By Dr. Charles Shaver
At the health ministers conference in Vancouver in January, federal minister Jane Philpott promised to co-operate in reducing drug costs - the first step toward a national pharmacare program. She also pledged to improve palliative and mental health care, and eventually to sign a new health accord with the provinces. However, she should have discussed another urgent issue:
Several weeks ago, Ontario corrections officers were granted binding arbitration. Unfortunately, despite an impasse in negotiations, Health Minster Eric Hoskins has refused to use this dispute resolution process for physicians.
The new Ontario budget fails to spell out how much money will be set aside for doctor compensation, but it hopes for a "predictable" budget. This will lead to unintended consequences for patient access to medical care.
The prevalence of diabetes mellitus, congestive heart failure, and dementia are all predicted to rise steeply over the next decade. Does it then make sense for OHIP to unilaterally slash by 30 per cent follow-up fees for internists, cardiologists, nephrologists, and gastroenterologists for these and nearly 30 other chronic diseases? This was done last April with the blessing of Hoskins.
The higher fee had been put in place 10 years ago to compensate physicians for the extra time required for a detailed history and physical exam, drug reconciliation, an explanation of drug interactions and potential side effects, a discussion of dietary restrictions, adverse effects of certain diagnostic procedures, etc. This type of preventive medical care would have helped to keep patients out of hospital, thereby saving money for the total health care system.
Because of the Canada Health Act, MDs cannot opt out or set their own fees. Their ethics preclude a strike. Despite 10- 5 years of education post-high school, their employment choices in Ontario are extremely limited, as they effectively have only one de facto "employer" - namely OHIP, albeit with no fringe benefits. Should they attempt to bill a patient even one dollar over the OHIP schedule of benefits to cover rising overhead costs, thanks to Ontario Bill 94, they can theoretically be fined $1,000.
For years, "negotiations" between the Ontario government and its physicians have become a mockery - replaced by a hard ceiling on total physician expenditures and targeted fee cuts of 20-30 per cent. For example, nearly four years ago, ECG interpretations fees were slashed by over 50 per cent, whereas previously they had been nearly the same as in most other provinces.
Although Hoskins repeatedly alleges that Ontario MDs are the best paid in Canada, the facts do not support this. In the Feb. 16 issue of the Medical Post, the Ontario compensation for family physicians was ranked number 9 out of nine provinces (P.E.I. was not included), for internists, general surgeons and pediatrics, seventh, orthopedics eighth, and urology ninth.
It is easy to understand why the Ontario Medical Association (OMA) initiated a Charter challenge in an attempt to win binding arbitration. Eight other provinces and territories already have such a mechanism in place.
Sadly, this process will take years. Can patients, physicians, and politicians simply wait and watch access to the Ontario health care system rapidly decline?
Binding arbitration would provide fairness. It would also not necessarily lead to excessive, unaffordable awards. Prior to the breakdown in negotiations, the OMA agreed to a temporary fee freeze. However, it certainly did not agree to drastic, targeted fee cuts of 20-50 per cent. It also did not agree to a hard, unrealistic ceiling on total physician services expenditures regardless of population growth (such as an influx of refugees and migrants), an aging, sicker group of patients, newer technologies, future possible pandemics, etc.
Hoskins falsely reassures the public that nothing will change. Yet he ignores the many younger, mobile physicians - many hundreds of thousands of dollars in debt from their years of training - who may, in frustration, simply leave the province or even the country. He also ignores the older MDs who may retire prematurely, the clinics that may close, and the rapid decline in access to care for patients across Ontario.
This stalemate could be resolved fairly quickly. Federal health minister Philpott should take the initiative to amend the Canada Health Act (CHA) to make binding arbitration mandatory when negotiations fail, as has occurred in this province.
The exact wording was proposed in the spring of 2013 by the Canadian Medical Association. Recall that the CHA has been amended before - and fairly recently - when in June 2012, Bill C-38 caused RCMP members to be covered by their provincial health insurance plans.
Guaranteed binding arbitration for physicians would improve patient access to care and validate in a concrete fashion the previous Liberal pledge of "collaborative federal leadership."
Ottawa physician Dr. Charles S. Shaver graduated from Princeton University and Johns Hopkins School of Medicine. He is currently chair of the section on general internal medicine of the Ontario Medical Association.