Ten­ta­tive deal with doc­tors not good for On­tario

Tight­en­ing of belt will lead to ra­tioning of care, not re­plac­ing equip­ment, clinic clo­sures

The Hamilton Spectator - - COMMENT - CHARLES SHAVER

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.

DAR­RYL DYCK, THE CANA­DIAN PRESS

Health Min­is­ter Eric Hoskins forged the ten­ta­tive deal with doc­tors but Dr. Charles Shaver says it does not serve On­tario well.

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