After a four-plus year battle, the provincial government and the Ontario Medical Association finally have a new fee contract — one that does not include a cap on how much doctors can be paid, but requires the elimination of $460-million worth of “inappropriate” medical services.
A three-member board of arbitration released its decision in the dispute on Tuesday. The dispute was referred to binding arbitration in 2017, after the two sides were unable to reach a negotiated settlement.
“It seems to us that at the centre of our mission in resolving the matters in dispute is (ensuring) a high-quality patient-centred sustainable publicly funded health-care system with fair and reasonable compensation for Ontario’s physicians,” wrote the board, chaired by arbitrator William Kaplan.
At more than $12 billion, physician compensation accounts for about 22 per cent of the health ministry’s $56-billion budget, the decision notes.
“Caution in increasing expenditures is obviously called for together with acknowledgement that fiscal resources are not infinite and that an increase in one area — for example, physician compensation — will have an impact in others,” it reads.
The new four-year physicians services agreement is partially retroactive, running from April 1, 2017 to March 30, 2021.
The board rejected the province’s request for a hard cap to be placed on the total amount physicians can bill the province annually.
“If the ministry wishes to limit the insured physician services patients receive, it can readily do so. What it cannot do is achieve this outcome by requiring Ontario doctors to subsidize public services. That would be the direct result of the imposition of a hard cap,” the decision states.
In making the case for a cap, the government had argued that Ontario doctors are working less and seeing fewer patients but billing more.
The OMA, which represents 31,000 practising doctors, denied that its members deliberately provide inappropriate services to increase their income.
But the board ordered that the two sides strike an “appropriateness working group” to eliminate or restrict inappropriate or overused physician services — $100 million worth in 2019-20 and another $360 million worth the following year.
The decision notes that the Canadian Institute for Health Information and Choosing Wisely Canada estimate that as much as 30 per cent of medical services are unnecessary and inappropriate.
It also cites a study which found that fewer than 4 per cent of Ontario’s 11,448 family doctors are responsible for ordering nearly 40 per cent of tests considered low value.
The arbitration decision provides doctors with redress, eliminating most but not all of the fee cuts imposed by the province in recent years, effective this coming April.
As well, it awards physicians with increases of 0.75 per cent for 2017; 1.25 per cent for 2018; 1 per cent for 2019; and 1 per cent for 2020.
The release of the decision marks the completion of phase 1 of the arbitration process.
Phase 2 will look at how the physicians services budget is to be divided up among different specialty groups, a controversial process known as “relativity.”
An internal OMA report previously found that some specialties are underpaid and others overpaid. It called for adjustments to be made.
In its decision, the arbitration board stated how it wants to see relativity addressed:
“We would not be inclined as a board of arbitration to direct that the fees or compensation paid to some groups should be reduced, in order to increase the fees or compensation paid to other groups … Given the history over the past several years, we do not believe that this is a time for any further reductions to physician compensation.”
The arbitration board also called for the creation of a working group to resolve a disputeover how much family doctors should make.
In written statements, Health Minister Christine Elliott and OMA president Dr. Nadia Alam described the arbitration decision as workable and noted that neither side got everything it wanted.
On social media, doctors had been expressing fear that the government would use the “notwithstanding” clause to get out of the arbitration requirements. Those fears were fuelled by an aborted move made by the government late last year to back out of arbitration.
Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle
https://www.thestar.com/politics/provincial/2019/02/19/doctors-get-new-contract-with-province-after-4-year-battle.html
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