In my previous post, I made the argument that the government is wasting money training a multitude of postdoctoral fellows for jobs that only a fraction will assume. Conversely, there is an argument to be made that this investment, while disadvantageous for the majority of postdoctoral fellows, is actually beneficial for science. This week I would like to play devil’s advocate and argue in favour of lengthy, low-paying postdoctoral fellowships. The argument is the same that can be made presently for medical doctors – perhaps even more so for medical doctors given Canada’s current unmet demand for more physicians.
The argument I am suggesting is that you lower annual salaries from the present $50,000-80,000/year in the residency years (which last two to six-plus years following medical school) to the salary levels of postdoctoral fellows ($38,000-50,000/year) and cap physician salaries at $115,000 (current average salary for full-time professors in Canada). You then use the difference to subsidize medical-school training for further graduates. Increased supply of medical graduates would increase competition for available medical positions – at first meeting societal need – and then creating increased competition for the remaining (presumably limited) number of jobs, keeping salaries low and possibly driving them lower.
Since physician salaries (like academic scientist salaries) are primarily subsidized by taxpayer dollars, this would translate into significant cost savings for the provincial and federal governments, and would go a long way to supporting our already cash-strapped healthcare system. Moreover, by eliminating income and prestige as driving factors for medical training, we ensure that only those persons willing to endure the rigorous training and difficult profession by virtue of their passion for medical care are retained.
Medical care therefore benefits from a greater number of passionate physicians, increased creativity, lower healthcare costs, and ample competition among all medical institutes for the best-performing doctors. Medical schools (such as at the University of Toronto, for example) already turn away thousands of prospective medical students per year, and universities would benefit directly from the increased tuition that higher medical student acceptance rates would provide. It is certainly not an impractical or unrealistic model and there is ample precedent in science.
The problem is that this becomes a slippery slope. As is currently happening in science, unless strict hiring practices were enforced, many physician jobs would be assumed by foreigners that are often willing to work for less salary and lower benefits (Is Canada discriminating against foreign-trained doctors. While many countries outside Canada have excellent track records for medical training, this presents issues of quality control – an opinion shared by the Ontario College of Physicians and Surgeons (see also “Recruitment of foreign physicians: a zero-sum equation?”). The more we lower physician salaries, the more likely we are to dissuade Canadian-trained professionals with higher quality-of-life expectations from applying for these jobs. Brain drain is already a significant problem in Canada for medical professionals, particularly to the U.S.
Canadian-trained physicians are highly regarded internationally, and drastically lowering salary and benefit expectations while retaining high quality of training will inevitably drive many of our best medical doctors abroad. We should also consider the argument most fervently presented by the business sector. Sometimes the most passionate physicians are not necessarily the best, and high salaries are necessary to retain the brightest and most capable people, who would otherwise pursue careers in more highly compensated professions. As a result, by selecting for individuals willing to tolerate low pay, long hours and limited career advancement (where the majority will remain in low-paying apprenticeship positions), we are simultaneously flooding the medical profession with individuals who, for whatever reason, are incapable of or unwilling to advance in the medical profession or transition into another industry, whether due to self-imposed limitations (dearth of ambition) or other limitations (lack of skill, ability to tolerate risk or creativity).
A large cheap workforce in medicine, as in science, will not necessarily promote a higher standard of care and innovation; in lieu of being able to support a large number of physicians/scientists of high quality, I support the maintenance of a smaller workforce of high quality. In my experience, one great scientist is worth dozens of good ones, and I suspect the same is true for medicine. While I expect our readership to be biased, I would love to hear your thoughts.