Doctor pay should be fair for all: Eric Hoskins

Posted on May 1, 2016 in Health Delivery System – Opinion/Commentary – Changes to how much we pay some medical specialists have not kept pace with advances in technology. It’s time to change the system
Apr 30 2016.   By: Eric Hoskins

How can we improve health care so that it better serves patients? As Ontario’s minister of health and long-term care, that’s the question I ask myself every day. I am responsible for managing the health care system so that it provides patients with faster access to care today and is able to meet patient needs in the future.

Our government has made tremendous progress over the past decade. Since coming into office, we have worked closely with health care providers across the province to make significant investments in health care. Our plan includes investing $51.8 billion in health care in the year ahead — including an increase by over $1 billion this year. That means adding 700 new doctors and specialists this year alone.

Ontario’s doctors have been invaluable partners in this progress. I’m a family doctor and public health specialist, and I know how hard our doctors work to provide excellent care. Ontario’s doctors are the best paid in Canada — and we make no apology for that. They deserve to be well compensated because they are the best.

But we need the Ontario Medical Association (OMA) — the organization that represents Ontario’s doctors — to come back to the negotiating table so that we can reach an agreement on physician compensation that is fair for all of us.

The current system is not entirely fair. Changes to how much we pay some specialists have not kept pace with advances in technology. As a result, many specialists make three or four times what the average family doctor makes — and sometimes much more.

Improvements in medical technology have allowed some high-billing specialists to perform many more procedures in the same amount of time, and their billings have gone up and up. Cataract surgery, which used to take more than an hour, can now be performed in 20 minutes or less.

Last year in Ontario, 500 doctors billed more than $1 million. Altogether, those 500 people billed more than $677 million. Those two per cent of doctors accounted for 10 per cent of all doctor billings.

The highest-billing specialists are not doing anything wrong, but they have an advantage over other physicians — including hard-working family doctors — in a billing system that is outdated and needs to catch up with the 21st century.

Spending more and more on those highest-billing doctors means we can’t invest as much as we would like to in other patient priorities like hospitals, home care and mental health supports.

Over the last four years, physician billings were almost $750 million over what had been budgeted. That $750 million could have paid for 60,000 chemotherapy treatments; five million more hours of personal support care in patients’ homes; two million home care nursing visits; and dialysis treatment for 2,100 more patients in hospitals.

We need a growing but predictable budget for the way we pay our doctors.

For more than a year now, I have urged the OMA to come back to the table and restart formal negotiations. I’m pleased that they have finally indicated their willingness to resume talks and I’m confident we can set a date as soon as possible.

Returning to the table is in the best interest of patients and physicians. And we are willing to discuss mediation/arbitration at the negotiation table, but it cannot be the only item on the agenda.

There are important issues that must be part of formal negotiations. We must reach a long-term agreement that provides for a predictable budget so we can invest in patient priorities. It must address a long-standing inequality in the billing system that disadvantages many of Ontario’s physicians. And finally, we must find a way to work together on transforming our health care system to ensure it continues to provide the best care possible to patients, now and for generations to come.

That is what both sides must agree on if we’re to ensure a truly sustainable health care system — which, surely, is what all of us want.

Dr. Eric Hoskins is Ontario’s minister of health and long-term care.

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