Ontario doctors should accept deal on pay

Posted on August 11, 2016 in Health Delivery System

TheStar.com – Opinion/Editorials – Ontario doctors would be both wise and socially responsible to vote in favour of a tentative agreement with the province this week.
Aug. 10, 2016.   Editorial

It’s no surprise that relations between Ontario’s government and the province’s 42,000 doctors have become downright nasty. After going more than two years without a contract and enduring back-to-back fee cuts, many physicians are hopping mad.

This week, though, they face a choice. They can continue their face-off with the government and risk further unilateral cuts, or accept a deal that would give them modest fee increases, a guarantee against more reductions, and a bigger role in managing the health care system.

On balance, they should accept the deal. It’s a significant improvement over what the government had been offering, and it offers a path towards a more responsible way of balancing doctors’ pay against other important parts of the province’s health-care budget.

There’s no guarantee of the outcome. As Bob Hepburn explains on the opposite page, a significant number of doctors are furious about the proposed four-year contract. They’re directing their fire both at the government and the Ontario Medical Association, which is in the uncomfortable position of conceding that while the deal is “imperfect,” it’s still a “reasonable offer to members in tough economic times.”

That’s hardly a ringing endorsement. But doctors would be both wise and socially responsible to vote in favour of the tentative agreement this week.

They’d be wise, because the government’s offer of 2.5 per cent increases in the overall physicians’ budget every year for the next four years is double what it was prepared to give previously. The government was determined to hold the line at just 1.25 per cent, an offer endorsed by conciliator Warren Winkler, a former chief justice of Ontario.

In addition, by signing on to the deal doctors would avoid further unilateral cuts to their fee schedules, such as those imposed twice recently to keep spending on doctors’ services in line. And the province is prepared to make additional annual payments of from $50 million to $120 million if budgets are met.

Importantly, doctors would get a stronger voice in managing reform of the health care system. And the OMA would be free to continue its court fight for binding arbitration in negotiations with the government. That could blow up health care budgets, but from the doctors’ point of view it would be a huge gain.

The most militant physicians, led by a group called the Coalition of Ontario Doctors, call the deal a sell-out by the OMA. They warn the proposed increases won’t cover inflation and pressures created by a growing and aging population.

But short of giving doctors a blank cheque, it’s hard to imagine what the government could do to keep them all happy. After enjoying substantial fee increases for years under the McGuinty government (individual billings increased an average of 61 per cent in 10 years), doctors are now learning the party is over. The more they get paid, the less money there will be for other important health priorities – notably expanding badly needed home care services.

The proposed deal will buy peace with doctors for a few years, if a majority of them vote to accept it. But the bitter dispute has underlined some real problems in the system that must be addressed.

They include big imbalances between fees for various physicians’ groups. It’s now well established that some specialists – notably ophthalmologists and radiologists – can rake it in simply because the existing fee structure rewards them well for tasks that don’t take a lot of time because of technological advances.

In fact, there needs to be a fundamental review of the fee-for-service model itself. Doctors naturally tend to perform tasks they can bill for – such as surgical procedures or prescribing drugs. The system doesn’t encourage simply talking and listening to patients, so often that doesn’t get done.

Moving to a more patient-centred system will take a lot of time and a lot of talk. In the meantime, doctors should accept the reasonable deal they’re being offered.

< https://www.thestar.com/opinion/editorials/2016/08/10/ontario-doctors-should-accept-deal-on-pay-editorial.html >

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