THE DOC­TORS’ RE­VOLT

Health Min­is­ter Eric Hoskins has locked horns with On­tario’s physi­cians. His gov­ern­ment is out of cash. The over­worked doc­tors are pro­tect­ing their pay­cheques. And nei­ther side will budge. In­side the blood­thirsty bat­tles over the prov­ince’s health care

Toronto Life - - Tech Boom - By PhiliP Pre­ville

ON­TARIO’S DOC­TORS ARE EN­GAGED IN CIVIL WAR

When eric hoskins took over as On­tario’s min­is­ter of health in June 2014, he walked right into a fight. The day he started on the job, his new min­istry was al­ready em­broiled in fail­ing con­tract ne­go­ti­a­tions with the On­tario Med­i­cal As­so­ci­a­tion, which rep­re­sents the prov­ince’s more than 28,000 prac­tis­ing physi­cians. Hoskins was the long­stand­ing MPP from the midtown Toronto rid­ing of St. Paul’s, with a PhD from Ox­ford and a his­tory of hu­man­i­tar­ian work in some of the world’s most war-rav­aged re­gions. He was also a doc­tor him­self. He seemed like the ideal per­son to bro­ker a new peace. The key is­sue was the money that was be­ing spent on physi­cians. Doc­tors’ billings had surged over the past decade, and in 2013, OHIP had paid them a to­tal of $11.4 bil­lion, the sin­gle largest line item in the pro­vin­cial bud­get. One of ev­ery four dol­lars spent on On­tario health care was go­ing to doc­tors. Hoskins’ march­ing or­ders were clear and sim­ple: keep a lid on it. He needed to im­prove the sys­tem with­out in­creas­ing costs, and that meant pay­ing physi­cians less—in some cases, a lot less.

Five months af­ter Hoskins be­came health min­is­ter, still with no agree­ment in sight, the two sides ap­pointed for­mer On­tario chief jus­tice War­ren Win­kler as their con­cil­ia­tor. Win­kler sur­veyed the sit­u­a­tion and quickly re­al­ized it was a dump­ster fire. The gov­ern­ment wanted to cap the amount it would pay its physi­cians at roughly $11.4 bil­lion, with a small an­nual in­crease. The OMA was con­cerned about the ef­fects of On­tario’s bal­loon­ing ag­ing pop­u­la­tion and the fact that, with up to 700 more doc­tors join­ing its ranks ev­ery year, that money would be spread ever thin­ner.

Th­ese po­si­tions, Win­kler later wrote in his fi­nal re­port, were “ir­rec­on­cil­able.” Fore­bod­ingly, he con­cluded that “ab­sent some ra­tio­nal­iza­tion, the sys­tem may not be sus­tain­able.” He told both sides that, un­less they over­hauled how health care is de­liv­ered, the day would soon come when they would never be able to get a deal again. Both par­ties agreed that his dooms­day as­sess­ment was cor­rect.

When the prov­ince tabled its fi­nal of­fer on De­cem­ber 11, the OMA balked. Win­kler told them that the deal was as good as they were go­ing to get. The OMA re­fused to re­con­sider—and Hoskins went on the of­fen­sive. He im­posed that fi­nal of­fer uni­lat­er­ally, which capped physi­cian pay­ments at $11.4 bil­lion. A few months later, when billings busted through the cap, Hoskins started claw­ing back doc­tors’ earn­ings. All physi­cians in On­tario now have 4.45 per cent of their in­come with­held from their monthly OHIP cheques. The gov­ern­ment keeps that money, for­ever, in its ef­forts to bal­ance its bud­get.

Many physi­cians be­lieved the Lib­er­als were charg­ing them a “doc­tor tax” and us­ing it to pay for bil­lion-dol­lar gas plant and eHealth scan­dals. In 2016, af­ter try­ing for more than 15 months to get the OMA back to the bar­gain­ing ta­ble, Hoskins changed his tac­tic. At a press con­fer­ence in April, he de­clared that

On­tario’s doc­tors, with av­er­age billings of $368,000 per year, were among the high­est-paid in Canada. A to­tal of 506 physi­cians in­voiced OHIP for more than $1 mil­lion in 2014, and three types of spe­cial­ists made up more than half of them: ra­di­ol­o­gists, oph­thal­mol­o­gists and car­di­ol­o­gists. If Hoskins could not ca­jole the OMA back to the ta­ble, he’d shame them back.

No doc­tor was more sen­si­tive to the ne­go­ti­at­ing po­si­tion than Vir­ginia Wal­ley, the OMA’s pres­i­dent. Wal­ley, a pathol­o­gist by train­ing, has been a teacher, a de­part­ment chief and a hos­pi­tal ad­min­is­tra­tor, so she un­der­stood the gov­ern­ment’s con­cern about ris­ing health care costs. But she wasn’t in­clined to let the gov­ern­ment uni­lat­er­ally de­cide doc­tors’ fu­ture with­out in­put from doc­tors them­selves.

So she sat down with the devil. Dur­ing a few days in late May, the OMA and the min­istry ham­mered out a four-year con­tract. The dis­cus­sions be­gan se­cre­tively, with of­fi­cial ne­go­ti­at­ing teams called in only mid­way through, when the broad strokes of a deal were al­ready in place. When Hoskins and Wal­ley an­nounced they’d reached a ten­ta­tive agree­ment on July 11, the news came as a sur­prise.

The de­tails, at first glance, were scandalous to many OMA mem­bers. Wal­ley agreed to abide by a cap of $11.9 bil­lion on to­tal OHIP billings. The earn­ings claw­back would re­main in place. While the deal in­cluded a 2.5 per cent an­nual in­crease to the cap, both par­ties agreed that most of those new funds would be eaten up by new doc­tors en­ter­ing prac­tice and ag­ing pa­tients need­ing more care. In other words, the deal would likely amount, at best, to a pay freeze for four years. The one up­side for the doc­tors was that the deal en­shrined the OMA as “co-man­agers” of the health care sys­tem, which meant that the gov­ern­ment would no longer be able to make bud­get de­ci­sions with­out them. Hoskins would have to work with the doc­tors on ev­ery change. The day af­ter the deal was an­nounced, Con­cerned On­tario Doc­tors, a Face­book group with 20,000 mem­bers, launched the Twit­ter hash­tag #IVoteNo. The next week, the group called for the res­ig­na­tions of Hoskins, deputy health min­is­ter Bob Bell and Wal­ley, as well as the OMA board of di­rec­tors and its ne­go­ti­at­ing team. The #IVoteNo hash­tag ex­ploded with com­ments, rang­ing from rea­soned de­bate to pure histri­on­ics. “I re­mem­ber when I used to trust OMA im­plic­itly,” tweeted Na­dia Alam, one of the founders of Con­cerned On­tario Doc­tors and its most pro­lific tweeter. “I used to trust Govt’s benev­o­lence. Now I ques­tion both.”

In the end, 63 per cent of the prov­ince’s physi­cians voted against the deal, over­whelm­ingly re­ject­ing Hoskins’ and Wal­ley’s gam­bit. They claimed they were de­fend­ing the best in­ter­est of pa­tients. If this were truly about pa­tients, it would have been set­tled long ago.

OHIP is the big­gest line item in the pro­vin­cial bud­get, and Kath­leen Wynne is de­ter­mined to cut costs

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