Ontario’s move to cut fees for some doctors is an aggressive but necessary treatment. The government’s message to physicians should not be misinterpreted. Their skills are needed, and valued. They spent years on education and training and should be well compensated. But they are funded by the public purse and are not exempt from the fiscal challenges confronting the province. Ontario must restrain health spending.
Ontario cannot escape the troubling reality that despite generous increases to physicians in past years, it has not bought the necessary health transformation. Despite paying richer fees to family doctors, Ontario’s provincial auditor found in a report in December that there is little proof patients are getting more access to their services. The cut in fees will result in $338-million in savings in 2012-13, allowing the province to invest in more home care.
Government is now reducing fees for medical services where technological advances have made them quicker to perform or where they have been proven to not be medically necessary.
New technology, for example, has reduced the time it takes to do about 250 diagnostic radiology tests, including X-rays and CT scans. Since echocardiograms done before routine non-cardiac surgery do not improve patient outcomes, there will be fewer of them done. Most fee reductions will be absorbed by specialist groups, especially ophthalmologists, radiologists and cardiologists, where average projected annual billings in 2011-2012 are about $666,000, $668,000 and $585,000 respectively, for each specialist.
This is entirely reasonable. If new technology means a cataract operation takes 15 minutes instead of two hours, the taxpayer who funded the investments should share in the rewards, not the surgeon alone.
The government’s move has generated fiery rhetoric from physician interest groups – threats that patients will suffer and doctors will flee the province.
Ontario’s approach is being carefully followed by others. Four provinces – Alberta, British Columbia, Manitoba and Nova Scotia – are now considering overhauling doctors’ pay.
Doctors, like others whose income comes from the public sector, must face the realities of a bad economy. It is not personal – Ontario needs to get its fiscal house in order.