Nearing 50 years of age, Dr. Christopher Sladden has been talking with financial advisors about his future.
The one message he's received loud and clear, Sladden said, is his current business model isn't working- and, the Kamloops dermatologist blames that on the provincial government and the B.C. Medical Association (BCMA) for allowing fees paid to his specialty to stagnate for years.
"I think people are seeing me as some greedy doctor," Sladden said, "but I'm one of the first to stand up and be counted."
Sladden, who works with dermatologist Dr. Richard Lewis at 712 Seymour St., said he has written a letter to provincial Health Minister Michael de Jong, explaining he plans to quit his practice at the end of July.
His reasons are many, but one of the main ones is the fee schedule paid to dermatologists through the province's medical services plan (MSP), a schedule that has not increased in years although dermatologists "are facing significant increasing costs for rent, wages for our staff and for all of the supplies in our offices," Sladden explained in the letter, copies of which are available at his office for patients.
Many of the patients he sees are dealing with cancerous skin growths, Sladden said.
He said he can bill MSP $60 for the first consultation to diagnose any such growth and $40 to remove it.
The overhead cost for such a procedure is about $40, he said, and the tax on income is another $20 to $30, leaving a net income of about $30 for treating the cancer.
Sladden takes issue with information provided to the media by the health ministry after his resignation was reported on by the CBC.
In particular, he's angry at the use of average and high billings provided without context and the ministry's inclusion that dermatologists can augment their salaries through cosmetic procedures paid for by private insurers.
The ministry noted in its information the average MSP billing by a B.C. dermatologist last year was $440,000.
Sladden billed for $369,377 last year.
Billed amounts do not take into consideration expenses, overhead and all the costs of running a practice, amounts that have continued to increase through the years, Sladden said.
And, in his own case, Sladden - formerly a general practitioner in his native England and then in Clearwater - chose to go back to school for three years to specialize in dermatology, noting the shortage of doctors with that specialty in the province and, in particular, in the Interior.
There are now just four dermatologists in the Interior - and Lewis has been in semi-retirement for years.
Another in Penticton is also nearing retirement age, Sladden said.
His return to school brought with it a three-year relocation to Vancouver for his studies while his wife and young children remained in Kamloops, loss of income during those years - Sladden billed MSP $86,794 in 2010-2011, before he was one of just 16 in the country to pass certification in dermatology - and significant debt to staff and equip his dermatological practice.
Sladden objected to the ministry noting a dermatologist on the Coast billed MSP $1.4 million last year without noting the doctor is one of just two in the province with significant specialization that allows them to work on the most difficult and often rare skin cancers.
The doctor in the example, Sladden said, has a full surgical floor with all the technicians, nurses and equipment it requires so he can perform operations on his cancer patients.
And, finally, Sladden is angry the ministry advocated dermatologists use Botox - a company's drug - to boost his income, an inclusion Ryan Jabs, the ministry's media-relations manager, acknowledged was included as an example of how dermatogists can add to their income.
"It is disgraceful of the ministry to make that suggestion, to advertise a company's drug in that way," Sladden said.
Sladden said he does no cosmetic treatments and uses the botulinum toxin used to produce Botox only to treat people with hyperhidrosis, the medical name for excessive sweating.
"I do it purely because it is a life-changing procedure."
Both Kamloops dermatologists acknowledged they could also boost their income by increasing their patient-load, but both said that would mean not providing the level of care they want to provide.
Sladden said he sees about 30 patients a day.
Lewis said many doctors in larger municipalities are seeing upwards of 70 patients a day.
"That volume of often double what we see in a day, that service is not identical with spending 15 minutes with a patient, rather than five or seven minutes," Lewis said.
As for his future, Sladden is not sure.
"I love Kamloops," he said. "It's a fantastic place to live. I have no beef with it or the people. It's a great place to raise a family."
However, since his dispute became public, he has received calls from Britain, the U.S. and Australia about moving there.
"There is a huge shortage of dermatologists across the world," Sladden said. "But, I may stay here and do something completely different with Dr. Lewis."
Jabs said Sladden's issue would best be dealt with by the BCMA, which is in negotiations with the province for a new agreement.