Ontario docs are leaving – patients have trouble finding good doctors

{May 16, 2012}   CMA President Dr. John Haggie to Premier Dalton McGuinty: You are “wrong-headed”

Canada’s medical associations lash out at Ontario over fee cuts

Written by Julia Belluz on May 16, 2012 for CanadianHealthcareNetwork.ca

Get back to the bargaining table—this was the message the leaders of Canada’s medical associations sent in an open letter to the Ontario government today, asking it to resume talks instead of imposing cuts on doctors and encouraging other provinces to do the same.

“The manner in which your government has imposed conditions on physicians without a true opportunity to build consensus is not acceptable,” the medical associations wrote, “and your efforts to convince the Premiers from the other provinces to adopt a broken model that excludes true collaboration are wrong-headed.” (View the full letter here.)

If that kind of legislated approach to (negotiations) takes root across the country, it’ll be a game-changer. It’ll wipe out the ability of doctors to negotiate.The letter, signed by Canadian Medical Association president Dr. John Haggie as well as the heads of all 12 provincial and territorial medical associations,  comes a week after the Ontario government announced that it made the unprecedented move of imposing unilateral cuts to the doctor fee schedule. Talks between the government and the province’s doctors had been breaking down, and since last Monday’s announcement of rollbacks, the government has refused to return to negotiations with the province’s doctors.

Though it’s unusual for the CMA and other provinces to get involved in jurisdictional affairs, Dr. Haggie told the Medical Post that the case in Ontario is “worrying” from the national perspective.

He said Ontario’s approach flies in the face of the Canada Health Act, which states that governments have the duty to negotiate responsibly with physicians. “If that kind of legislated approach to (negotiations) takes root across the country, it’ll be a game-changer. It’ll wipe out the ability of doctors to negotiate.”

This week, Ontario Premier Dalton McGuinty sent a letter to the provinces, appealing to them to follow Ontario’s lead and cut back fees paid to doctors (see below for details). “I urge you to consider how we might work together through strong, forward-looking reforms—such as those we are implementing in Ontario.”

Other provinces have reported that they may follow suit. Yesterday, Alberta Health Minister Fred Horne announced that his province is looking to overhaul its physician pay formula and rein in escalating fees. A representative at the health ministry in British Columbia said it is watching the developments in Ontario. As well, Nova Scotia said it is reviewing its fee schedule for doctors.

Involve doctors

Still, the provincial and territorial medical leaders urged governments to involve doctors in the process instead of shutting them out. “Right across Canada there are shining examples of innovative improvements in health care when physicians and governments work together to improve patient care,” the medical associations wrote. “Canadians expect nothing less from their elected representatives.”

As for the minority Liberal government in Ontario, the provincial leaders stated, “We encourage you to accept the Ontario Medical Association’s offer to continue negotiations, without any preconditions. A renewed approach that helps to find common ground has no risk and lots of potential opportunity to balance the current fiscal challenges with the increasing pressures facing the health care system.”

Some observers noted that doctors need to keep some perspective in this changing fiscal landscape. “They are still by far the highest paid professionals in the country,” said the Quebec-based health economist Pierre Thomas Leger. “We know it’s a lucrative field because there’s a lot of people waiting to become doctors.”
As Saskatchewan-based health-policy analyst Steven Lewis put it, “From time to time, governments have imposed constraints on doctors. I think the reason why it appears really draconian in this instance is because, for the last ten years, all governments have been extremely generous with medical associations.”
B.C.-based health-care economist Morris Barer said he wouldn’t be surprised if others follow Ontario’s example. “Provinces are trying to get their fiscal houses in order, and are not prepared to see exceptions made for the doctors.” He added: “This wouldn’t be the first time a province has cut back fee levels. Given the fiscal health of Ontario, I’m not surprised it’s happened there.”
Ontario fee cuts explained
In Ontario, the combined changes to the fee schedule, effective retroactively as of April 1, 2012, are expected to result in savings of $338.3 million in 2012/13, a government statement said. Cuts include:
  • CT and MRI scans for chronic low-back pain: This service will be removed, except where medically justified.
  • Echocardiograms: Fees will be reduced by half because of technological changes. Preoperative ECGs will now be cut because evidence shows they do not improve patient outcomes.
  • Diagnostic radiology: Fees for interpreting results will be reduced by 5%.
  • 3D interpretation fee for radiology: Fees will be reduced by 50%.
  • Cataract surgery: Fees will be reduced by 10%, from $441 to $397.75.
  • Self-referrals for diagnostic services: Payments for diagnostic services—when the physician providing that service is the same doctor who ordered it—will be cut by 50%.
  • Chronic dialysis team fees: These fees will be reduced by 10% to “reflect increased productivity.”
  • X-rays, CT/MRI scans and ultrasound: Fees paid for these tests will be reduced by 11% over four years.
  • Eye injections: The fee paid for this service will be reduced from $189 to $90 over four years.
  • OCT (optical coherence tomography) test for eye disease: The fee will be cut by 60% from $35 to $25 and this service will be limited to four times a year from six.
  • After-hours surgery: The premium for operations done between 5 p.m. and 7 a.m. will be cut to 40% from 50%.
  • Minimally invasive surgery: The premium for key-hole operations will be cut to 10% from 25%.
The silver lining: A new $16 fee for doctors who consult with other physicians via e-mail. Consulting doctors get $20.50.

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