Re: Billing disparity

Dr Rafi-Zadeh has been perusing the latest financial statements of the MSC, otherwise known as “The Blue Book of Envy and Resentment” [BCMJ 2013;55:8-9]. I can remember when this book was first published at the behest of Premier W.A.C. Bennett in 1971, and one of the first copies reached the hands of Jack Webster, the feisty Scottish talk show host of CKNW. He invited listeners to phone in their doctors’ names and he would read out their gross incomes, often accompanied by “What a bonanza!” 

In his letter, Dr Rafi-Zadeh describes a small community of 8000 people 2 to 3 hours from Vancouver where one GP grosses over $1 million annually. It adequately describes Merritt and the Nicola Valley, where I worked for many years and where I am now happily retired. I have known this particular “high earner” since he came to Merritt in 1980 and, yes, he does work 7 days a week, as I did when I was in the saddle. 

This rural practice area bears no relation to city or suburban practice. The population doubles in the summer months with visitors, and the Nicola Valley is home to two First Nations (the Nlaka’pamux [Thompson] and Okanagan) and sev­en Indian bands with over 60 separate reserves. When you add the 15 000 vehicles passing through each day on the Coquihalla Highway, you can see that there is a great medical need. Sadly, the logistics of medical practice are not taught at medical school, and I could be at the hospital or my office in less than five minutes. A doctor behind a steering wheel is a doctor wasted. 

Dr Rafi-Zadeh wants the BCMA to take definitive action to address the disparity in GP and specialist earnings. I would consider it far more im­portant to address the unacceptable disparity in physician distribution in this province. This community depends on three South African and three Canadian physicians, all of whom are middle-aged or older. There are no female physicians, and no younger UBC graduates. Why?
—Robert G. Holmes, MB
Nicola Valley