Be… in this place (without a doctor)

Respect is a universal requirement. We all need it. Country songs bemoan the lack of it. (“Take this job and shove it”). Aretha Franklin had a song called “RESPECT.”

Doctors are suing the New Brunswick government for reneging on a tentative salary deal. According to the president of the N.B. Medical Society, “The proclamation of Bill 93 is a bitter reminder of the Shawn Graham Government’s total disrespect for the negotiations process.” Unfortunately for the doctors, a serious decline in government revenue forced Premier Graham to consider a wage freeze.

There is a delicious irony that recalls the NB Power v. Venezuela case. We insisted then that a deal which had been negotiated, but not officially signed, was valid.

Is Premier Graham trying to have it both ways? It seems so.

So, what’s the point of this lawsuit? It’s about the money, of course. The negotiated settlement of $35.6 million would have brought each doctor a $24,000 increase, on average. That’s an eight-per-cent wage increase. The final contract will not ensure that all citizens have a family doctor. It won’t provide for creative and sustainable solutions to medical care.

One in every five health dollars goes to pay doctor’s salaries. The 2007/2008 global wage budget of $455 million, shared by 1,482 doctors, gives an average salary of $304,000 per year. Typically specialists make more and general practitioners make less. To be fair, there are expenses for a receptionist, office and related things. But all in all, far from poverty wages.

Eight per cent of the 750,000 New Brunswick residents don’t have a family doctor, the gatekeeper for entry into the health care system. Those 60,000 people aren’t too happy that governments didn’t act on the demographically predictable aging of physicians.

The province is presently served by 723 general practitioners and 759 specialists. The College of Family Physicians suggests that each family doctor should have approximately 1,200 to 1,500 patients. If this is true, we should have between 500 and 625 GPs. Theoretically, we have enough but emergency room doctors, those in management or semi-retirement perhaps make the difference.

The government is committed to adding 50 doctors in the next few years, which should fix the problem. The question for many people is, when?

Couldn’t we bring doctors in from Cuba or Mexico into New Brunswick on a temporary basis to fill the gap until we train other doctors? We do that with welders or many other trades. Talk to anyone out in Alberta.

Logic would say yes, but the doctors’ union is very tough. Canadian immigration permits a foreign doctor into Canada based on credentials, but provincial medical societies refuse to accept those same credentials in many cases. Better that they drive a cab for a year or two to gain Canadian experience. Should Canadians die from no treatment, or have a foreign-trained doctor examine them?

You, like me, may be one of the 20,000 people on the Regional Health authority waiting lists for the next available doctor. There’s a recording, “Leave your name and number.” Several months after I left my name and number, someone called me, but that was a long time ago. No explanations and no personal touch. The whole system radiates lack of respect.

Recently, I called an after-hours clinic to schedule a prostate exam. Apparently, they don’t do that. They said I should go to the emergency room at the hospital. That is too funny! I instantly had this mental image of me trying to explain to the triage nurse what I wanted. Her response would probably be, “This kook will wait here for three days.”

So what are eight per cent of New Brunswickers to do for the gaps in our medical needs? Continue to pay our taxes for medical treatment we don’t receive? I could have prostate cancer developing and wouldn’t know it until too late.

Perhaps we should look south at the experience of Cuba. According to some evaluations, “Its public health indicators are consistently similar or superior to those of wealthy, industrialized nations such as the United States and Japan. Cuba’s per-capita GDP, however, has more in common with Third World countries such as Indonesia and Bolivia. Their solution has been built using low-cost, high-impact techniques in preventative medicine, primary care and community education.”

Cuban society is fairly egalitarian but poor. People make roughly the same amount of money. Doctors make $20 a month, which is $240 a year. Put another way, the average Canadian doctor works less than two hours to make the annual salary of the Cuban doctor. Cuba has sent doctors to Venezuela and other countries as a way to earn foreign exchange. I suspect they could provide 50 doctors to New Brunswick until we train more local students. Alternatively, Mexico has doctors who could fill in for a short term.

Doctors are better respected than most in our society. It would be nice if that respect was extended to those paying for Medicare but not having access. Is it time for us to organize politically to ensure that the situation is solved quickly?

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Develop an energy strategy that serves New Brunswick

Building a new oil refinery with a price tag of $8 billion was never going to be an easy task, but saying goodbye to a project where millions have been already spent must be quite difficult.  Collateral damage may include employees losing work and the investments made by individuals in the community expecting a boom.

There is always a risk of becoming emotionally invested in a concept, whether it’s private or public sector managers.

According to news reports, Irving Oil now sees declining customer demand for gasoline “from 2015 out for the next 25 years.” They didn’t divulge the reason for the decline, despite an expanding U.S. population. One likely cause is the reinvigorated corporate average fuel economy standards (CAFE) in the U.S. gas market and hence in Canada. The new refinery would have added capacity into a declining market.

But looking beneath the surface, rising oil prices in 2007 and 2008 made it clear that we are reaching a tipping point in world oil supply. About 40 of the world’s 54 oil producing countries have passed peak production and are declining. Reduced supply means fewer refineries, as I noted in a previous column from 2007.

Has the present government become so emotionally attached to its self-sufficiency agenda and “energy hub” job strategy that they reject the reality of an oil production decline in coming years with its consequential economic chaos? Or is it just saving face until the next election?

Self-sufficiency, as proposed by Shawn Graham, was fatally flawed from the beginning.

It was based on growing a larger population, a strong industrial economy and sufficient cheap energy, all of which are unlikely in the next decade.

With the passing of the refinery project, the “energy hub” seems an empty shell.

There is talk of an Irving wind power export project, which is like assembling Lego blocks made elsewhere – few construction jobs, and few or no permanent jobs. A related concern: do we want to use the best wind sites for export power rather than local use? A proposed natural gas plant is comparable, giving some short-term construction work but few permanent jobs.

The fallout from the refinery decision means expected tax revenue will not materialize.

Based on reduced revenue expectations, one would hope that the expenditures of government (both capital and ordinary) would be reviewed. As an example, New Brunswick’s latest budget proposes spending $160 million on new technical schools and programs, which were partially intended for training of refinery construction trades.

Demographic forecasts of a 20-per-cent reduction in student population in coming years and with more distance education, would see significant spare capacity in existing“bricks and mortar”institutions.

Does this expenditure still make sense? Perhaps lowering tuition would keep the institutions filled in coming years.

Having misunderstood the threat of an impending energy crisis, it’s time for Premier Graham to return to the basics of government.“Government intelligence” could produce an energy policy that meets our needs.

Should new homes have to meet an energy code? Is Efficiency NB making a serious impact on heating costs for existing homeowners? I recently talked to a hard-working woman in the process of being cut off from electricity. Due to misfortune and remarkably high bills, she couldn’t catch up from the high winter costs. This is real life for the less fortunate among us.

What is the role of wood in New Brunswick for heating homes? Why can’t NB Power reduce its winter peak? Should NB Power be consolidated and work on improving operational efficiency and reducing costs? Should new appliances sold have to meet energy efficiency standards? Since we are facing an impending crisis of very high gasoline prices and energy shortages in the near future, should we be setting a floor price for gas to encourage the purchase of high-efficiency vehicles? Would incentives help us? What about mandatory standards for vehicle mileage or speed limits?

These are but a few of the questions that I would ask the premier. Will he change course? What will be his legacy? His three years of power have shown little progress in setting a new course on energy. Considerable time was occupied in the energy department marketing the “energy hub” idea.  Being a strategy for job generation, it should have been handled by Business New Brunswick.

Who are the losers with three years of an energy policy abyss? The people of New Brunswick, who won’t be prepared for hard times.

But it could be worse, I suppose. Mexico is again facing large decreases in government revenue, as their oil exports declined 14 per cent during the first half of 2009. That decrease of 200,000 barrels a day amounts to $4 billion less revenue for Pemex, the state oil company.