Municipal Doctor System

The municipal doctor system was an important form of both pre-paid medical care and health services delivery in rural Saskatchewan before the implementation of Medicare in 1962. Under this scheme, rural municipalities, villages and towns hired local doctors, financed from local taxation, to provide medical services to their residents. The origins of Saskatchewan's municipal doctor system can be traced to the province's Public Health Act of 1909, which required every municipal council to appoint a medical health officer for the provision of public health services. From salaries for public health work emerged the idea of paying doctors an annual grant as an inducement to reside and practice in a community, as well as full salaries for the provision of medical services to the residents of the municipality. The rural municipality of Sarnia at Holdfast was the locus of this transition.

Concerned that Dr. H.J. Schmitt, their local physician and medical health officer, would leave the area because of difficulty collecting fees during a year of crop failures, in 1915 the rural municipality of Sarnia, without legislative authority, offered a grant of $1,500 as an inducement to stay. The following year the doctor accepted a contract at $2,500 per year to provide general practitioner services to all resident tax-payers. This was the first full-time municipal doctor contract in Canada. The provincial legislature subsequently amended the Rural Municipality Act in 1916 and 1919 in order to legalise the arrangements pioneered in Sarnia, thereby creating the first municipal doctor legislation. Subsequent amendments and further legislation between 1919 and 1941 permitted municipalities, towns and villages to offer a doctor a salary or fee-for-service payments for general medical care, surgery, maternity care, and public health work. To oversee and regulate the municipal doctor system, the Health Services Board was set up with equal representation of the province, the rural municipalities, and the medical profession.

During the 1930s, the municipal doctor scheme was adopted in areas where private practice was still viable, including some of the most densely populated and prosperous farm regions of the province. It also spread to Manitoba and Alberta and attracted the interest of the United States Committee on the Costs of Medical Care. The Committee sent the esteemed economist C. Rufus Rorem to study the scheme in 1929-30, and in its main report recommended the adoption of the system in similar areas of the United States. The program's fusion of preventive and curative services was celebrated in several high profile national health plans devised by government, labour, and agricultural organizations in the 1930s and 1940s, such as the federal Heagerty Health Insurance Committee.

Organized medicine was less than enamoured with the system, owing to lay control and salary remuneration, and maintained that it should be employed only in areas where private practice was no longer viable. Many municipal doctors favoured the scheme because it offered both guaranteed payment as well as opportunities for private practice among patients from the towns and villages within, and patients from outside, the boundaries of the municipality. These municipal doctors were strongly attached to their private practice privileges and their substantive private income. They objected to the development of the scheme into provincewide salaried general practitioner service in rural Saskatchewan, with no private practice permitted, as proposed by the State Hospital and Medical League from 1941 onwards, and by the CCF government's Health Services Planning Commission in 1945.

The CCF sought to extend the municipal doctor plans throughout rural Saskatchewan with the introduction of a grant-in-aid scheme in 1945. The system grew incrementally until 1947, its peak year, when it covered 210,000 people - nearly one-quarter of the population. By that year, the better rural practices had all been taken. In order to prevent the spread of these lay-controlled salaried medical care plans, from 1955 Saskatoon's doctor-controlled Medical Services Incorporated (MSI) expanded into rural Saskatchewan. Some communities switched to the MSI schemes because they offered free choice of physician anywhere in Saskatchewan, as well as access to specialist services in the cities and larger towns. With better transportation and rising incomes, many residents in rural Saskatchewan were no longer content with the services of the country doctor and demanded the skills of the specialist. By the mid-1950s a growing number of rural residents who paid taxes to maintain a municipal doctor received their medical care elsewhere. Other communities were forced to discontinue their municipal doctor schemes and obtain contracts with MSI when their resident physicians refused to resign salaried agreements. The Health Services Planning Commission sought to prevent municipal councils from opting out of the municipal doctor system by withholding and increasing the value of their municipal medical care grants. When the Douglas government announced its plans to introduce a provincewide medical services scheme in 1959, the municipal doctor system provided medical coverage to 103,750 persons. The scheme was discontinued with the introduction of medicare in 1962.

Gordon S. Lawson