Ahead of doctors' vote, activist groups warn physician pay cuts could kill patients

Ahead of doctors’ vote, activist groups warn physician pay cuts could kill patients

Dr. Keith Meloff speaks at a press conference at Queen's Park on August 9, 2016. Jessica Smith Cross / QP Briefing

Dr. Keith Meloff speaks at a press conference at Queen's Park on August 9, 2016. Jessica Smith Cross / QP Briefing

Doctors held a press conference at Queen’s Park Tuesday, warning that if their tentative agreement with the province is ratified this weekend, patients will die.

It’s a dire claim from the "Coalition of Ontario Doctors," and it’s one the Ontario Medical Association (OMA) rejects.

The coalition of doctor groups is made up of Concerned Ontario Doctors, Doctors Ontario and several subsections of the OMA. It has been battling with the OMA leadership over the tentative Physician Services Agreement the OMA reached with the Ministry of Health in July. Doctors are set to vote on it at a general membership meeting in Toronto on Sunday.

The agreement concerns the physician services budget, from which doctors are paid for providing OHIP-insured services to patients. The deal allows the OMA to "co-manage" the budget with the Ministry of Health to determine how doctors' pay will stay within the budget, which would be capped at $11.9 billion this year and increase approximately 2.5 per cent a year over the four-year agreement, plus providing $370 million in additional payments to doctors.

At Tuesday’s press conference, neurologist Dr. Keith Meloff framed the vote as a choice for doctors between ratifying the agreement and having a say in the budget or rejecting it and saving lives. “We have to choose between saving money as a co-manager of the system or saving lives, that is what we’re being asked to do,” he said. “I think that is an impossible choice.”

He and the other doctors at the press conference said if agreement is ratified people will die because the agreement will lead to cuts to doctors' pay.

At the press conference, radiologist Dr. David Jacobs spoke about the connection between the agreement on physician compensation and patients’ health.

The agreement covers OHIP billings but does not cover most of the aspects of the healthcare system that most people understand affects patient health, such as the availability of hospital beds and operating rooms, and emergency care, he said.

Patients die because of problems in those areas caused by chronic underfunding of Ontario's healthcare system — but none of it is covered by this agreement, Jacobs said.

The agreement covers how much doctors are paid through OHIP for their services; doctors run clinics and pay for their operations out of the money they make in OHIP billings, Jacobs said. If doctors aren’t paid enough, they’ll close their clinics or work less, and patients will wait longer for treatment, he said, “and then what could have been a treatable disease is now fatal."

Meloff illustrated this with an anecdote about a neurologist — whom he wouldn’t identify — who had told him she couldn’t make ends meet by doing medical services for OHIP billings anymore, so she had to turn to doing better paying private work for insurance companies and lawyers.

He declined  to give a number for how much money he believes specialists such as this neurologist should make in order to provide patient care, but he said his anecdotal neurologist couldn’t make ends meet on the average compensation a doctor in her specialty gets. He pegged that at $120,000 a year, based on $200,000 gross OHIP billings minus 40 per cent in overhead — but that appears to be inaccurate.

The best available data suggests they’re paid more. The Canadian Institute for Health Information (CIHI) last reported OHIP billings by specialty for the 2013-14 fiscal year, and found the average gross OHIP payments to Ontario’s neurologists were $316,970 and they received $42,474 more in other payments.

Given Meloff’s estimate of 40 per cent overhead, that’s a net pay of $232,656.

Neurologists aren’t unique — their billings are about average for a non-surgical specialty. But $316,970 is an average and some neurologists make less and others make much more. According to figures published by Postmedia, three Ontario neurologists billed OHIP more than $1 million each in 2014-15, totalling $4,059,286 between them in 2014-15. (The overall gross compensation for the average doctor in Ontario is $368,000, the highest in the country according to government figures, and they’re allowed to incorporate to pay a lower tax rate.)

In any case, the neurologist from his anecdote couldn’t make ends meet because of her family circumstances, Meloff said. “The particular physician has three disabled children that require a lot of care,” he said. “She cannot afford, on OHIP fees alone, to support that burden.”

While Meloff wouldn’t give a figure for how much he believes a neurologist should make, he quipped that it should be same as the deputy minister of health — whose salary was $426,535.20 in 2015, according to the sunshine list.

“I’m not interested in doctors’ earnings, I’m interested in patient care,” he said, when pressed to elaborate. “And I’m worried that these fee reductions are going to have a negative impact on patient care, for sick and vulnerable people, and that is the bottom line here.”

The Coalition of Doctor Groups provided an economic analysis by University of Toronto professor emeritus of economics Jack Carr to support its argument that the agreement will lead to cuts in physician compensation.

The agreement caps increases to the physician services budget at 2.5 per cent a year, plus a series of additional payments that boost the growth to approximately 3.1 per cent a year. That would maintain doctor's fees, without an inflationary increase, assuming a utilization increase — the increased demand for OHIP-insure healthcare services — of 3.1 per cent, he said.

However, utilization has gone up more than that in some recent years, including 4.6 per cent in 2014-15, and if that happens, doctors will be paid less per service than they are today, on average, he found.

The OMA contends, however, that the 3.1 per cent is enough to cover the expected increases from an aging population and the increased number of doctors in Ontario — and is exactly the expected increased demand on the system for the duration of agreement, said OMA president Virginia Walley.

“Those are figures we’ve had had independently verified, for example by ICES, the Institute for Clinical Evaluative Sciences,” she said. “That’s the growth of utilization we’re currently experiencing and we’re confident that physicians exercising their growth and expertise, and exercising their leadership, they will be able to make the best decisions for patients going forward over the next few years.”

Walley said she couldn't speak for the doctors who claimed the agreement will lead to patients dying, but for the vast majority of physicians in the province, patients are first and foremost for them.

“We will always put our patients first,” she said.

To contact the reporter on this story:
Twitter: @jessiecatherine

Jessica Smith Cross

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