Reverberations

Eberhard Renner, MD
Internal Medicine Department Head

Nothing that I have ever written has created so much immediate attention and lead to so many rapid responses than my last blog “About Money”. There were 195 hits on the blog during the first day after posting, and over 250 more since. This is five times the attention that previous postings received. A few colleagues responded in the comment section of the blog, many by e-mail, many more on occasional informal encounters in the hallway. The comments varied widely and ranged from astonished disbelief and feeling disadvantaged, over rationalizing and defending incomes and income differences, to offense, anger, and suspicion this may be the first step into an equalizing payment future.   

None of these reactions were specifically intended. I simply wanted to be transparent and stimulate a discussion, nothing more, nothing less – and am glad that I apparently got your attention. That said, let me clarify some things that came up:

Firstly, and maybe most importantly, the latest blog on facts “about money” should not distract from some other equally or even more important facts, namely that you all should be proud of your accomplishments as compassionate clinicians who competently serve your patients, as engaged teachers and educators who train and mentor the next generation of physicians, and as prolific scholars who innovate and move your fields forward. All this in an environment with a lot of moving parts and huge constraints on many fronts including outdated infrastructure and limited support staff. I fully acknowledge that it is your hard work and achievements that make our Department successful. I would like to thank each of you for your individual contributions many of which are not and cannot be properly rewarded by money.

Secondly, our incomes are largely publicly available by individual provider: fee for service income from Manitoba Health’s annual report (latest version available: Annual Report 2016-2017 – Province of Manitobahttps://www.gov.mb.ca/health/ann/docs/1617.pdf), University salary (over $50k per year) from various libraries (https://legislativelibrary.mb.catalogue.libraries.coop/eg/opac/record/107421669; U of M does not post on line), WRHA income (over $50k per year) from WRHA’s “sunshine list” (http://www.wrha.mb.ca/about/compensation/index.php). All of us and every interested fellow citizen can look this data up, for each of us individually, and do the math.  I was therefore surprised that some colleagues reacted by implying that putting aggregate numbers into the public domain was somehow inappropriate. Conversely, the astonished disbelief conveyed to me by others about the income differences existing in our Department also took me by surprise.

Thirdly, beyond stating that we are privileged, my blog only stated facts and asked questions. I believe it is hard to dispute that we are privileged – but I am open to hear the reason(s) if somebody feels differently. If we all feel that our incomes are justified – and my blog did not say they aren’t – there is no need to justify them to ourselves and/or to our colleagues, as some respondents correctly stated. But if the facts are in the public domain accessible to anybody, I would suggest we better have good arguments to justify them towards the public/taxpayer. The arguments I heard with regards to the latter were not convincing enough for me to trust they would hold up in a public debate, but I have been wrong before… 

Fourthly, since our individual incomes are all available in the public domain, I have difficulties understanding, why my blog has angered or offended some of you. With regards to particulars, I want to stress that ”interventionalist” is a generic term characterizing anybody in any subspecialty performing interventions. In general, as you all know, interventions tend to be better remunerated in any subspecialty than non-interventional activities, and my blog explicitly acknowledged that there are credible reasons for this.

Finally, any interpretation of my blog being a first step towards changing existing remuneration models is not only entirely wrong, but totally overestimates the influence and power of a University Department Head and Shared Health Provincial Specialty Lead: As such, rest assured that I am definitely not in a position to change existing remuneration models, even if I would want to.

That all said, let’s not get too much distracted by the always controversial and often divisive discussion about money. Let’s acknowledge that we are all privileged and keep up the good work!


One thought on “Reverberations”

  1. Although it is true that gross payments to physicians are a matter of public record the “public” should also be informed of the cost of doing business, taxation rates, deferred income accrual due to prolonged education and training, etc. In addition, we should find a way to create public access to other professionals’ incomes in a comparable way. Are we overpaid compared to dentists, accountants and lawyers, for example? And is this on a purely gross income basis? Or an adjusted income calculation on a per-hour worked basis?
    How about consultants from either within Manitoba or from other jurisdictions? We hear that they get a lot of money asking Manitobans for their views and then summarizing them in reports. Where’s our consulting fee from that process?
    The issue of incomes is a sensitive subject if there is an associated sense of blame, wrongdoing or, even worse, disdain at certain salary levels. This is unfair and unwarranted.
    Thanks for the kind and appropriate comments about the excellent job our faculty is doing in all areas of their professions. Such comments are long overdue and are much appreciated.

    I have never responded to any blog, etc., in my many decades at the U. of Manitoba. However, it is clear that many felt uncomfortable enough to share their views.

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