Ontario doctors vs. the Ontario government: the public deserves better

Last week, taking in the failed negotiations between the MOHLTC and the OMA, Dr. Mario Elia voiced his thoughts in the Healthy Debate column: “Ontario doctors vs. Ontario government: we need better”.

The ‘we’ in Dr. Elia’s title refers to the collective group of physicians represented by the OMA, and his arguments draw attention to what he and many others feel is disingenuous political spin by Health Minister Dr. Eric Hoskins.

A major component of the Physician Service Agreement (PSA) being negotiated is physician billing. Physician billings represent a huge chunk of money, making up about 10 per cent of Ontario’s budget, and any change to these fees affects the take-home pay of Ontario’s over 30,000 physicians. Thus, the failed negotiations are of great interest not only to physicians, but also to all Ontario taxpayers. The parties began the negotiation process in January 2014, four months before the 2012 PSA was to expire. Despite third party involvement, including a facilitator, Dr. David Naylor (former president of the University of Toronto) and then a conciliator, the Honourable Warren Winkler (former Chief Justice of Ontario), the parties have yet to reach an agreement. Since the negotiations are confidential, public opinion relies on media coverage, OMA and ministry communications, and the recently released conciliator’s report.

The OMA, which represents the political, clinical and economic interests of Ontario’s physicians, insists that their rejection was in order to protect the public. They are certain that the government’s plan will result in decreasing overall access to care and put patients at risk and have made a number sweeping claims to this effect; however, they have not provided evidence showing how decreases to physician compensation will negatively impact patient outcomes. Minister Hoskins, on the other hand, insists very little will be felt by the public. Perhaps a bit of spin of his own (no denial here), but he does not attempt to pull on our heartstrings to get the message across nor explode social media with this message, as opposed to the OMA and their use of catchy #hashtags and patient stories.

It’s incredibly scary to hear our physicians, who hold an enormous amount of social clout, saying that the care they provide will be compromised by the ministry’s proposed cuts. But, the entire narrative created by the OMA that our government does not care about healthcare is just misleading. This narrow, sensational view does not recognize that PSAs and the provincial healthcare budget do not exist in a vacuum. Ontario’s precarious economic situation, with the highest debt-to-GDP ratio in the province’s history, has left the government with some difficult decisions. Of course, healthcare is important and better care should be everyone’s priority, but it’s not as if all other provincial responsibilities can kneel to healthcare. There are innumerable areas in need of greater public policy investment including, for arguments sake, Toronto now ranks first in Canada when it comes to child poverty. Ontario’s poverty reduction strategy could likely use a few bucks as well.

With physician compensation attracting public attention, physicians are, rightly so, concerned that the public easily mistakes physician billing as take-home salary. We agree that it’s important to acknowledge that most physicians face significant overhead costs (a mean of about 28% of their gross income), no benefits and no pensions. And, no, the government does not often communicate this, but let’s also consider that the OMA would never include in their communications that, contrary to most tax payers and all other public servants, many physicians are incorporated and receive generous tax exemptions.

Or, how about the complete lack of transparency when it comes to physician salaries in general? Most taxpayers, and even physicians, would better understand the implications of these negotiations if this was not the case. Disclosing OHIP billings is strongly lobbied against by the OMA.

Physicians are generally empathetic, charitable, and extraordinary at what they do. Physicians make many sacrifices during years of arduous education and incur extensive debt. Their chosen career is very stressful and demanding. Perhaps some physicians are underpaid, depending on where and what they do, but, the thing is, many professions are underpaid and overworked, particularly in healthcare – consider the average salary of a social worker. This is why the OMA has spun their public messaging around everything except billing details, the major item on the negotiating table.

Finally, the repeated references made by many to other government controversy or scandal is distracting, has no bearing on these negotiations, and is as irrelevant as presenting, say, the lack of disclosure when it comes to medical errors as a reason to cut physician billing.

As Dr. Elia eloquently put it, physicians generally feel that they are paid adequately for the services they provide, so let’s move on and stop interpreting this situation as an attack on the cherished role physicians play in our society but instead as a difficult policy decision in a time of serious economic hardship. Of course the government is spinning their message, but please expect no less from the OMA.

Maaike deVries is an epidemiologist and currently working in the healthcare sector. Follow Maaike on Twitter @deVriesMaaike. Jonathan Gravel is an epidemiologist and currently a medical student at the University of Ottawa. Follow Jonathan on Twitter @gravel_jon.