Over the next few months, Ontario doctors are going to be subject to severe clawbacks from the Ontario government, and I want my patients to know exactly what will be happening, and why we’ve gotten to this point.

The Ontario government and Ontario doctors failed to come to a funding agreement in January 2015. Rather than opt for a fair, binding arbitration process, the government proceeded to unilaterally impose a 3.15% cut to all doctor services (on top of the 2.5% cut from 2012) and, most concerning, to set an arbitrary cap on total compensation to doctors.

For those who don’t understand how physicians are compensated, here’s a Coles Notes version. Some doctors are paid fees for services based on a fee schedule set out by the government. Do a specific service, get paid a specific amount. Simple. Some doctors get paid based on the number of patients on their roster. Again, the government has agreed on a specific amount to pay them per patient. Simple. Depending on the patients seen, or the roster size, the government pays doctors once a month the owed amount. Simple again.

But here is what the government has decided to impose on doctors. They have decided to cut all of the individual visit fees by a set percentage, as well as setting a cap on total billings by all doctors. If total billings by doctors provincewide go above this arbitrary upper limit, the province will claw back that money from all doctors. Remember those monthly payments? For a few months this winter, each doctor might be paid zero dollars. Staff and expenses will still need to be paid, and I’ll show up to work every day to care for you for free, and I will pay for all of this out of pocket.

Let that sink in for a second. The government has set specific fees that they pay physicians for certain tasks or responsibilities. But if demand from patients over the next year (aging population, immigrants, outbreaks, etc.) exceeds the cap, then the province will not pay for that extra care. Patient demand for care is largely out of the control of physicians, yet the government is dictating that any demand above its arbitrary cap won’t be paid for. Physicians will continue to see patients, and not be paid for it.

There is no maximum clawback. Could it be five per cent or 10 per cent? With an aging population requiring more care than ever before, we can’t possibly fathom how high demand might go. If the government decides that it wants to fund more surgeries or new clinics or new nursing homes or any new program, total physician billings will increase, and the government won’t have to pay a penny more than the cap it has set. More physicians providing more services, and far less pie to share.

This column isn’t meant to earn your sympathy because I know many of you are struggling financially and doctors are still well paid. But we are asking the government for a fair process. It refuses to let an independent third party decide on fair compensation through arbitration, choosing instead to impose its own cuts. Any other profession would go on strike, but doctors realize how much our patients need us, and we would never go on strike (nor are we allowed to by our regulatory college).

If the government continues to make these severe cuts, the only recourse doctors will have will be to retire or to leave the province. Many already have since the negotiations fell apart in January.

Family doctors will leave the province, since other provinces need family doctors just as much as Ontario does, and seem to value them more. Alberta’s doctors agreed to a seven-year deal in 2013. Manitoba’s doctors agreed to a four-year deal in 2015. Saskatchewan agreed to a four-year deal just last month worth a two-per-cent increase per year over four years. Even Quebec has come to an agreement with its general practitioners.

In the past few months, doctors across the country have seen the negotiations playing out in Ontario. No other province has unilaterally imposed cuts and changes on its doctors. What this means is very few doctors will come here for the foreseeable future. Wait lists will continue to grow, and fewer patients will have access to a family doctor.

We aren’t asking for raises. We want the government to agree to a binding arbitration process, and let a third party decide on a fair outcome. Please contact your MPP to let them know your feelings on this issue. We can’t afford to lose Ontario doctors because of the stubbornness of this government.

Mario Elia is a London doctor.