Tentative deal with doctors not good for Ontario
Tightening of belt will lead to rationing of care, not replacing equipment, clinic closures
Younger, more mobile physicians may, in frustration, leave the province or the country. Many older MDs may retire prematurely.
The recent tentative agreement between the province and Ontario doctors provides for only 2.5 per cent annual increases in the total physician services budget, with additional one-time payments of $50-120 million per year. With a growing, aging, sicker population and new technologies, the anticipated increase in expenditures will go up by at least 3.1 per cent. There will be two $100 million reductions in fees. After 2017, these and any overruns beyond 3.1 per cent will be addressed by “co-management” in which MDs are responsible for rising health care costs largely outside their control, and must personally subsidize them.
The net result will be rationing of care for patients.
In addition, the agreement lacks an important safeguard — namely the guarantee of binding arbitration. Police, firefighters, and other essential workers are entitled to this. Justice Emmett Hall recommended it, and it was suggested, but not absolutely mandated, in the Canada Health Act. Despite a rising GDP and the prospect of a balanced provincial budget, Health Minister Dr. Eric Hoskins refuses to give it to MDs.
The Ontario Medical Association Charter Challenge to obtain this will take many years. Even if successful, the OMA has agreed that it will not seek or be entitled to damages from previous fee cuts or billing clawbacks. Thus, by the time that binding arbitration was hopefully won, the fee schedule would have been even further eroded.
What would be the impact on physicians and their patients?
Younger, more mobile physicians may, in frustration, leave the province or the country. Many older MDs may retire prematurely. Some physicians may decide not to replace outdated, expensive equipment in their offices. Certain clinics may close.
The new agreement does not restore any of the previous fee cuts. These include a 30 per cent reduction in followup fees for several medical specialties so as to allow for increased time to treat patients with some 30 chronic diseases, including diabetes mellitus, congestive heart failure, and dementia.
On April 26, 2016, Canadian Medical Association President Dr. Cindy Forbes sent a letter to Federal Health Minister Dr. Jane Philpott. In it, she asked that the Canada Health Act be amended, if necessary, so as to protect physicians from unilateral actions such as have occurred in recent years to those in Ontario. She stated, “it is simply unacceptable that physicians can be left in limbo when governments fail to come to agreement with their provincial or territorial medical association. It is an issue of fundamental fairness.”
Sadly, Dr. Philpott has not replied to this most reasonable request.
If OMA members decide not to ratify the new agreement, matters will indeed fall into limbo. Ottawa must become involved and act quickly for the benefit of physicians and their patients, who will otherwise see a rapid decline in access to health care.
Dr. Philpott should promise to amend the Canada Health Act so as to mandate binding arbitration. The wording was already suggested by the Canadian Medical Association.
Dr. Shaver is an internal medicine specialist from Ottawa.
Health Minister Eric Hoskins forged the tentative deal with doctors but Dr. Charles Shaver says it does not serve Ontario well.