Doctors need salaries and pensions, not fees for service

"Fifty-three years ago next month, doctors in Saskatchewan and the provincial government struck a historic compromise after a bitter 23-day strike. That compromise became part of national medicare. It remains at the heart of Canadian health care today.

What might be called the “Saskatchewan Compromise” gave each side something deemed essential. The CCF government of premier Woodrow Lloyd enshrined public financing and organization of health care. Government, through the tax system – not patients from their pockets – would pay for essential medical services. These services were, and still are, those delivered in hospitals and by doctors in or out of hospitals.

In exchange, doctors would retain their professional autonomy and be paid on a fee-for-service basis, charged to the state rather than to the patient. Doctors would thus avoid the dreaded status of becoming employees of the state, told how to practise by “bureaucrats.”

The result was and still is: autonomy and fee for service for the doctors; public organization and financing for the government. Something important was left out, although it did not seem important at the time. If doctors worked in a public system then why, over time, were they not given, or did they not demand, pensions, as was done by nurses, teachers and university professors? That’s because, in part, acknowledging the need for a pension would have been a tip of the hat to more government control – to doctor as a public employee, a status the profession hated. More than a half-century later, perhaps it’s time to rethink the issue."

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