‘Desperate’ optometrists’ wage protest costs Ontario $250K a day
Critics say eye doctors using patients as ‘cannon fodder’ in fight over compensation
As a funding dispute with the province intensifies, Ontario optometrists are redirecting patients to emergency departments, part of a negotiation tactic costing the public health system $250,000 a day.
The job action, the financial details of which are described in internal communications by the Ontario Association of Optometrists, is facing criticism for treating patients like chess pieces during a pandemic, unnecessarily sending them to hospitals that have worked to maximize capacity to handle COVID-19.
The internal communications show the association is encouraging its more than 1,700 members to redirect at least one patient a day to emergency departments or other health-care providers.
That means a patient experiencing something flashing or floating in her vision, who would normally be examined by an optometrist, is instead being sent to an ER at a significantly greater cost to the public health system.
“Once we start hitting the half a million dollar mark in redirection costs ... this is a leverage point to get commitment from the government to fix the funding problem,” association president Dr. Sheldon Salaba wrote in a July email distributed to optometrists.
In an interview, Salaba said it was a “difficult decision” to pursue a job action that “turned patients away or denied them care.”
“We’re in a desperate situation. We can’t afford to see these patients in this environment because of this funding inequality,” he said.
“I understand that it’s inconvenient for people. I don’t like having to go to an emergency room myself ... but we didn’t create this problem,” he said, saying the blame lies at the feet of “successive governments (that) have failed to come to the table and find sustainable funding solutions for optometric services.”
Salaba said the optometrists’ association, which represents close to 70 per cent of the province’s optometrists, chose emergency rooms with patient care in mind, as they have the necessary equipment to properly diagnose patients’ eye issues.
The Ontario Health Insurance Plan covers optometry services for people under 20 or 65 years and older, as well as individuals of any age with certain medical conditions. These OHIP-covered patients make up roughly 70 per cent of Ontario optometrists’ practices, Salaba said.
But remuneration for these services has barely changed over the last 30 years, and the modest increases in funding are dwarfed by the rate of inflation, Salaba said.
It costs at least $80 to $90 to see a patient, but the province reimburses only $44 on average, Salaba said.
That means Ontario’s optometrists are spending $173 million a year to subsidize the province’s eyecare system, he said.
The precarious financial footing has been weakened by COVID-19, with most optometry clinics reporting a revenue drop between 75 per cent and 85 per cent since March, according to the association.
The decision to funnel patients to emergency departments as a negotiating tactic is concerning, said Dionne Aleman, an associate professor at the University of Toronto who specializes in pandemic planning.
“Sending people to an emergency department right now, even though public prevalence across the province is pretty low, is putting people at a really unnecessary health risk and exposure level to COVID,” Aleman said.
“If I was a patient who had some kind of minor optometry problem and my optometrist sent me to an (emergency department), I would feel like cannon fodder in their fight with the province. I would not be OK with that, personally.”
She said the unnecessary influx of patients also puts an added burden on emergency departments that for years have struggled to promptly treat people.
Assuming a redirected patient does not in fact have an urgent health problem, the person will be triaged as a lower priority.
“They might end up spending all day waiting in an emergency department while patients with actual emergency issues are seen ahead of them,” Aleman said. “It’s basically a huge waste of a patient’s time.”
Salaba said he does not think the job action is putting patients at undue risk.
“The environment we’re in now is dramatically different than it was at the beginning of the pandemic. Case counts are very low.
“An emergency room is as safe a place to be seen, I would think right now, as our offices would be,” he said.
The job action was launched in mid-June. As of mid-July, 43 per cent of the patients redirected from optometrists were being sent to emergency departments, according to Salaba’s internal message to the optometrist association. Most of the remaining patients — 41 per cent — were being sent to physicians.
In the email, Salaba said by sending all redirected patients to ERs instead of family physicians, the job action could cost OHIP $400,000 a day.
In a statement, the office of Health Minister Christine Elliott said payments for OHIPinsured optometry services have risen as the number of patients seen grows. “We expect optometrists to continue to deliver the quality care that patients expect and deserve, as they always have,” the statement reads.
Salaba called the province’s comments “misleading,” and said a growing number of patients does not make the system any less unsustainable if optometrists must continue covering half the cost of their services.
“If this is allowed to continue and our offices close, then the access to care becomes permanent and people will definitely fall through the cracks,” he said. “We need a public commitment from the province to work with us to fix the problem.”
The College of Optometrists of Ontario, which regulates the profession, is closely monitoring the job action and has advised optometrists to consider how withdrawing services may adversely impact patients.
College president Dr. Patrick Quaid said the regulator is less concerned about whether an optometrist is seeing or redirecting a patient and more focused on ensuring patients receive timely care.
“The patient should not be abandoned,” he said.
“If (optometrists are) delegating or triaging to someone else, you want to follow up to make sure that patient actually got seen.”
He said he’s hopeful “level heads will prevail” and the province and optometrists reach a resolution.
“Ultimately, if the job action escalates, it’s very likely it will be the public who will pay the price for it,” Quaid said.
“Sending people to an emergency department right now is putting people at a really unnecessary health risk and exposure level to COVID.”
DIONNE ALEMAN UNIVERSITY OF TORONTO