OMA urges doctors to back ‘imperfect’ deal
Agreement to bring ‘stability to system’ opposed by some of the highest-paid specialists
Doctors Virginia Walley and Scott Wooder have spent the past three weeks criss-crossing the province, trying to sell physicians on a tentative agreement between the Ontario Medical Association and the provincial government.
The results of their efforts will be revealed Aug. 14 at a general membership meeting of the OMA, which represents the province’s 42,000 doctors — including residents and students, as well as those who are practicing or retired.
Both Walley, president of the OMA, and Wooder, a former president and co-chair of its negotiating committee, say they are confident a majority of doctors will see the reasonableness of the deal and accept it.
But they are being forced to work hard for every vote as some of the highest-paid specialists and a dissident group known as Concerned Ontario Doctors lobby to defeat the deal.
If ratified, the agreement will put an end to two years of acrimony with the province, marked by two rounds of unilateral fee cuts, a reduction in the number of spots in family practices for new grads and limited physi- cian input on much-needed system reform.
“I feel the majority of our members will understand that the (deal) will bring some stability to the system,” Walley says.
“The various promises in it are substantial and will serve as a bridge for us as we go forward with our charter challenge,” she adds, referring to the OMA’s legal quest for the right to binding arbitration to resolve future bargaining disputes.
The four-year deal would increase the physician services budget by 2.5 per cent annually, raising it to $12.8 billion in 2019-20 from $11.9 billion in 2016-17.
That’s double the 1.25-per-cent annual increase unilaterally imposed by the province and twice what conciliator Warren Winkler two years ago suggested doctors should accept.
There are also one-time annual payments ranging from $50 million to $120 million, which would be cut proportionately if physicians go over budget.
Doctors would co-manage the physician services budget with the province, have a strong voice in system reform and an assurance from government of no further unilateral action.
Family medicine graduates would have more opportunities to join group practices.
In a big win for doctors, the bill would strike sections of Bill 210, the Patients First Act, which would have given significant oversight of the profession to LHINs, or Local Health Integration Networks. These are the 14 arm’s length government agencies charged with distributing provincial health funding and for planning and integrating health services in distinct geographical areas of the province.
Important to the province and taxpayers, the deal would provide certainty in physician spending. With the fee-for-service method of payment, doctors have much discretion in payments they claim from OHIP. In past years, they have been known to overspend their budget by hundreds of millions of dollars, monies that the government is forced to take from other ministries, including education and social services.
The deal calls for modernizing the schedule of benefits, which includes more than 7,000 fee codes that doctors use when charging OHIP for procedures they perform.
Many fees are considered overvalued, particularly those involving technologies which allow specialists to do more procedures faster.
It’s this part of the proposed deal that has some of the highest-paid specialists, such as radiologists, ophthalmologists and cardiologists, concerned.
The contract would aim to level the playing field between them and some of the lower-paid specialties, including pediatricians, psychiatrists, neurologists, geriatricians and physiatrists, Wooder explains.
To recalibrate the fee schedule, consideration will be given to best evidence, value for money and appropriateness, he says.
The deal might cut fees for doctors who bill more than $1 million annually.
So opposed is the Ontario Association of Radiologists to the tentative contract that it recently succeeded in using legal action to get the OMA’s membership list — complete with email and postal addresses of all doctors — presumably to lobby them directly. Concerned Ontario Doctors , whose membership includes some specialty groups, charges that the deal was made in secret and does not include enough money to cover the costs of serving an aging population and paying a growing physician workforce.
It has condemned the OMA leadership for failing to get binding arbitration.
The group recently held a news conference at Queen’s Park where radiologist Dr. David Jacobs slammed the deal as a “complete surrender.”
Last week it managed to scuttle a referendum vote on the deal that was supposed to take place from July 27 to Aug. 3, by getting more than 3,000 signatures on a petition to hold a general membership meeting instead.
But also last week, the 3,500-member strong Ontario Medical Students Association endorsed the proposed offer.
Third-year University of Ottawa medical student Jonathan Gravel said, “There is no way that we can/ should get a better deal from the government right now. Physician payments don’t exist in isolation from the rest of the government finances.”
Walley and Wooder say this is the best deal doctors can extract from the province and it’s far better than the alternative — more unilateral action.
Government sources say treasury board refuses to cough up another cent.
It’s “imperfect,” Walley says of the deal, but at the same time it’s a “reasonable offer to members in tough economic times.”