They comprise less than 10 per cent of Ontario's physician work force. But their fate is at the core of the country's most ambitious effort to curb the amount of money spent on doctors, and the biggest stumbling block in stalled negotiations between the province and the Ontario Medical Association.
Three groups of specialists – radiologists, cardiologists, ophthalmologists – have seen their pay rise astronomically since the 1990s, largely because advances in technology have enabled them to perform more procedures than previously. Now, Dalton McGuinty's Liberals want to cut their rates by double-digit percentages, generating hundreds of millions of dollars in savings. It's not the only measure aimed at freezing the total amount spent on doctors' wages, which effectively means a cut to per-doctor spending, but it's the largest one.
It's easy to see where the government is coming from. Cataract surgeons are acknowledged even by many doctors to be overpaid, with some making more than $1-million annually. Diagnostic radiologists join them in averaging more than $650,000 in annual fees, making them the two highest-paid groups of doctors. Cardiologists aren't much behind, averaging nearly $600,000 annually. Even subtracting overhead costs that doctors pay, that's a lot of money for fairly straightforward work, by medical standards.
But it's also understandable if those specialists feel they're having the rug pulled out from under them. Even if they knew they had it good, they've made life decisions without reasonable expectation their income could suddenly dip heavily. (Ophthalmologists already accepted a roughly 15-per-cent reduction to their fees, starting in 2009, but the government wants to go further.)
All this evidently leaves the OMA feeling it has little choice but to push back hard. Trying to hold together a sometimes fractious membership, which in 2004 rejected a deal negotiated on its behalf, it can't be seen to throw some members under the bus.
What has emerged is a battle between the OMA and the government for hearts and minds of other doctors in general, and family practitioners – who comprise the biggest group, and have clout within their communities – in particular.
To that end, the OMA has framed the dispute as affecting all members more or less equally. Its case hinges on the average pay for an Ontario doctor going down under the government's proposal, rather than dwelling on the cut being disproportionately targeted. And it claims – falsely, according to the government – that $300-million would also be taken out of primary care.
Meanwhile, the government is trying to go around the OMA and communicate directly with its members. In a letter sent this past week to family doctors, a copy of which was obtained by The Globe and Mail, the Health Ministry listed ways they've benefitted since the Liberals took office in 2003. And it insisted any cuts to their fees will be replaced with other forms of new income.
In the end, who wins the PR battle may not matter much for now. The government appears hell-bent on curbing doctors' pay, both to help get the deficit down and to send a message to other members of the broader public sector up for new contracts. So unless it loses its backbone, or the OMA caves, the likeliest outcome is that it will simply impose a new deal through regulations.
Antagonizing an entire profession, whose buy-in is needed for ongoing changes to the health system, is not without its risk. But the government seems convinced it can get away with alienating a small segment of that population, which it thinks has had it too good for too long.
Adam Radwanski