Tentative deal between OMA and province does not provide more money for patient services or improved access to health care
This column by Dr. Merrilee Fullerton originally appeared in the Toronto Star in the July 18, 2016 paper.
Mon., July 18, 2016 – Whether you are an MD, a patient, or an Ontario resident, you should know what the tentative deal between the Ontario Medical Association and the Ministry of Health means to you. In essence, this deal will not provide greater access to care, nor will it meet the growing demand for care. With the proposed co-management arrangement, the Wynne Liberals will be dictating doctors’ services to an even greater extent, making it harder for many patients to get the care they need and harder for physicians to provide it.
It is clear something had to happen as Ontario MDs have been without a contract since 2014. Of the contract details, two proposed aspects are being heralded as breakthroughs: the 2.5 per cent “increase” for doctors and the “co-management” of the system by physicians and Ministry of Health officials.
The sudden news of a 2.5 per cent “increase” annually for four years arriving on the coat tails of the hard-nosed negotiations by the ministry seems too good to be true. Understanding the details is critical to understanding what this contract really provides.
The 2.5 per cent “increase” is for total services to be provided by physicians via the “Physician Services Budget.” Just as the name implies, this is a pool of money government provides for physician services. It does not mean that your local physician will receive a 2.5 per cent pay increase. This does not signal that she or he will now be paid more and able to provide more patient services or that patients will have improved access.
So, what does it mean then?
The 2.5 per cent “increase” is simply an expansion of the funding pool to be spread across more people and more services as our population ages and expands over the duration of the four-year contract. However, this falls short of the demand for physician care. It is estimated that the need for physician services rises on average by 3.1 per cent per year. That 2.5 per cent “increase” per year is simply a continuation of the underfunding of the health care system by the Wynne government.
Once again, hidden behind the headlines we see that political optics drive the self-serving Liberal agenda. This deal is not about access for patients or empowering front-line providers to meet the demand for care. If it was, it would have taken a very different form. Instead, the tentative agreement is about self-preservation, by both the Ontario Medical Association and the Ontario Liberal government. It’s about how best to sell the public (and the physicians) on the merits of a possible contract that will continue to underfund health care.
The harsh reality across Ontario has many medical clinics struggling to stay viable and hospitals being forced to cut front line workers in order to meet budget obligations required by law. Meeting the growing need for patient care is being made harder and harder under the Ontario Liberal government. As overhead costs continue to rise due to flawed provincial energy policies (and now we all must brace ourselves for the introduction of the provincial carbon tax), costs of operating medical facilities will grow — whether they are hospitals or community clinics. Under the Wynne Liberals, it is harder and harder to provide medical care to a larger and aging population.
Under this tentative contract, physicians will be co-opted into “co-managing” the health care system hand-in- hand with a reckless government. Is this something to be celebrated as the headlines suggest? Where is the independent physician organization that can stand up to government’s self-serving political agenda?
Co-management of Ontario’s health system is a slight of hand given the government’s ability to pay for the services Ontarians require is diminished with every monthly billion dollar interest payment on the provincial debt. As is the Liberal tradition of naming their legislation, the new deal is being sold to physicians and to patients as “The Best Deal Ever for Everyone.” But it isn’t — far from it.
Physicians, patients, and the public in general should understand that the tentative agreement as it currently exists will not provide more access to care or meet the growing demand for care. What it will create is further rationing of care required contractually to be done by physicians. And, unfortunately, Ontario’s physicians, through their provincial association and the new “co-management” arrangement, will be co-managing our health system’s retractions.
Ontarians and the province’s medical community are to learn more about the details of this Ministry of Health-OMA agreement in the weeks ahead. One can only hope there is a more serious review of both the inadequate funding and proposed “co-management” arrangement. Our doctors deserve better; Ontarians deserve better.
Dr. Merrilee Fullerton is a retired family physician who has been active in medical politics and health care policy. Follow her on Twitter at @doctorfullerton and on her blog at