Social Policy in Ontario

The current debate in Ontario over physician compensation is focused on how much doctors make, but we would all do well to circle back to a more primary question: how do doctors get paid?

I am a physician who welcomes the Ontario government’s plan to improve transparency of physician billing under the Ontario Health Insurance Plan (OHIP). I can say this with confidence because I am one of the 400 Ontario doctors who works in a salaried, team-based model of health care, and my full salary is already publicly available on Ontario’s Sunshine List. Transparency? Check.

I have full respect for my fee-for-service colleagues and the challenges they face running for-profit businesses within a publicly funded health-care system — it’s difficult. It’s also an out-dated model and it’s time we put the needs of patients, communities and our health care system first.

I work at a community health centre where physicians are employees of a larger team that delivers day-to-day primary health care alongside other health professionals, such as dietitians, physiotherapists, and mental health professionals, in a health promotion and community development setting.

For me, working in a salaried health care organization means I can provide care in ways that best meet patient needs, including appointments where I can deal with more than one issue per visit and fully collaborate with team members. In other words, I can be effective and efficient in ways that focus on the patient and are not influenced by the way I get paid.

Operating as a salaried physician frees me from this entire sphere of issues. I can participate in delivering home-based primary care to those who need it; I can take phone calls with case workers of patients to make sure care is co-ordinated and not duplicated.

As the Ontario government bolsters its oversight of OHIP, I would like to see physician accountability move away from billing practices to emphasize quality of care and population health indicators that incentivize following best practices and address the real needs of people and communities.

If Minister of Health Christine Elliott is seeking to ensure a more sustainable health care system, and I believe she is, then now is the time for her and the provincial Ministry of Health to start thinking about a transition in the current compensation model. Currently, there are no policy mechanisms by which Ontario can hire more salaried physicians or create more positions.

Ontario has the capacity to change this, especially as it restructures the health care system through the Ontario Health Teams (OHTs).

A more affordable, simpler and transparent approach to health care can start with creating more opportunities for salaried physicians to be hired by emerging OHTs.