Tentative agreement between doctors and province ‘horrifying,’ doctors group says

An Ontario physicians’ group is calling the tentative agreement reached between the Ontario Medical Association and the province “horrifying” and says it won’t cure what ails the health-care system.

The Ontario Medical Association (OMA) announced it had reached a tentative four-year agreement with the province following two years of off-and-on — and at times tense — negotiations on Monday. The deal is slated to go to a ratification vote in August.

Dr. Nadia Alam, co-head of Concerned Ontario Doctors, says her first reaction to the agreement was relief. “Then I read the details of the contract and my heart just sank,” Alam, an anesthesiologist and family physician in Georgetown, told CBC’s Metro Morning on Wednesday.

“It was just horrifying. It doesn’t match the reality of what’s going on in the health-care system at all.”

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According to a copy of the deal obtained by Metro Morning, it calls for a physicians services budget (PSB) of $11.5 billion for the 2015-16 fiscal year, with 2.5 per cent increases in each of the following four years. That budget is the total pool of money that covers physician billings in the province.

The deal also provides for annual extra payments to physicians in each year of the deal, if they stay within each year’s PSB.

‘Purposefully underfunding’

Alam’s group has been fighting what she calls “purposely underfunding” health care in the province. She says the OMA’s own estimates suggest 3.2 per cent annual increases are required to meet patients’ needs. Earlier this year, the province’s Financial Accountability Office found the health-care needs of patients grow by five per cent every year.

I read the details of the contract and my heart just sank.
– Nadia Alam, co-head of Concerned Ontario Doctors

Alam suggests that over the four-year deal, there is a $500 million gap between the medical services Ontarians need and the money the government has budgeted.

“When you don’t put enough money to match patient need in the health care system, clinics close, doctors leave, wait lists grow. It’s very simple,” Alam says. “It’s happened before in history many times in the last decade and it’s happening again. The contract just perpetuates it.”

OMA president Dr. Virginia Walley counters that when all elements of the agreement are taken together, the deal amounts to a 3 per cent increase year-over-year for physicians’ services.

“We’ve had independent studies assure us that that is, in fact, going to accommodate for natural growth in the system,” including a growing and aging population that will need more doctors, Walley told Metro Morning.

Walley rejects the accusation that the deal legitimizes underfunding health care.

“I think what this agreement proposes is that physicians — who have an extraordinary expertise, great experience, who are already leaders in the system — what this agreement does is gives them an opportunity to rebuild their relationship with government and hand in hand to work together to redesign the system in the best interest of the patients of this province.”

‘Doctors are feeling betrayed’

Alam also accuses the OMA of keeping doctors in the dark over the latest negotiations that led to the deal. “They need to have a serious look at the subversion of due process and transparency that’s taken place to produce this contract.”

“Thousands of doctors are feeling betrayed by the fact that, one: the media knew about this contract before doctors did, and two: this contract legitimizes the government’s position to willfully underfund the health care system. And that is a troubling detail.”

A tentative agreement reached between the province and doctors includes funding for hiring more doctors and improving access to primary care physicians. (CBC)

Walley offered an apology to individual OMA members who may have missed the organization’s email about the deal before the media was notified.

“Over the course of less than the last two weeks, we discovered that, in fact, there may be some common ground…”
– Virginia Walley, president of the Ontario Medical Association

The most recent talks that led to the deal began as talks just to get the two sides back to the table, she says.

“Over the course of less than the last two weeks we discovered that, in fact, there may be some common ground that could be found and, in fact, that common ground would be enough to constitute at least a very high level tentative physicians’ services agreement. And that is literally what happened over the last few days.”

‘I cannot predict illness’

The deal also calls on doctors and the province to work together to manage the PSB. Alam says she’s not sure how to do that, because she cannot predict what her services will add up to each year.

“I cannot predict illness. Patients just come and see doctors when they are sick. Doctors don’t really have any control over that other than saying to patients, ‘Sorry your illness isn’t urgent enough for me to look at. I’m sorry, we’ve reached the hard cap the government has set. You can’t see a doctor in Ontario for the next month or the next two months.’”

She says if care could be improved by taking a pay cut, doctors would agree to one.

“We want to seize this opportunity to forge a new relationship with government…”
– Virginia Walley, president, Ontario Medical Association

Walley says “it’s early days,” and her organization is working to inform all of its members about all the terms of the deal. But, she adds, the agreement is “reasonable” and provides “stability” for doctors, and also represents an opportunity for physicians to work with the province to improve patient care.

“When the government attempts to redesign the health-care system on patients’ behalf without the input of physicians who are so incredibly knowledgeable and are so motivated for the interest of patient care, that’s folly,” Walley says. “We want to seize this opportunity to forge a new relationship with government to return to a partnership that historically has worked so well in the best interest of patients.”