). Overhead is substantially higher (~60%), but take home is still about 150k GBP (~260k CAD). This is about $40k CAD more than a Canadian family doctor doing the same job. About 60% of British GPs are working as contractors. Sources this, there, and that.

The other example is Australia, where they also have a public/private system. A full time GP works on average 7 sessions a week in Australia. Each session is a half day, so this amounts to about 3.5 days a week. The average gross income for a GP in Australia $365k AUD (330k CAD). Overhead is about 30%, similar to Canada. Take home works out to about $10k CAD a year more than what Canadian GPs earn.

The US is also very open to FMGs and clearly does not have a sole payer public system. GPs are predominantly salaried there and usually make around $200-$300k USD a year before benefits. Source: conversations with colleagues, but easily verified with a quick google search.

There really is no evidence that bringing in more private pay will reduce doctor's salaries, or that opening the "flood gates" to foreign medical grads (FMGs) would amount to anything. In fact, there aren't even any flood gates. The Canadian system is already heavily reliant on FMGs and we try to license as many of them as we can. I've posted this many times before, but proportionately there are more foreign trained doctors practicing in this country than there are foreign born people (pre-JT international student surge obviously). A lot of them came from the UK, but the appeal of Canada was not the higher income. It was the low cost of living and cheap cost of housing. This is obviously not as big of an attraction now. The other big group were trained in South Africa and India, but honestly the latter group is often problematic and you wonder how they got to practice here. Anyways, the problem of the Indian neurosurgeon driving a taxi cab in Toronto is a trope as old as I am, but was always greatly overexaggerated. If it was ever true, there was something very wrong with him. Getting licensed in a new jurisdiction is a pain in the ass, but we do it all the time for foreigners. This is a low hanging fruit that has had its tree picked bare many times over by now, but continues to get attention because of special interest groups - namely, Canadians who did not qualify for medical school locally and are now trying to come back to publicly subsidized residency programs after completing medical schools at expensive but shady schools in the Caribbean or in eastern Europe.

[Truenorth00]

^ Thanks for your detailed post. So if those doctors are getting paid more than their Canadian counterparts, does that mean that their governments spend more on healthcare?

I'll go back to the original question that the next federal government is likely to ask. What can they do to contain their (federal) costs without impacting service too much to the public? It will be a provincial problem eventually and I don't see provinces not interested in reformulating licensing if it results in more physicians.

Lastly, the trope maybe old. But the guy running on it believes it. So I'd say he's quite likely to act on it.

[theman23]

I don't know the answer to your first question, but overall spending per capita is similar across the most of the anglosphere and is still mostly government funded. The USA is the outlier.

I'm sure he believes it now, and he may well act on it. It would be a useful PR distraction and no realistic person would expect him to have results within an election cycle. It won't amount to much beyond making the licensing system a bit less of a bureaucratic hell, which is a win in its own right. But there is no large mass of qualified foreign trained doctors being gate kept out of the system. It would be more useful to have a national licensing system to make it easier for doctors already here to work in multiple provinces, but that also is not really a fix for anything.

[MonctonRad]

Originally Posted by theman23

The idea that we could easily attract UK trained doctors with "no effort" as YOWetal put it is a joke. There's nothing preventing them from coming as it is, but they all go to Australia instead. They don't come here because we pay less for more work, have similar or higher cost of living outside of London, and have terrible weather. How exactly are you going to change all of that "with "no effort" ?

100%

Canada is increasingly a tough sell for FMGs (at least quality ones). Sure, we could bulk up the system by accepting recent graduates of the University of South Sudan, but, they have no experience with treating western diseases (diseases of the elderly), and have no experience in working in a highly technical westernized medical environment. They might know how to treat Lassa Fever, but would be way out of their depth in this country. Extensive remedial training is necessary.

There is a strong feeling out there that somehow Canadian physicians are grifting the system and are overcompensated, and a lot of this is due to confusion between physician billings, and, what the physician actually makes in take home pay. The expense of becoming a physician is another thing (probably $200,000 these days), the administrative costs of running a small business and the complete absence of benefits are also major considerations.

theman23 has done an excellent job in showing how physician compensation in Canada is actually similar to comparable countries. If any government decides to save money by cheaping out on physician compensation, they will have another thing coming. We are highly mobile, and our skills are in demand everywhere.

I am as loyal a Canadian as they come, but even I nearly moved to the US in 1995. My Maine state licensure was all set up, and I was 2/3rds of the way through my green card process. I probably made a mistake by not completing the process........

[Nashe]

Originally Posted by MonctonRad

I am as loyal a Canadian as they come, but even I nearly moved to the US in 1995. My Maine state licensure was all set up, and I was 2/3rds of the way through my green card process. I probably made a mistake by not completing the process........

Maine? Really? Of all the states?

[MonctonRad]

Originally Posted by Nashe

Maine? Really? Of all the states?

The Maine state license was easy to get. There used to be reciprocity between Maine and NB for licensure (for physicians practicing in border communities). All you had to do was drive down to Bangor and pass an oral exam.

The beauty of the Maine state license is that Maine also has reciprocity with about 45 other American states. If you had your ME licensure, then you could really practice anywhere in the USA.

Maine's a nice state though. It's close to home, and, my mother was born there (in Rumford).