Ontario needs to overhaul how physicians are paid in order to clamp down on the hundreds of doctors who regularly bill the system more than $1-million a year, Health Minister Eric Hoskins said Friday.
More than 500 Ontario doctors billed more than $1-million in 2014-15, including an ophthalmologist who billed $6.6-million. Those high-billers represent just 2 per cent of the doctors in the province, but account for 10 per cent of the nearly $11-billion physician pay budget. Nearly half of those doctors billing more than $1-million are ophthalmologists and diagnostic radiologists.
"We need a new collective approach to how physicians are compensated," Dr. Hoskins said, emphasizing a fee system that promotes better care and patient outcomes.
Dr. Hoskins revealed the figures at a news conference, where he excoriated the Ontario Medical Association for refusing to resume negotiations over physician pay. Ontario's doctors have been working without a contract for more than two years, and the dispute between the two parties is becoming increasingly bitter. The OMA wants the province to commit to binding arbitration before it is willing to negotiate.
In Ontario, doctors work under a fee-for-service model. Dr. Hoskins said he wants to make cuts to fees, change the fee code structure and revamp the "out of balance" system to address the inequity between high-billing specialists and family doctors, pediatricians and other physicians. The OMA has called for a two-year wage freeze.
But Concerned Ontario Doctors, a grassroots organization of 11,000 physicians, says the minister is grossly oversimplifying the situation in order to gain public support. It is "inconceivable" for one physician to bill $6.6-million a year, according to Nadia Alam, co-leader of the group and an anesthesiologist based in Georgetown. She said many community clinics will have a number of specialists working under one roof and billing under a single physician's fee code.
"On paper, it is going to look like a single person, but in reality, it isn't," she said.
Dr. Alam added that some doctors spend half – or more – of what they make on the overhead costs of running an office. But Dr. Hoskins took aim at this oft-repeated statement on Friday, pointing out that physicians receive subsidies for things such as liability insurance, and lower tax rates through incorporation.
Concerned Ontario Doctors is holding a rally at the provincial legislature in Toronto on Saturday to call attention to the damage the ongoing dispute can have on patient care. The group is funded by donations from doctors and has an informal relationship with the OMA.
The OMA declined an interview request. In an e-mail, president Mike Toth reiterated the desire for a commitment to binding arbitration and asked Dr. Hoskins to communicate directly with the group instead of what he called mischaracterizing the facts through the media.
Progressive Conservative health critic Jeff Yurek criticized Dr. Hoskins for attacking doctors, suggesting the province is "turning its back on some of the province's most vulnerable."
NDP health critic France Gélinas questioned why the province would "poke the other party in the eye" if it was serious about resuming negotiations.