Ontario physicians will not be spared from the Premier's edict of no new money for public sector workers, says the province's new health minister, a family doctor now charged with improving patient care while keeping a lid on costs.
One of the first challenges Eric Hoskins will face is negotiating a deal with the province's more than 25,000 doctors, who have been without a contract since the end of March.
Under his predecessor, Deb Matthews, the government managed in 2012 to freeze total physician pay at $11-billion per year for two years after a bitter standoff with the Ontario Medical Association.
While Dr. Hoskins could not comment directly on the ongoing negotiations, he said he believes this round will be less acrimonious, despite Kathleen Wynne's warning that her government, newly re-elected with a majority, has no new money to offer public employees as it works to eliminate the $12.5-billion deficit by 2017-2018.
"I think the Premier has been clear across the board, not specific to physicians, but it includes physicians, that there is no new money available outside the envelope that's provided," he said, adding later that he is confident a negotiated settlement can be reached that respects both doctors and the need to make Ontario's health-care costs sustainable.
The OMA said in an e-mailed statement from its president that it cannot comment during the talks.
The issue of sustainability came up again and again in a wide-ranging interview with The Globe and Mail on Friday.
Dr. Hoskins, a Toronto MPP perhaps best known as the founder of the charity War Child Canada before his election in 2009, said he is determined to improve the patient experience while keeping a firm hand on spending in his $50-billion portfolio, the Ontario government's largest.
He pointed to initiatives started under Ms. Matthews, including Health Links, a program to help the system's heaviest users avoid becoming revolving-door visitors to emergency departments, as examples of how to improve care and control costs at the same time.
Shifting care out of pricey hospitals and into homes is another, he added.
Unlike funds for physician pay and hospitals, the envelope for home care grew significantly under Ms. Matthews.
"It's counterintuitive," Dr. Hoskins said, "but our increased investments in home care and community care will allow us to … maintain a sustainable health-care system from a fiscal point of view."
Dr. Hoskins also said he is eager to hire the province's first ombudsman for patients.
He brushed aside opposition arguments that ombudsman André Marin should investigate flaws in health care.
"Rather than one individual, and in this case his office, being responsible for so many issues across government and our society, this is an individual focused solely on our health care, and that's a good thing," Dr. Hoskins said.
The new patient ombudsman's office was part of a large accountability bill the Liberal government reintroduced this week. Other health-related initiatives that died with the election and which Dr. Hoskins expects to see revived include a bill to ban payments for blood and plasma, and enhancements in the budget, including a raise for personal support workers who care for patients in their homes.
He said he has no inclination to change the structure of the Local Health Integration Networks or the Community Care Access Centres, two levels of bureaucracy some of the Liberals' opponents want melded or abolished.
Dr. Hoskins said his experience on the front lines of health care in Canada and around the world have made him acutely aware of his responsibility to make a good system great.
"I can say with confidence having lived and worked in many, many countries ... [that] we have without a doubt one of the best health-care systems in the world," he said.
"Can it be better? Of course it can."