Many physicians feel that in addition to negotiating a cost-of-living increase, the time is ripe to push for enhanced fringe benefits � something many of our patients already enjoy.

Precedents for some fringe benefits already exist. Many western provinces subsidize continuing medical education and at least one matches RRSP contributions. Near-total reimbursement for the cost of malpractice coverage through the CMPA is available across the country.

In the past, provincial medical associations were reluctant to negotiate further fringe benefits. Most of them kept their membership numbers up by offering group life and disability insurance. With the Rand formula � in use in Ontario, Manitoba, New Brunswick, Nova Scotia, and Prince Edward Island, and which mandates payment of dues by all physicians � this is no longer an issue.

At least six provinces face deficits this year. Provincial governments are using this as an excuse to stonewall physicians. But it's na�ve and short-sighted on our part to refuse to discuss fringe benefits on the grounds that we are self-employed entrepreneurs and not civil servants. We must recognize the fact that our fees and total incomes are essentially dictated by one paymaster � the provincial government. If we are to achieve anything above token cost-of-living fee increases, it must be by pushing for fringe benefits now.

Such benefits would entail a relatively low short-term cost, and would thus have a negligible effect on the provincial deficit. In contrast to fee increases, which could subsequently be clawed back, these benefits would be politically very difficult to rescind.

� Dr Charles S Shaver