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On Monday, the arbitration positions of the Ontario Medical Association and the Ontario Ministry of Health and Long-Term Care were made public.

There is nothing new in the documents and that, in itself, is surprising, and a bit troubling.

The bitter labour dispute between the Ontario government and the OMA has been going on for years.

The one glimmer of hope came last summer when the province and the OMA agreed to a framework for binding arbitration.

The first step of that process, in which each of the parties lays out its position, makes clear that both sides have dug in their heels.

This is the biggest labour contract in North America − it covers 38,450 physicians in 48 specialty groups. It’s almost impossible to get it right, but we owe it to ourselves to try.

There are three principal issues to be discussed and resolved during the arbitration process:

  • Redress for the cuts that have been imposed during the past four years that physicians have been without a contract;
  • Compensation changes: increases in payments to physicians in a new four-year deal;
  • Establishment of the overall physician services budget.

Let’s look at each of those in turn.

Ontario physicians have seen their fees cut by approximately 7 per cent during the time they have been without a contract. The number is imprecise because the cuts have occurred in different ways, including across-the-board reductions in fees, larger targeted cuts for specific specialties and rollbacks when the overall physician services budget is exceeded.

The impact also varies considerably between individual physicians. Ontario doctors bill, on average, $375,500 annually, but that’s before overhead for offices and equipment, which can vary a lot.

The OMA is asking the arbitration panel to reverse the cuts and allow doctors to recoup those monies. The ministry position is that the payment discounts and fee cuts should remain in place and there should be no redress.

That’s a reminder that there is a yawning gulf between the two parties on how to patch things up for the poor labour relations of the past four years.

And negotiating a contract for the next four years is, arguably, even more difficult.

The OMA is looking for a 4.26-per-cent fee increase effective April 1, 2017 – 1.4 per cent annually for the past three years, roughly equivalent to increases afforded public-sector workers.

In addition, the OMA is asking for a 2.6-per-cent increase annually for the next four years. All told, almost 15 per cent more by 2021.

Ontario, by contrast, is offering 3 per cent more over four years, with no retroactive payments for the years without a contract. In addition, it proposes that high-billing physicians would see their fees rolled back – 10 per cent for those who bill more than $1-million and 20 per cent for those who bill more than $2-million.

The physician services budget is currently $11-billion, about 20 per cent of the overall provincial health budget. It increases with demand for services – 140,000 new citizens, 1,000 new physicians, an aging population and new technologies.

The province wants to cap the overall increase at 1.9 per cent a year and, if the cap is exceeded, physician fees would be rolled back.

The OMA says costs are rising at 3.6 per cent a year, without taking into consideration increased physician fees. It wants no cap on the physician services budget.

Negotiations begin in earnest on May 24, with presentations to the board of arbitration, and they are scheduled to continue until October.

Beyond the contract, there are fundamental questions raised here: Does the way we pay physicians make any sense? If you cut funding to doctors, does patient care suffer? How does government rein in spending if it puts no caps on spending – for doctors and elsewhere? And, most important of all, how do we ensure value for money for the health dollars?

The Ontario election is in June. By agreeing to arbitration, the government managed to punt some tough decisions forward. Whatever party wins will inherit this hot mess.

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