Meantime, the OMA is seeking redress for fee cuts and freezes that doctors have been hit with in recent years.
But it’s patients who ultimately pay the price when physician fees are out of sync with health-care needs. When physician services are overvalued, there is less money available for lower-valued colleagues and for other parts of the health system such as hospitals and homecare.
The imbalance presents medical students with an incentive to specialize in overvalued specialties, such as radiology, cardiology and ophthalmology.
The contract dispute was at the binding arbitration stage prior to the June provincial election. But the province’s new Progressive Conservative government wanted to take a stab at resolving it, so the two sides went back to the bargaining table.
However, talks broke down earlier this month because the province isn’t offering as much new money as the OMA wants. The two sides remain billions of dollars apart.
This coming Monday, the ball will be back in the court of an arbitration board led by William Kaplan, a seasoned lawyer, mediator and arbitrator. In resolving the dispute, the board has two main questions to address:
- How much more should the province pay the approximately 30,000 doctors who bill OHIP, including part-timers?
- How should funding be divvied up among the 35 different medical specialty groups?
It’s this second question that the 200-plus members of the OMA’s governing council will grapple with when they gather Sunday at a Toronto hotel. Their plan is to come out of the meeting with recommendations for the arbitration panel to consider.
It’s accepted that some physicians should be paid more than others. Doctors who deserve higher wages include those who have spent more years in training, do more complex and intense work, have higher overhead costs and work longer hours.
But it’s also recognized that the existing system of compensating physicians is unfair. Disparities have grown over the decades, fuelled in part by improved technology, much of which is funded by taxpayers.
These technological advances have mostly benefited “proceduralists” such as radiologists, ophthalmologists and cardiologists. Because they are paid per procedure — for example, per diagnostic test or operation — these specialists are able to work faster and bill OHIP more.
Those physicians who have not benefited as much are known as “cognitive” specialists. They include infectious disease specialists, pediatricians, psychiatrists and geriatricians. They also include family doctors (who are not formally considered specialists.) These doctors use their experience, learning and interpretative skills to determine diagnoses and provide treatment advice.
Restoring fairness to the compensation system is what the medical profession refers to as “achieving relativity.” But progress on this has been glacial, despite repeated efforts over the years. The OMA’s governing council passed a motion in 2010 to achieve pay equity across every specialty by 2024, but the association is not on track to reach that goal.
The slow pace of change is acknowledged in a report by the OMA’s Relativity Advisory Committee, which is going to be up for debate on Sunday. “Income relativity disparities have existed in the medical profession for a long time, and the Ontario Medical Association has identified this as an important issue requiring correction,” the report says. “There have been many efforts over the past 25 years to develop an appropriate relativity model.”
The relativity report reveals the highest billing specialties are overpaid to the tune of 52 per cent and the lowest billing ones are underpaid to the tune of 30 per cent.
Among recommendations contained in the report is one to cut the pay of the four top-billing specialty groups by up to 1 per cent annually for 11 years. Those four specialty groups are radiologists, ophthalmologists, cardiologists and gastroenterologists.
The report also recommends payment top-ups of up to 4 per cent annually for 28 underpaid specialty groups. For another three specialty groups, there would be no redistribution of funding.
At the end of the 11-year plan, inequities would be significantly reduced, but still not eliminated. The highest billers would still be overpaid by 10 per cent and the lowest billers underpaid by the same amount.
The report does not spell out what kind of changes an individual specialist could expect in annual income under the plan, but to get a sense of that, one just has to cross reference data from the Canadian Institute for Health Information.
According to 2016 CIHI data on Ontario physicians, the average payment to an ophthalmologist was $691,575, while the average payment to a psychiatrist was $210,188.
The committee’s proposals to address relativity would see the ophthalmologist’s pay cut by just under $7,000 in the first year of the 11-year plan. A psychiatrist would see a top-up of just over $4,200 in the same period.
Council will vote on the proposals to address relativity on Sunday. Those that are passed will then be presented to the arbitration board as recommendations from the OMA. They are not binding.
The proposals are not going over well with some specialists who would see their pay cut. In late September, the day after the relativity committee presented its report to the OMA’s 24-member board of directors, radiologist Dr. David Jacobs announced his resignation from the board.
Jacobs, who is also vice-president of the Ontario Association of Radiologists, wrote an open letter to doctors in which he warned that Sunday’s special meeting “will further divide” the OMA. He announced intentions to form a breakaway association of specialists who could negotiate their own payment deal with the province.
Jacobs has not responded to requests for an interview. It’s unclear how much support his movement has.
In response to the breakaway threat, the OMA’s board has come up with an additional approach to address relativity. This idea, which will also be debated Sunday, would allow individual specialty groups to make their own recommendations on how to deal with relativity to the arbitration panel. Different specialties would be able to voice their unique concerns rather than relying solely on the OMA to speak on behalf of the entire profession.
In a written statement to the Star, OMA president Dr. Nadia Alam indicated the association would stand a better chance of remaining intact if this new approach is adopted.
“We’re confident that the profession can work through the relativity challenge without fracturing, and that the overwhelming number of OMA doctors support the OMA’s role as their bargaining agent. After five years of cuts and freezes, this is not a time to provide an opening for divide and conquer which is a real risk if the profession were to fracture.”
But some physicians are unhappy with the OMA’s response and charge that the organization is bowing to pressure from the high-billing specialists. London family physician Dr. Frank Warsh, who maintains a blog about the goings-on in the profession, recently expressed doubt the relativity dilemma will be resolved any time soon.
“Doctors from lower-earning specialties have good reason to be pissed. Relativity has been a festering problem in the profession for decades, and only a handful of the highest-billing specialties stood to lose anything under the new framework,” he wrote in reference to the relativity committee’s proposals.
“Seeing as the plan is being changed to meet the demands of specialists looking to go their own way regardless, it’s hard to see this whole process playing out to a conclusion,” he continued.
Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle