Ontario doctors are ramping up their months-long battle with the province over pay, publicly voicing their anger over fee cuts that take effect this week and raising the threat of reduced access to care – a move Health Minister Eric Hoskins says amounts to "fear mongering."
The latest chapter in the wage dispute began earlier this month after the cash-strapped Ontario government told doctors it was imposing a 1.3-per-cent reduction to fee-for-service rates on Oct. 1. The measures also include deeper cuts to specific fees that will affect some specialists more than others. The changes follow a 2.65-per-cent across-the-board cut imposed by the province in January after contract talks with doctors collapsed.
Keeping wage increases for physicians in check is key if the Liberal government hopes to tame the provincial deficit. Doctors' pay accounts for about 25 per cent of health spending and 10 per cent of the provincial budget.
But late last year, the Ontario Medical Association rejected a three-year deal that offered to increase the pool of funds available for doctors' pay by 1.25 per cent each year, saying the extra money wasn't enough in a province where the population – and number of doctors – continue to go up.
With this fresh round of cuts, doctors have chosen to go on the offensive. The OMA has retained media-and-crisis-management firm Navigator and OMA president Mike Toth is travelling the province to meet with members and is pleading his case in the press. Disgruntled doctors are taking to Twitter and penning letters.
Since doctors can't strike, the OMA is asking that the matter be settle through binding arbitration.
Dr. Toth, a family physician, warns the "falsely capped" envelop for doctors' wages is unsustainable. He harkens back to the 1990s when a battle over fees prompted some doctors to leave the province, suggesting the same could happen again.
"We think eventually – sooner rather than later – it's going to affect the health care that is provided to patients," he said.
The Health Minister, himself a doctor, says such threats are baseless.
"There are individuals who are quite frankly fear mongering, suggesting doctors will leave the province," Dr. Hoskins said in an interview, noting Ontario's doctors are the highest paid in the country and will remain that way.
For specialists affected by the new round of targeted fee cuts, it doesn't feel that way.
Christopher O'Brien, president of the Ontario Association of Nuclear Medicine, says his members – 89 doctors across the province – will see their fees reduced by about 17 per cent on average, and he is predicting dire consequences from what he calls the government's "draconian steps."
"I've been on the phone. Every nuclear medicine doc will be affected by the reduction," he said. "One of them was in tears today saying, 'You know my kids will be better off if I'm dead.'"
Dr. O'Brien said nuclear medicine physicians, who work in hospitals and private clinics, had median gross billing last year of $371,000 before taxes and expenses, which ranks them as the 14-highest-paid group of doctors in the province.
The new cuts, he said, together with others in recent years, mean billing rates for his specialty are back at 1980s levels, predicting some members in private clinics could face bankruptcy.
Doug Hepburn, who runs a private fertility clinic east of Toronto, won't go that far but says he and his partner will lay off one staff member because of cuts to the fees the government pays for blood tests it does on site.
Dr. Hepburn left Ontario for South Carolina in the 1990s. (He returned to Canada shortly after for personal reasons, he said.) Now in his 50s with a family, he says he has no plans to leave the province but may revert to a regular practice as an obstetrician and gynecologist.
He argues doctors should have the same access to arbitration as other essential services such as police officers.
Dr. Hoskins says his ministry will continue talks with the OMA on Monday. As for specialists upset about cuts to specific fees, they need to ask the OMA why it did not provide feedback when the proposed reductions were presented, he said.
"We are always willing to have discussions with the OMA. It has been one-sided until now," he said.