Some members of eight well-paid physician specialty groups recently voted to leave the Ontario Medical Association (OMA) to form the Ontario Specialist Association (OSA). These specialists claim the OMA does not represent their interests and have asked government to negotiate with them separately from the rest of the province’s doctors.

Despite lofty rhetoric about self-determination and minority rights, this splinter group seems mainly concerned with protecting high incomes resulting from Ontario taxpayers investing in the technologies or practice changes that support their specialties.

Three of the eight groups that voted to leave the OMA are diagnostic imagers (also known as radiologists). In most cases these doctors earn their living at computers reporting on digital images captured from MRI, CT, and other imaging equipment.

Similar to other specialists in the OSA, radiologists have substantially increased their income in the last 20 years. According to government arbitration documents posted on the OMA website, from 1992 to 2016 radiologists increased their billings by 163 per cent to earn an average of more than $560,000 a year. During this time period, average Ontarian wage growth was 66 per cent.

About 13 per cent of Ontario radiologists billed more than $1 million in 2016/17.

The same government documents show the average radiologist worked 12 per cent fewer days in 2015/16 compared to 1992/93.

How did radiologists achieve this substantial increased income while working fewer days? My view, as a former cancer surgeon who analyzed MRI’s, CT’s and other images as a daily part of surgery practice, is that radiologists have benefitted from a technology windfall funded by Ontario taxpayers. It is no surprise that these specialists now want to leave the OMA in order to protect this windfall.

The technology windfall started with taxpayer funded purchases and operational funding for MRI and CT equipment in hospitals. Over the past 22 years, radiology billings for MRI’s have increased by 3,400 per cent and CT billings have increased by more 400 per cent. In 2013, the Canadian Institute of Health Information found that Ontarians had more access to MRI tests than other Canadians.

During the same time interval, taxpayers also purchased hospital computer work stations and radiology digital systems that allow radiologists to read images more efficiently.

These investments in imaging modalities have improved patient care. However, these taxpayer purchases have also allowed radiologists to improve their productivity and transform their billing profiles to increase tests with higher income value (MRI vs. plain X-rays).

In arbitration proposals available on the OMA website, government suggests that radiology fees should be reduced along with fees paid to other specialists (all members of the OSA) who have benefitted from similar taxpayer investments. These reductions would equilibrate OSA incomes with other specialists’ compensation. The proposed fee reductions would reduce annual Ontario healthcare costs by about $120 million (1 per cent of the physician budget).

The OMA governing council endorsed a recommendation (subsequently rejected by OMA board) that high-earning specialists should be paid less. The recommendation differed from government in recommending that reduced high earners’ incomes should be redistributed to lower paid doctor groups rather than decreasing health costs.

Given this focus on lowering high billers’ incomes, it is no surprise that these specialists want to leave the OMA. However, it’s not up to the specialists to decide whether they can leave the current OMA arbitration; it’s up to government.

In previous deals with doctors, government agreed that the OMA would be the sole bargaining representative for physicians. The government is now considering whether to unilaterally revoke this agreement and negotiate separately with the OSA.

If separate negotiations were held with the OSA it is likely that a quick agreement would follow with OSA accepting a four-year fee freeze. The government would suggest that they had achieved a good deal for taxpayers. In reality, this freeze would leave the OSA with their technology windfall protected forever and ignore a potential 1 per cent reduction in physician costs.

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Allowing these specialists to escape arbitration with their windfall intact would be an affront to the taxpayers of Ontario. We have all paid for the technology that allowed these well-paid specialists to increase their compensation.

If the government respects the taxpayer, the OSA will not be allowed to protect their technology windfall with separate negotiations.