Guest Editorial

We have a right to expect proper disability coverage

Imagine if the unthinkable happens and you, the physician, wind up needing care — urgent cardiac surgery or a joint replacement perhaps. Naturally, your first concern would be to get back in good health. But what if this means taking two to three months off from your practice to recover? Ever wonder how well you would be protected financially?

Nearly 10% of physicians are unable to purchase disability insurance when they initially apply because of pre-existing medical conditions. Yes, it's shocking but it gets worse — as the physician population ages, many others will likely develop diabetes, cardiac disease or other illnesses, and then they too will not qualify for coverage. Of course by then, the monthly cost for coverage would have gone up to keep up with the true inflation rate.

To make an insurance claim, you must fill out a form that's roughly a dozen pages long and forward your income tax returns from the past two years to the insurance company — this is besides any additional forms they may require you to send and the repeated telephone conversations you'll have to put up with. In the end, you'll probably wait nearly three months before seeing a cheque if you get one at all — partial disability is especially difficult to obtain.

The sad truth is that we're not as well protected for disability as most of our patients. Yet not only are we subject to the same chronic disorders as they are, but in our line of work we're also exposed to the additional risk of infectious diseases such as HIV, SARS, hepatitis C and more. Surely the public and our sole paymaster, the provincial ministry of health, owe us greater peace of mind.

Across Canada, provincial governments tend to balk at giving us fee increases that correspond to the true inflation rate. In effect, we don't receive the same treatment as teachers, nurses and other hospital workers. It's time we demanded workplace benefits such as income replacement during periods of disability. The public could hardly begrudge us benefits similar to what most of them enjoy.

Here's what I think is fair in terms of insurance claims: physicians who've practiced in a given province for five years should receive 70% of their average monthly billings after a three-week waiting period. Those in practice for 10 years should receive 80% after a two-week wait, and those in practice for at least 15 years should receive 90% after one week. This would cover all practicing physicians — not just those healthy enough to qualify for private insurance.

This proposal would entail a relatively low up-front cost and be fairly easy to implement. I could envision a physician-patient and the MD's attending physician sending a letter (not a 12-page form) to the local medical director of the provincial ministry of health to initiate a direct payment process. Direct payment isn't a new concept — several years ago when a strike by Ontario government employees made it impossible to submit claims, even by computer, all physicians on disability received a direct deposit equal to their average monthly billings over a four-month period.

Physicians across Canada already receive Canadian Medical Protective Association (CMPA) reimbursement and most provinces also provide maternity and paternity benefits, yet physicians have not lost their status as "self-employed professionals" in the eyes of the Canada Revenue Agency and are able to deduct practice expenses. Disability coverage would be a logical extension. It might also help to retain older physicians in practice until they can be replaced.

In the past, the Ontario Medical Association was unwilling to consider this proposal because it was promoting its own Sun Life group insurance as a 'carrot' to keep up membership. However, this incentive is no longer necessary, for in recent years, dues have been deducted automatically in Ontario and in four other provinces thanks to the RAND formula.

The time has come for provincial medical associations to be more open-minded and creative when they meet again to renegotiate with provincial governments. They owe us at least that much.

— Dr Charles S Shaver, Ottawa, ON

For our second installment on physician disability insurance click here.

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