Philpott urges doctors to help improve health of most vulnerable patient groups

Federal Health Minister Jane Philpott says Canada's doctors have a major role to play in improving the health of the country's most vulnerable populations, including those at risk for a fatal overdose due to rampant opioid use and abuse, a crisis she characterized as a national public health emergency.

In a speech Monday to delegates attending the annual meeting of the Canadian Medical Association in Quebec City, Philpott said any approach to the crisis needs to be comprehensive and collaborative.

"Doctors have a huge role, including promoting awareness that social inequity and unresolved trauma are often at the root of high-risk drug use. This includes homelessness, poverty, violence and sexual abuse," she said.

"Addiction is not a crime, nor a mark of moral failure. It is a health issue ... people who use drugs are people who do not need judgment. They need what all Canadians expect from health systems — that is, compassionate care."

Asked by reporters after her speech if the opioid crisis should be formally declared a national emergency, Philpott said there is no federal public health law that would provide any additional tools to fight the crisis "that we don't already have."

"It would offer no advantages to us," she said, noting that one area the Liberal government has been focused on is harm reduction, including the approval of 14 new supervised injection sites, bringing their number to 16 across the country.

Outgoing CMA president Dr. Granger Avery said the organization is "entirely congruent with how we need to work" in a collaborative manner with government and other health providers, not only to tackle the opioid crisis, but also to help other vulnerable groups focused on by Philpott, among them Indigenous Canadians and youth with mental health issues.

"The whole principle of shared care ... the CMA and doctors in general have that way high on the list," Avery told The Canadian Press in an interview.

In a question-and-answer session with delegates following her address, Philpott was questioned about the government's intention to close tax loopholes for incorporated businesses, which includes many doctors' medical practices.

In July, federal Finance Minister Bill Morneau released a policy paper that proposes significant changes to how private corporations are taxed. Doctors and other businesses have been asked to comment on the proposal during a 75-day consultation process that ends Oct. 2.

The tax changes have become a hot-button issue for the 85,000-member CMA, which argues that doctors in private practice do not have pensions or receive benefits like most salaried employees, and tax changes would make it more difficult for physicians to save for retirement, cover maternity leave, or work part time while raising a family. Female physicians, in particular, would suffer, the organization says.

"We assume the risks of establishing offices and clinics, employing staff and purchasing equipment. Many of us do not have access to paid sick leave benefits or retirement pensions," said Dr. Gigi Osler of Winnipeg.

"What assurance can you give us that the government will take our concerns into serious consideration?" asked Osler to thunderous applause, hooting and table-pounding by fellow delegates.

Philpott responded that the concerns expressed by doctors are being taken into serious consideration, but she encouraged CMA members to read the proposals carefully and not to believe hearsay being circulated on social media about what they might mean.

"This really is actually about fairness. Does it make sense to create a system where some of you in the room can take advantage of those mechanisms in a way that others can't?" she asked, referring to such tax deductions as income splitting.

"If you are someone who has a spouse that makes significantly less income than you or you have children of a certain age of 18 to 24, then you can take advantage of legitimate rules that currently exist to reduce your personal income tax burden.

"But the person sitting beside you or across from you who is single, who has very young children, no children, children who are grown up and making their own income, are going to pay much more tax than you."

Avery said the proposed tax changes could affect how doctors are able to operate their practices and may lead to some people thinking twice about going into the profession.

He also said physicians were troubled by the "tone" in Morneau's paper outlining the potential alterations and the reasons behind them.

"I think there's been implications that doctors — and other small businesses, too — really are in some way tax cheating," Avery said. "And that is absolutely not true."

Philpott, who formerly had a family medicine practice, was also challenged by reporters after her presentation about her own status as an incorporated physician. Her professional corporation with the College of Physicians and Surgeons of Ontario was "revoked" late last week, and she was asked whether there was a link with the pending tax changes.

"I can say unequivocally that it has absolutely nothing to do with the recent tax changes," she replied. "I decided that I would not be practising medicine for at least four years (after being elected) and that it made no sense to keep the corporation open. I took steps to shut down that corporation. It was shut down on Oct. 19, 2016, because I had no use for the corporation anymore."