Doctors’ job action looms over contract dispute

Ontario’s doctors are talking about a job action in the new year, escalating their argument with the province over how and how much they should be paid.

“We’re ... consulting our members,” said Dr. Virginia Walley, president of the Ontario Medical Association. “We want to keep front and centre our concerns about patient care . ... The disrespect the government has shown to the profession has backed us into a corner.”

It’s a sign that a year of rhetoric between the OMA and the government is getting the two sides no closer to a settlement.

Ontario spends about $11 billion a year on doctors, a quarter of its health budget, which is the province’s single biggest spending area. The details of that spending are a rat’s maze, but much of the money goes out in fees-for-service, where one procedure, one appointment, one task brings a doctor a number of dollars defined in a Physician Services Agreement that’s like a labour agreement for the OMA’s 42,000 members.

The last agreement expired in 2014 and attempts to bargain a new one have failed. The government wants a hard cap on total physician billings and to “modernize” (that is, cut) what it pays for some procedures that technology has made a lot easier. The OMA wants intractable disputes sent automatically to binding arbitration as a precondition for negotiating anything else. And a lot more money.

The health ministry has imposed freezes and clawbacks and cuts. The two sides, negotiating in secret, reached a tentative deal last summer that included a hard cap on billings that would increase every year, plus side payments. Doctors voted to reject it nearly two to one.

The association is splintered into factions with divergent interests, from do-it-all doctors in the North to specialists in private practice in downtown Toronto. They’re welleducated and hardworking and they’re accustomed to deference and respect because they literally save people’s lives. It’s their job, in their various areas of expertise, to know what’s best. They’re not easy to employ or to represent.

Since the August vote, the OMA has not obviously gotten its act together. The same leaders, like Walley, are in place, chastened and stiffer of spine. Negotiations have not resumed.

In mid-December, the provincial government made a new proposal in public that was similar to the deal the doctors rejected in the summer, except that it offered raises to several thousand doctors who work in “family health teams,” effectively on salaries, and took a percentage clawback off solo doctors’ billings over $1 million. And over the proposed four-year term, it included nearly $1 billion less in pay.

“You can imagine how our members are viewing the government’s most recent ‘proposal,’ ” Walley said. “It is less than what was on the table in the summer. You can imagine the frustration growing in physicians’ minds.”

Like anybody on the public payroll, there’s only so much they can do in a labour dispute that doesn’t involve damaging public services. They’ve tried demonstrations and ad campaigns.

The government has focused on the highest-billing specialties, the ones whose fees really do need to catch up to the times, by emphasizing that single doctors who know exactly what to do, and who are willing to work some really long hours, can bill millions of dollars in a year.

The OMA never misses a chance to emphasize how many of its members are family doctors. When I asked Walley whether there’s anything else I should know, she praised the doctors working over the holidays.

Billings do need modernizing, and we do need to pay more for the care we want. Both sides are certain of their rightness. So expect this thing to get worse before it gets better.