I’m very pleased that after what seemed like an eternity (but was probably more like two years) without an agreement, the Province of Ontario and the Ontario Medical Association (OMA) are tabling a potential agreement. The tentative agreement is now being communicated out to the OMA’s 33,000 member physicians who will vote on whether to ratify it in the coming weeks. This is a long time coming, and is a very welcome turn of events. To say that the relationship between the OMA and the government over the last two years has been frosty is an understatement. It’s critical for our patients and for our health system that strong relationships characterized by open lines of communication exist between these two entities.
Some of the highlights of the tentative agreement are:
- A 2.5% increase in funding per year for the remainder of the contract (4 years).
- One-time payments ranging from $50M to $120M per year, with the caveat that those dollars cannot be used if the total physician compensation budget is exceeded.
- The OMA and the government will work together to identify $100M of savings in each of the years 2017 and 2019 based on a hard look at the fee schedule.
- There will be co-management of the agreement which includes a co-management process looking at health human resources.*
*The Deans have clarified with the OMA that they will be consulted during any HHR discussions.
From the vantage point of Queen’s, where we have a comprehensive alternate funding plan (AFP), exactly how these elements will be reflected in the AFP has not yet been clarified. However, one anticipates that it’s likely that payment to physicians in an AFP will echo the general arrangements that are being proposed in the agreement.
Of particular significance is the agreement to look at the two planned $100M carve-outs from the fee schedule. I predict this is going to be done largely based on the issue of relativity. Relativity, simply defined, is the issue of the tremendous variability we have in our fee schedule with respect to how we financially reward different types of specialists. For example, a young trainee who goes through three years of internal medicine training followed by two years of training in a subspecialty, will earn significantly more if he or she chooses a subspecialty in the areas of cardiology or nephrology as compared to geriatrics or rheumatology. The training times for those four subspecialties are the same, and yet the swing in income between the higher and lower can be hundreds of thousands of dollars. These discrepancies are largely an artifact of a historical fee schedule that really hasn’t changed with the times and does not recognize that changing technologies has impacted significantly on the time that is necessary for certain procedures. In the same vein, some of the fees within the surgical specialties were set for procedures that used to take several hours, yet now take just a fraction of the time.
I’m hopeful that the agreement will be ratified by the OMA membership. In my own personal view, it’s important that we move on from the chill that we’ve experienced in the last few years, to a more constructive relationship between the OMA, which represents our physicians and our government, which is responsible for the overall health of our population. Once the issue of physician compensation is addressed and an agreement is ratified, we can shift our attention to the challenges that our healthcare system faces with an aging demographic that’s requiring more demands for services and new technologies emerging that might materially improve the lives of our patients.
Please share your thoughts on the tentative agreement by commenting on the blog, or better yet, drop by the Macklem House… my door is always open.