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Health-care professionals say change to small-business deduction forces them to pay tens of thousands more a year.FabioBalbi/Getty Images/iStockphoto

Ontario's doctors say all options are on the table, including withdrawing some services for patients, after the provincial government proposed a new three-year deal that would increase pay for family doctors while cutting fees and clawing back pay for high-billing specialists.

The president of the Ontario Medical Association (OMA) said she and her colleagues were "shocked" when officials from the Ministry of Health and Long-Term Care presented the offer without warning at an 8 a.m. meeting Wednesday, an hour before Health Minister Eric Hoskins, himself a doctor, went public with the details at a news conference.

"The frustration of our members is growing by the minute," Virginia Walley said in an interview. "To be treated in this way, in this cavalier fashion … is absolutely unacceptable to us."

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Dr. Walley said the OMA is now considering every possible option for fighting Kathleen Wynne's Liberal government. Asked twice if that could include withdrawing some services for patients, she said doctors, who have been without a contract for nearly three years, would rule nothing out.

Dr. Hoskins said he was "really disappointed" in the OMA leadership for dismissing the offer out-of-hand and for hinting at job action that could affect patients.

"We're talking about new investments in family doctors and improving access [for] patients and they're talking about the opposite," he said. "They're talking about the potential for taking away access."

Dr. Hoskins said he decided to make the new offer public right away for the sake of transparency, and because the province's last attempt to negotiate with doctors behind closed doors – at the OMA's request – ended so poorly.

In August, OMA members voted down a tentative deal that was reached in secret and endorsed by their own leaders, including Dr. Walley. Riven by infighting through the summer and early fall, the OMA has refused to come back to the table unless the government first agrees to grant doctors binding arbitration if negotiations prove fruitless.

Kulvinder Gill, a Peel region pediatrician and allergist who speaks for Concerned Ontario Doctors and the Coalition of Ontario Doctors, two groups that sprung up to lead the "no" campaign, said the new proposal was not much different from the deal doctors already turned down.

"It's basically the [tentative physician services agreement] from the summer disguised with some Christmas wrapping," she said.

Dr. Hoskins countered that the new proposal offers more money for family doctors, and promises a wholesale "fairness" review of the thousands of fee codes that determine how doctors in Ontario are paid.

The new offer would increase the physician services budget – the total amount of money that the government pays physicians – by 2.5 per cent a year for three years, the same annual increase laid out in the rejected tentative agreement. The extra money would allow the system to welcome new doctors and treat more patients, Dr. Hoskins said.

The government is also aiming to save $303-million over three years by going after high-billing specialists in three ways. First, the proposal would slash by 10 per cent a slew of fees for diagnostic tests and procedures that have been made swifter and simpler by new technology, including reading X-rays, CT scans and MRI scans, and performing cataract surgeries.

Second, the proposal would ding physicians who bill the Ontario Health Insurance Plan more than $1-million annually, reducing by 10 per cent the portion of their billings over $1-million and by 20 per cent the portion over $2-million.

Approximately 470 doctors billed the province more than $1-million last year. Thirty-four billed more than $2-million. (Billings do not equal take-home pay; doctors draw from their billings to pay expenses such as office rent and staff salaries.)

Third, the province is planning to make unspecified changes to some of its contracts with specialists that it expects will save money over time.

While specialists such as cardiologists, radiologists and ophthalmologists might expect to earn less under the new terms, family doctors would likely earn more, depending on how much they work.

The proposal envisions a 1.4-per-cent pay increase each year for a three-year period for primary-care doctors that would cost $186-million in total. The plan would also set clear targets for how often family doctors in group practices are required to work nights and weekends, something the province's Auditor-General recently criticized the government for failing to do.

Dr. Hoskins told reporters Wednesday morning that he was hopeful the new offer would serve as a jumping-off point for negotiations. But with the OMA rejecting it as "disrespectful and unacceptable," the province is likely to impose the plan beginning April 1, 2017, when the last set of terms the government imposed unilaterally on doctors is set to expire.

Dr. Walley said relations between Ontario's government and its doctors are worse today than at any point in her medical career.

The government last week passed Bill 41, health-care restructuring legislation that doctors have been decrying as a needless increase in bureaucracy. The OMA has also filed a constitutional challenge against the government for denying doctors access to binding arbitration.

The government's confrontational attitude is costing them the co-operation of doctors, she said.

"What they [the government] lose in this is the engagement of physicians, the people who know the best about front-line care."

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