Last week, taking in the failed negotiations between the MOHLTC and the OMA, Dr. Mario Elia voiced his thoughts in the Healthy Debate column: “Ontario doctors vs. Ontario government: we need better”.
The ‘we’ in Dr. Elia’s title refers to the collective group of physicians represented by the OMA, and his arguments draw attention to what he and many others feel is disingenuous political spin by Health Minister Dr. Eric Hoskins.
A major component of the Physician Service Agreement (PSA) being negotiated is physician billing. Physician billings represent a huge chunk of money, making up about 10 per cent of Ontario’s budget, and any change to these fees affects the take-home pay of Ontario’s over 30,000 physicians. Thus, the failed negotiations are of great interest not only to physicians, but also to all Ontario taxpayers. The parties began the negotiation process in January 2014, four months before the 2012 PSA was to expire. Despite third party involvement, including a facilitator, Dr. David Naylor (former president of the University of Toronto) and then a conciliator, the Honourable Warren Winkler (former Chief Justice of Ontario), the parties have yet to reach an agreement. Since the negotiations are confidential, public opinion relies on media coverage, OMA and ministry communications, and the recently released conciliator’s report.
The OMA, which represents the political, clinical and economic interests of Ontario’s physicians, insists that their rejection was in order to protect the public. They are certain that the government’s plan will result in decreasing overall access to care and put patients at risk and have made a number sweeping claims to this effect; however, they have not provided evidence showing how decreases to physician compensation will negatively impact patient outcomes. Minister Hoskins, on the other hand, insists very little will be felt by the public. Perhaps a bit of spin of his own (no denial here), but he does not attempt to pull on our heartstrings to get the message across nor explode social media with this message, as opposed to the OMA and their use of catchy #hashtags and patient stories.
It’s incredibly scary to hear our physicians, who hold an enormous amount of social clout, saying that the care they provide will be compromised by the ministry’s proposed cuts. But, the entire narrative created by the OMA that our government does not care about healthcare is just misleading. This narrow, sensational view does not recognize that PSAs and the provincial healthcare budget do not exist in a vacuum. Ontario’s precarious economic situation, with the highest debt-to-GDP ratio in the province’s history, has left the government with some difficult decisions. Of course, healthcare is important and better care should be everyone’s priority, but it’s not as if all other provincial responsibilities can kneel to healthcare. There are innumerable areas in need of greater public policy investment including, for arguments sake, Toronto now ranks first in Canada when it comes to child poverty. Ontario’s poverty reduction strategy could likely use a few bucks as well.
With physician compensation attracting public attention, physicians are, rightly so, concerned that the public easily mistakes physician billing as take-home salary. We agree that it’s important to acknowledge that most physicians face significant overhead costs (a mean of about 28% of their gross income), no benefits and no pensions. And, no, the government does not often communicate this, but let’s also consider that the OMA would never include in their communications that, contrary to most tax payers and all other public servants, many physicians are incorporated and receive generous tax exemptions.
Or, how about the complete lack of transparency when it comes to physician salaries in general? Most taxpayers, and even physicians, would better understand the implications of these negotiations if this was not the case. Disclosing OHIP billings is strongly lobbied against by the OMA.
Physicians are generally empathetic, charitable, and extraordinary at what they do. Physicians make many sacrifices during years of arduous education and incur extensive debt. Their chosen career is very stressful and demanding. Perhaps some physicians are underpaid, depending on where and what they do, but, the thing is, many professions are underpaid and overworked, particularly in healthcare – consider the average salary of a social worker. This is why the OMA has spun their public messaging around everything except billing details, the major item on the negotiating table.
Finally, the repeated references made by many to other government controversy or scandal is distracting, has no bearing on these negotiations, and is as irrelevant as presenting, say, the lack of disclosure when it comes to medical errors as a reason to cut physician billing.
As Dr. Elia eloquently put it, physicians generally feel that they are paid adequately for the services they provide, so let’s move on and stop interpreting this situation as an attack on the cherished role physicians play in our society but instead as a difficult policy decision in a time of serious economic hardship. Of course the government is spinning their message, but please expect no less from the OMA.
The comments section is closed.
With your view that the Ontario government has had to cut payments to physicians because the province is strapped for cash, how do you rationalize the same government’s 2.5% economic increase in payments to teachers?
interesting debate. As a physician who works in the community health Center, we’re seeing the impacts of budget cuts in social services affect the financial well-being and ultimately the health of our patients. %featured%I agree that there is a lot of media spin on the part of the OMA. However, I think there are a couple of other policy issues being left out of the debate on the part of the province. Our understanding of health care and social services is also affected by the cuts in federal transfer dollars to health care. The current federal government has proposed a 36 billion dollar hot in transfer payments to health care to the provinces. The current federal government has snubbed the recent premiers conference that has being attended by by Prime Ministers for nearly a century. Simultaneously they have given tax breaks to the wealthiest segment of the population. Let’s put that on the table too.%featured%
As a soon to be (CaRMS willing) family medicine trainee, I would love to hear the author’s view on the policy decision made by the Ministry around access for new family doctors to team-based practices outside high needs areas. It’s unclear to me how this fits into their cost-saving strategy, and whether this is a temporary freeze or a longer term policy reversal. FHOs are not universally admired, but as far as my experience goes they are excellent for patient care. The imposed changes also alter income stabilization, disproportionately affecting new physicians. I think you have hit upon a really important issue, which is that neither the OMA or government has really put forward a coherent policy argument regarding how to find savings through rationalizing care based on evidence. Does rationing entry into team-based models negatively affect patient care by reducing the number of the nearly 1 million unattached Ontarians who will find a family doctor this year? If it does, should it really be where the ministry goes slashing?
Well done! And way to be far more diplomatic than I could ever be about this.
Thank you for bravely tackling an issue as divisive as this – I agree with you wholeheartedly. As a physician-in-training, I have watched with great dismay how organized medicine side-steps issues of fiscal sustainability and long-term collaboration for lowly quarrels and fear-mongering.
It is especially troubling when physician “leaders” urge their members to leverage the relationship they have with patients to pursue a political aim, rather than advocating for a balanced debate on MD compensation in the context of long-term health care sustainability. I, for one, am disillusioned – our supposed medical political leaders state the need to ensure cost-effective care, and yet shirk from this responsibility when negotiations and MD compensations are discussed; any public comments suggestive of collaborative approach or civic professionalism are systematically met with personal attacks and accusations.
It is time to elevate the debate.
Thanks for your comments Disillusioned. It is heartening to hear a physician-in-training becoming involved in the discussion – and being brave enough to question their more seasoned (and better paid) colleagues who seem to be able to “leverage the relationship with patients to pursue a political aim” simply in pursuit of more money. Perhaps all is not lost yet. Hang in there – and please get involved in this discussion every chance you get. Our healthcare system may depend on it!
Comparing underpaid health care sector workers to doctors is an apples to oranges comparison. “They suffer so we should to” is not a productive approach.
The current problem with the OMA’s approach is that they do not admit that there is a large discrepancy in funding between different specialties. They have offered no solutions for this problems.
As it stands, family doctors are continuously getting their fees hacked and are encouraged to join government-run collectives that will erode their autonomy and ability to advocate for patients. Pathologists are not even on the fee schedule – they are primarily salaried employees who have no autonomy and no grounds for advocacy without sacrificing their jobs if their organizations are below-par. It’s no secret that pathologists are the most “error prone” doctors, and this lack of autonomy is probably the biggest contributor to that.
If patients want to obtain high-quality care, and physicians want to provide it, physicians require autonomy. The current fee schedule supports autonomy for some specialists, while completely denying it for others. A balance in the fee schedule is sorely needed to rectify this very crucial issue.
Displaying physician incomes publicly is not the solution. Instead, there must be transparency in regards to how fees are determined. I am unsure as to why particular events, like the usual family doctor visit, is billed in a particular way as compared to, say, a chest-abdo-pelvis CT. Or why a lap chole is billed a particular way in comparison to a phacoemulsification.
Could the authors point to a single instance where the OMA makes reference to Government controversy or scandal?
I have not seen any and I’ve looked pretty hard.
The authors don’t attribute that to the OMA, they refer to: “the repeated references made by many to other government controversy or scandal”. Doctors have been all over Twitter with this, and Mario Elia explicitly brought it up in his own Healthy Debate blog.