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Letter to the Editor: The tipping point

“The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.
Letters to the editor

To the editor:

“The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.” - Malcolm Gladwell, The Tipping Point

In Canada, and Ontario especially, we are rapidly approaching a tipping point in health care. Unfortunately, it will not be the magical moment Malcolm Gladwell’s quote above evokes.

Over the past three years physicians have been the target of ever-increasing unilaterally imposed fee reductions and now increased taxation on our business income. In addition, there has been a never-ending stream of political rhetoric, much of it disingenuous, aimed to distort public opinion regarding these changes. The result is physicians are slowly being pushed towards the point at which they will feel they are better off being somewhere else or doing something else. This point will be different for each physician.

There are a group of physicians who did not require much push to cross their threshold. We have already seen this in our community. If you know a physician who has significantly changed their practice, decided not to start a practice here, or stopped practicing altogether they may be part of this group. If this happens in small enough numbers the losses can be absorbed with minimal negative impact felt by the healthcare system at large.

But what about the group who require a larger push? This group makes up the majority of physicians - a group I include myself in. We aren’t in medicine to squeeze every last dime possible out of the system, but we’re not willing to sell ourselves short either. We have absorbed significant cuts to our income over the last three years while watching other public servants collect raises.

Throughout, we have continued to try to provide the best care we can without interruptions despite being without a contract for those three years. All the while we have been called greedy, overpaid, tax cheats who use up too much of the government’s bottom line and don't contribute enough in return. Your provincial and federal politicians are pushing this group collectively toward their lines in the sand. As this groups tips over, the health care system is going to suffer significantly. Even a small tip can cascade larger as group practices become unable to support their costs or specialists become unwilling to be the sole providers of their services in a given area. Jobs provided by physician offices will decrease. Access to physicians will decrease. Wait times will increase. Travel for appropriate care will increase. Inevitably, the quality of care delivered by our system will decrease.

The thing about tipping points is that it’s often not possible to determine when the tip will start, but once it does it is very difficult to stop and takes a long time to recover from. In Northern Ontario we will likely be the first ones to see evidence we might be approaching that point - our resources are stretched to the max as it is. A recently published letter from my hardworking colleagues in the emergency room is direct evidence of this. This is not reassuring in a health care system that is already straining to support the aging baby boomer population bulge.

Prime Minister Justin Trudeau, Finance Minister Bill Morneau and their local colleagues will have you believe this is about fairness. They’re “going to do less for those who don't need it” they say, followed by numbers and comparisons that don't make much sense. There has been lots of commentary on this and I won’t devote space to those arguments.

I will say this, if this was really about fairness the Liberals wouldn’t have abandoned their plans to increase tax to the true wealthiest of Canadians, the corporate executives who form Mr. Morneau’s social circle.

Those individuals who are not being fully taxed on stock options which can form the bulk of their compensation packages which are often in the millions of dollars. Justin Trudeau’s election platform in 2015 included a plan to cap this benefit and was suddenly abandoned after a few well placed letters to Mr. Morneau from his friends. According to a recently published study, 99% of these benefits go to Canada’s top 10% in income earners and essentially nobody earning under $215,000/year is benefiting from this (

Unfortunately for all the small business owners in this country, many of those who are benefiting also happen to know Mr. Morneau on a first name basis. Physicians and small business owners don’t have lucrative stock option packages as part of our compensation.

Our local MPs also provided some numbers in their media response to my ER colleagues. In the interest of fairness allow me to retort. $49,000 is over $150,000 less than our current prime minister and some of his pals spent on a one-week vacation to a private island on taxpayers money. Again, our prime minister who claims to be interested in fairness, spent quadruple what the average Canadian earns in a year on a one-week vacation. Those were our tax dollars in an environment where our federal government is running an ongoing deficit in the face of a mountainous national debt.

Who is greedy and entitled?

Unlike Justin Trudeau, I cannot run a deficit budget in my business. Like my colleagues, I am hardworking, educated and motivated. I love my job, but over the past three years, I’ve been pushed closer to my line in the sand than I ever thought possible. The tipping point is coming. Is this shove the one that pushes us across the threshold?

Dr. Graham Exley
Family physician in Thunder Bay