quota, there is no more money to
spend. In that case, doctors might
_ be working for.nothing.

In reality,: Bill 18 allows. for ’
monthly adjustments. that project
annual billings ‘and there’s.a.

process’ called "fiscal year recon-

ciliation” to sort out any over or:
under, payments. It is unlikely,
therefore, that’ the allocation of. ~
$1.48 billion will be spent before .

the end ofthe year
The $300,000 and $360,000
figures will probably stick in your:

mind more than any other ‘infor- .

mation presented above. These

figures may draw you into the

crowd that says, "About time. "Or,
_."So what?”

'. Are. health care ‘costs too
high? Are doctors paid too much?
No, says Appleton. If anything, in
fact, . they’re . underpaid. When
statistics “showing individual
annual billings from doctors to
MSP are published they're very
misleading, says Appleton.
- True,\ some doctors do bill
MSP over-the period of a year for
amounts in the neighbourhood of
$300,000 and more, but not many,
says Appleton. The best-paid
doctor in the province is a
Vancouver specialist: who bills

MSP for around $700,000 in fees:

each year.

But thinking of those num-
bers in terms of wages is the
wrong thing to do, in much the
same way as it would be wrong to
look at the owner of a corner store
with gross sales of $100,000. a
year in envy.

_ Doctors hire receptionists and
nurses, They build or rent an
office. And there is a great deal of
expensive equipment to purchase
.and = = maintain.
expenses paid, says Appleton,
"The average physician in
Canada, and it applies to B.C. as.
well, makes $95,000 per year
before taxes, And with no benefits
intluded. No vacation pay... No
medical, dental, pension... Noth-.

ing, That’s Revenue Canada sta- :

tistics."
Doctors who make more: than
that national average, says Apple-

With. those.

ton, make. more simply by work-
ing harder. In ‘Terrace, for
example, doctors work “on call",
going to the emergency ‘room and

‘assist in operating procedures
whether. they: like it or not, as
well as taking care ‘of their reg-
_ ular, duties.

This. means long
hours: around 65 hours a week at:

any: and all hours of the day,.
seven days a week, ©

Compare those hours to a
construction worker, say, at a

base rate of $20 an hour, and:

with overtime at time-and-a-half
and double time, he would gross
around $89,440. Plus his holiday
pay, travel time and expenses,
medical and dental benefits, pen-
sion ‘fund... and whatever else
happened to be in his contract.

' Appleton: would like to know
who’s better off.

The problem with a doctor

working all those hours, though,

ig.that there is a good chance it
will put him over the $300,000
MSP limit. At that point, he
starts performing his regular
duties, attending to accident vic-
tims in emergency, and adminis-
tering medications for two-thirds
their worth. He will be asked to
absorb the other third as a per-
sonal expense. Earn too much
more, and soon he’s working for
half his regular wages.

"From our perspective,’ says
Appleton, "to make $300,000
you've got to work your buns off.
Anything above that and you're
talking about middle of the night
work, emergency: work... And to
be told that [’m going to called
down to emergency at three in the

morning for two-thirds of what I
-would.. have charged in. the

daytime is ludicrous. Nobody's
going to do that."

So what are the choices?
Appleton says no one will be
denied treatment. On the other

hand, doctors don’t really want to
work for less.

‘Basically, says ‘Appleton,
there are two choices. Pack up
and leave, which he says two
Vancouver specialists — already
have done. Or to opt out of the

‘oS Terrace Review. May 8; 1992 7

government medical plan’ and
start billing patients directly.

Opting out is an interesting
choice. B.C. physicians have two
rates, One they feel they're worth,
the other the government: has
decided they're worth. What does
this mean to you?

For an annual checkup; as an
example, you would-be billed $60

- = exactly what B.C. doctors think
. the service is worth ‘and what

non-residents are paying now.
You would then be on your.own to:
bill MSP, and, if the annual allot-
ment hasn’t run out, would be
reimbursed $40 — the amount

the government says'a checkup i is

worth.

The end result. The doctor i is
happy. The patient is out-of-
pocket $20, And the government
pays out the same number of
dollars. they are paying ‘out any-
way.

In a way, says Appleton, it

might not really be all that bad.

People might think before rushing
to the doctor for all and sundry
ailments. In other words, - the
problem’ of over-utilization might

- be dealt with as a result ‘of doc-

tors opting: cut. And, Appleton

. says again, patients who could not
. afford the price would not be

turned away.

Along with the doctor’s billing
dilemma there’s also the problem.
of the doctor’s pension, which
Appleton says needs to be
addressed.

Appleton says there’ s not a lot
of money involved. In his case for
example, he has been practising

in Terrace for 20 years. already

and at age 65 it would entitle him
to a unindexed pension of only
$20,000 a year.

"An MLA after seven years,”
though, says Appleton, "gets
$20,000 a year... Right from when
he’s kicked out of office. Not from
when he’s 65. From day one."

Still, the pension plan agreed
to by the Socreds on Dec. 20,
1990, in lieu of a fee increase,
required the government to
deposit into the pension plan $25
million a year from now until