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
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.