The authors respond to “Fueling the culture of distrust in doctors”

The authors respond to a letter from Dr. Nadia Alam.¹

In discussing the findings of our study on the effect of provincial spending on social services and health care on outcomes in Canada, we chose the physician remuneration example because it is a classic funding issue in Canadian health care.² In the past, negotiators have strategically used the media to apply pressure or sway public opinion, making this an example to which CMAJ readers could relate. Another example is the recent open letter from Quebec physicians in which they protested a pay increase.³

Examples are helpful as they underline the difficult choices that must be made before money can be reallocated between health and social portfolios. Controlling growth and reducing total expenses are two different things; we are not suggesting that we remove well-established health care services like vaccination or that physician salaries should be the one and only source for potential reallocation of tax dollars from health budgets to social services budgets. Instead, what is needed is a thoughtful comparison of the health benefits to the population that are attributable to spending on provincially funded health care relative to the benefits generated by spending on affordable housing, social assistance and programs designed to address food insecurity.