The Ontario government’s long-running fight with physicians has been settled – for now, at least – with an arbitration decision that will see the total amount the province pays to doctors increase by at least 3.5 per cent over four years.
Nadia Alam, the president of the Ontario Medical Association (OMA), welcomed the ruling as a “fair” decision that “introduces much-needed stability for doctors” after years of unilateral cuts by the former Liberal government and an aborted attempt by its Progressive Conservative successor to kill the arbitration process.
“The last few years have been really tough for physicians,” Dr. Alam said. "They’ve sacrificed a lot since 2015. I know of many good doctors who’ve had to make difficult business decisions, some who have closed their practices, retired early or even moved away. The uncertainty has been hard. This agreement puts a close to that chapter.”
Ontario Health Minister Christine Elliott said in a statement that Premier Doug Ford’s government intends to respect the three-member arbitration board’s decision, which was released on Tuesday.
“Our government believes that this award is a positive step forward, and we are committed to a renewed and productive working relationship with the OMA and Ontario’s doctors,” Ms. Elliott said.
Dr. Alam said that positive note from the Health Minister should reassure physicians who feared the government would try to pass legislation nullifying the arbitration award if it was deemed too generous.
“Their commitment to respecting the arbitration award, which [Ms. Elliott] spells out pretty clearly in her statement, is deeply reassuring to me. And it will be seen the same way by many, many other doctors around Ontario.”
The four-year agreement is retroactive to April 1, 2017. It includes “global payment increases" of 0.75 per cent for 2017, followed by hikes of 1.25 per cent for 2018, 0.5 per cent in 2019 and 1 per cent in 2020, plus an extra 0.5 per cent this year to make up for a payment discount enacted in 2012.
But that does not mean that annual increases to the physician services budget – the total amount the province pays its doctors – will be limited to the amount of the global payment increases. The arbitration panel rejected the government’s request for a hard cap on the physician services budget, meaning it could increase further if a growing and aging population uses more health services.
“If the Ministry wishes to limit the insured physician services patients receive, it can readily do so," the panel wrote. "What it cannot do is achieve this outcome by requiring Ontario doctors to subsidize public services. That would be the direct result of the imposition of a hard cap.”
The arbitration decision will also see some across-the-board “payment discounts" halted as of April 1, but targeted cuts implemented by the former government will remain in place.
The thorny question of how much of the global payment increase will go to which kinds of doctors will be answered in the next phase of arbitration.
In the meantime, the arbitration panel punted some other contentious issues to two working groups – one of which will tackle changes to family medicine, while the other will try to reduce the use of medically unnecessary or inappropriate medical services.
The latter group has been asked to find $100-million in savings by May 1 for the 2019-20 fiscal year and a further $360-million in savings by Sept. 30 for the following fiscal year – all without changing, setting or reducing fees.