Why Ontario’s doctors won’t win fight on fees

Posted on May 13, 2012 in Health Delivery System

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TheStar.com – news/canada/politics
Published On Sat May 12 2012.   By Martin Regg Cohn, Queen’s Park Columnist

Remember that warm and fuzzy ad campaign depicting doctors in white coats, sporting stethoscopes and smiles?

Doctors aren’t smiling any more.

That feel-good branding exercise, part of a year-long charm offensive by the Ontario Medical Association just ahead of fee negotiations, has faded from bus shelters. Now, doctors find themselves sheltering from a perfect storm that is branding them as the fall guys.

It’s not just the governing Liberals taking a hard line, but the opposition Tories demanding a blanket freeze and New Democrats wanting to make the rich pay. With public servants taking a hit, the healing profession is feeling everyone’s fiscal pain.

This time, the writing was on the wall before both sides even sat down at the table. Cabinet approved its final negotiating “mandate” in February for doctors — and teachers: No spending increases.

Doctors are paid about $11 billion; factor in teachers and other public servants with contracts up for renewal, and about $25 billion is at stake in negotiations this year — nearly one-quarter of total government spending. That’s why retreat is unlikely, lest the government’s deficit-reducing fiscal plan crumble.

Read more:How Ontario’s doctors get paid

Outgunned, the OMA deployed a secret weapon of its own: It hired the government’s guy.

As deputy minister of health in the last negotiations, Ron Sapsford helped craft the government line. After leaving in the wake of the eHealth scandal, he joined the OMA, rising to CEO last year.

Sapsford has changed chairs, but times have also changed.

Last time, the government was flush with cash and keen to win OMA support in a highly politicized drive to reduce surgical wait times and increase the supply of family physicians.

This time, doctors can’t complain of falling behind: payments have increased by 75 per cent since the Liberals took power in 2003. They remain the best-paid in the country (despite quibbling from the OMA and others, the data suggest our docs are tops when all payments are included for 2011).

This time, threats of another brain drain are contradicted by the quiet return of émigré doctors from the once-promised land of America, describing how private insurers won’t authorize treatments, patients don’t pay their bills, and malpractice premiums are punishing. Also, medical school slots have recently doubled with a clutch of new schools across Ontario, plus a surge in foreign-trained doctors.

This time, technological advances have bolstered the government’s case for fee reductions. Exhibit A is cataract surgery, which takes 15 minutes today compared to two hours in the past.

This time, expert opinion — and a strong all-party political consensus — is pushing to reallocate spending to long-term care and home care, freeing up acute care beds.

And this time, the government is being goaded by outside experts to hang tough. In his high-profile reported last February on public spending, economist Don Drummond warned, “Aggressively negotiate with the Ontario Medical Association for the next agreement.” In his annual report, Auditor General Jim McCarter complained that Ontario may not be getting value for money from special incentives for doctors.

Against that backdrop, Sapsford hasn’t been able to deliver any medical miracles for the doctors he once bargained against, but now bargains on behalf of. In frustration, the OMA walked away from the table last month.

Sapsford also faces a formidable opponent in Deb Matthews, the health minister whom he served for a few months before taking his leave. Matthews is not above demonizing doctors in public. She has artfully sugar-coated the freeze, which in reality amounts to cuts for some (since more than 550 new doctors every year will compete for that fixed pie).

Last week, Matthews went ahead with nearly 40 unilateral fee changes that achieved most of the government’s targets for this year. Now, she is inviting them back to the table to address the unfinished business for the next three years.

As for Sapsford, his OMA sought a private meeting with Premier Dalton McGuinty. But it was seen as an end-run around Matthews, his former boss. In the end game, the meeting never materialized.

And doctors aren’t smiling any more.

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