While front-line nursing home workers making on average $17 an hour fought for pandemic top-up pay, the Nova Scotia government launched a program to protect doctors’ incomes that paid out $65 million over four months to nearly 600 physicians.
In April 2020, just weeks after the pandemic hit, Doctors Nova Scotia and the province reached a deal to make sure doctors were paid and would be available during the health-care crisis.
The Chronicle Herald obtained details of the “income stability” program through a freedom of information request. The documents included individual amounts paid out to each of the 579 doctors who participated in the program. The payments averaged more than $110,000 per doctor for a four-month period.
The voluntary program was aimed at supporting doctors whose income was hit hard by the pandemic, particularly specialists and family doctors who are not on a salary but bill the province directly for the patients they see and services they provide. Some doctors are paid both ways. Any who made more than one-fifth of their income from fees were eligible for the program.
Because of public health restrictions put in place at the outset of the pandemic, some family doctors said they were seeing fewer patients. Likewise, some specialists saw surgeries cancelled as operating rooms were repurposed to prepare for a feared influx of COVID patients.
The program offered doctors two guaranteed salary options based on their previous year’s billings. Higher-earning doctors could get 80 per cent of their total billings in 2019 up to a bi-weekly salary of $23,000. The other option allowed doctors to make the equivalent of their previous year’s billings, up to $9,973 every two weeks. In return, doctors had to commit to being deployed during the pandemic. If physicians were deployed, they were paid over and above their base salary. About half of those in the program were family doctors, according to the province. The others were specialists, but the province didn’t provide a breakdown on the type of specialists.
Though the program formally began in May 2020, participating physicians were paid retroactively to the beginning of the pandemic on March 13. Originally the program had no firm end date and it was up to the government to decide when it would end.
Under the terms of the contract, participating physicians could earn a maximum of $600,000 a year. Several were on pace to do so.
Documents provided through the freedom of information process show that when the program wrapped up in July, 60 doctors had earned more than $200,000. Two doctors made more than $300,000 in that four-month period.
A typical physician in Nova Scotia makes between $250,000 to $310,000 a year. The document showed that 225 doctors were on pace to match that income and had made more than $110,000 in four months. Under the program, doctors could also be paid a deployment rate of $180.60 per hour. The Health Department would not specify whether the payouts listed in the freedom of information document included deployment payments.
While many doctors endorsed the program, an evaluation published on the Doctors Nova Scotia website shows others were concerned with the amount of money being guaranteed to doctors at a time when many Nova Scotians were experiencing financial hardship.
In the early months of the pandemic, unions representing thousands of continuing care assistants and other front-line nursing home workers were urging the province to provide more support. In April, a deadly outbreak hit the Northwood nursing home in Halifax killing 53 residents and infecting dozens of workers.
Unifor Atlantic Region director Linda MacNeil wrote then premier Stephen McNeil several letters between March and late April 2020, urging the province to add more staff and to provide more money for front-line workers during the pandemic.
By that time, Ontario and Quebec were already paying pandemic top-ups to front-line nursing home workers. On the weekend of April 25, Ontario Premier Doug Ford announced a pandemic premium of $4 an hour to continuing care assistants, licensed practical nurses, dietary and cleaning staff who worked at nursing homes and other care facilities.
Nova Scotia’s Liberal government announced its plan a couple of weeks later, on May 7—a $2,000 bonus for continuing care assistants and other essential health care workers. To qualify for the money, workers had to have been working for four months providing hands-on care. Most of the roughly $90 million in the program came from the federal government’s Essential Workers Payment. The province contributed $10 million.
A few months after the doctor’s compensation program ended, Doctors Nova Scotia hired Pyra Management Consulting to evaluate the deal doctors struck.
The report, which was completed November 2020 and is available on Doctors Nova Scotia’s website, includes feedback from more than 400 doctors along with high-level health-care bureaucrats and administrators, including the province’s deputy minister of health and the CEO of Nova Scotia Health Authority.
The consultants surveyed 468 doctors. Of that, 221 were paid from the income stability program and another 100 chose not to participate. The report also included notes from focus groups and individual interviews.
Many of the doctors quoted in the report believed the program met two of its intended purposes. The first was to stabilize income for fee for service physicians, many of whom have to pay office staff, rent and other bills. The program also aimed to ensure doctors were available to respond to a surge in COVID-19 cases. https://e.infogram.com/92d37cab-ca39-44e0-87af-787e8cce48f8?parent_url=https%3A%2F%2Fwww.saltwire.com%2Fatlantic-canada%2Fnews%2Fcovid-deal-pays-out-65-million-to-nova-scotia-doctors-100683751%2F&src=embed#async_embed
Nearly half of the respondents who participated in the program said without it they would have lost at least 20 per cent of their income. But others raised concerns about the program, including the amount of money being paid out to doctors.
Several respondents felt the program was too generous and/or that physicians as well-paid independent contractors should have been able to handle their own income challenges.
One doctor appeared morally offended.
“Lots of people lost their jobs. A lot of people in the province had nothing and some docs were still getting $400,000-$600,000. Many docs said no to the program for ethical reasons.”
A second seemed uncomfortable, as well.
“Personally, I felt guilt. Although I think the work I do is very important and is worthy of significant remuneration, I have seen many other hardworking Nova Scotians much more severely affected than I was.”
By way of comparison, other Canadians who lost their income during the pandemic were paid $500 a week through the Canadian Emergency Recovery Benefit.
Concerns were also raised about the amount of work some doctors were doing while on the program. https://e.infogram.com/0bf9fe71-6b45-41ad-a576-04e9dfa9617e?parent_url=https%3A%2F%2Fwww.saltwire.com%2Fatlantic-canada%2Fnews%2Fcovid-deal-pays-out-65-million-to-nova-scotia-doctors-100683751%2F&src=embed#async_embed
“A lot of my surgical colleagues were getting paid 2 to 3 times more than I was even though they weren’t working,” one physician said.
“I was putting on PPE every day and looking after COVID patients while they were at home.”
Some surveyed suggested implementing an accountability mechanism if the program were to be reoffered.
In theory, doctors who were not deployed at hospitals or long-term care facilities were to continue to provide all normal office or hospital-based services, in person or virtually, while recognizing limitations imposed by the pandemic.
Most fee for service doctors in the province normally bill Nova Scotia Medical Services Insurance (MSI). Even though they were being paid a base income under the program, doctors were expected to continue to bill for their services. The purpose was to prove they were working to the best of their ability when not deployed.
The Department of Health denied The Herald’s request to speak to someone in the department knowledgeable about the plan. Marla MacInnis, a department spokeswoman, said in a written statement that the compensation program was put in place during the early months of the pandemic when the government of the day was unsure of the impact across the province. Nova Scotia was one of several provinces that implemented a similar program, she said, and was the last province to end it. She said it was a short-term agreement between government and Doctors Nova Scotia intended to help meet the needs of the health system during the first wave of the pandemic.
Besides stabilizing fee for service physicians’ income during the pandemic, the program served two other objectives, said MacInnis. Those included ensuring that the province had a physician roster to draw upon during COVID and to collaborate and respond to partners’ and physicians’ issues. She said the collaboration has several long-term positive impacts, including physician retention.
In response to the first wave of the virus, hospitals set up and staffed COVID units. The Herald asked how many doctors were deployed and where, but that information was not provided. MacInnis said hospitalizations were low during the first wave and there was no need for additional doctors registered with the program to be deployed.
The department has so far not audited the program. MacInnis said an “evaluation of the program will occur.” The Herald also asked whether the income stabilization program has been replaced by another but that question was also not answered.