Why your doctor may go on strike

Ontario doctors are on a collision course with Queen’s Park in their fight for a pay raise — a track that may see physicians close their offices and clinics in the coming weeks and months.

If that happens, patients will be the big losers.

They could be forced to wait days for their family doctor to complete routine paperwork or forced to go to hospital emergency rooms for medical care instead of a neighbourhood family clinic.

The ominous warning of “job action” was issued this week by the Ontario Medical Association (OMA) in an “open letter” to patients across the province.

The letter stated doctors “continue planning for job action” in the event that the government refuses to accept their demand for binding arbitration in their pay dispute.

The OMA insists the “job action” wouldn’t really be a strike, namely because the group isn’t a union and that as providers of an essential service, doctors are legally prevented from striking. Instead of “striking,” doctors would be shutting their offices and clinics in order to attend “professional development” sessions.

I might be naïve, but I’m sure that smells like a “strike” to most patients.

At the heart of this bitter dispute is money.

Doctors have gone nearly three years without an increase in the fees they are paid by the government. Last summer, they rejected a deal endorsed by the OMA executive that would have added $1 billion to the overall fees awarded, but would have also cut fees for some services by high-income doctors, such as radiologists.

Since the contract was rejected, the OMA has been wracked by nasty internal fights, which resulted in the entire executive resigning en masse last month and a new governing council being elected this week in which many doctors who favour a “get-tough” approach to the government won seats.

Tellingly, in the contract negotiations last summer both the government and the OMA moved away from the binding arbitration issue after months of disagreement because agreement was impossible.

Doctors want to be able to seek binding arbitration to resolve their pay dispute and see it as a way to get more money than Queen’s Park — and ultimately the taxpayers — is willing to pay.

For its side, the government generally opposes binding arbitration because third-party arbitrators have generally sided with unions, granting them huge salary raises based on the employer’s ability to pay the higher wages. As far as arbitrators are concerned, all any government has to do is raise taxes, which is political suicide for governments these days.

In the case of Ontario doctors, Queen’s Park is against handing over control of 10 per cent of its overall budget, specifically the nearly $12 billion a year set aside for doctors’ fees, to an outside arbitrator. To help reopen negotiations, Premier Kathleen Wynne and Health Minister Eric Hoskins agreed last month to discuss binding arbitration with the OMA at the start of renewed contract talks. That way it was not a precondition for the negotiations, for which no date has yet been set.

The big problem, though, is that the government needs predictability and sustainability in its fiscal planning. Thus its goalposts for arbitration will probably be too narrow for the OMA. For example, Queen’s Park may be willing to consider arbitration in the range of 2 per cent to 2.5 per cent, while the OMA may want to go to up to 7 per cent.

That would be a total non-starter for the government — and for the OMA.

Importantly, the doctors may find little real support for their case from the Conservatives and their leader, Patrick Brown. Like the Liberals, the Tories have historically opposed binding arbitration for government agreements. Privately, some Tory insiders say Brown is quietly backing Hoskins on this issue.

With both sides dug in so deeply, job or strike action by doctors seems inevitable.

Any action would probably be launched shortly before the June 2018 provincial election, with doctors also protesting at Liberal campaign events.

The OMA, though, is likely overestimating its political clout. Indeed, Wynne may view any doctors’ actions as a midlevel annoyance and not the massive headache the OMA believe it would be for the government.

That’s because the last time the OMA took such steps back in 1986 when some doctors struck over extra-billing, patients sided with the government, seeing the doctors as being too greedy.

The 1986 action was a public relations disaster for the OMA. A similar fate may await doctors if they use the same tactics today.

Instead of “striking,” doctors would be shutting their offices and clinics in order to attend “professional development” sessions