The leadership of the Ontario Medical Association has voted in favour of a recommendation to narrow the large gaps between what different medical specialties are paid.
At a special meeting on Sunday, the 200-plus members of the OMA’s governing council endorsed a proposal to more fairly distribute funding from the provincial government to 35 medical specialties.
The endorsed recommendation would see that new funding from the province for doctors goes to 28 of the 35 specialties considered by the OMA to be underpaid. They include psychiatrists, family doctors, infectious disease specialists, geriatricians and pediatricians.
As well, the recommendation could result in pay cuts to the four top-paid specialties, considered overpaid. Those are radiologists, ophthalmologists, cardiologists and gastroenterologists. The money from the high-paid specialties would then be redistributed to the 28 lower paid ones.
The OMA released a statement on Monday, announcing the outcome of the meeting: “Council, the representatives of physicians across Ontario, voted to adopt an ‘allocation-then-redistribution’ mechanism.”
The OMA did not release the vote results but numerous sources said the recommendation was handily endorsed. The sources spoke on condition of anonymity because they have not been authorized by the OMA to speak to the media.
Some of the higher paid specialists, opposed to having their pay cut, have threatened to break away from the OMA. It’s unclear how big this movement is or where it is headed.
One specialist from this faction has claimed an official from Premier Doug Ford’s office, who recently met with a number of doctors in this group, was receptive to what they had to say. But the premier’s office later disputed that.
The OMA statement alluded to the tensions between the high- and low-paid specialties: “Council debated … at length. It was a tough conversation — redistribution is not ideal — and it was a tough decision.”
The outcome of the vote is not binding. Rather, it will be presented to an arbitration board charged with resolving a four-year-old contract dispute between the province and OMA.
Binding arbitration resumed Monday after attempts by the new Progressive Conservative government to achieve a negotiated settlement failed. The conflict had been at the arbitration stage prior to the June provincial election, but the Conservatives announced within days of their victory that they wanted to take it back to the bargaining table. The Ford government recently appointed Robert Reynolds, a former labour negotiator with the City of Toronto, to lead its talks with the doctors.
The province is not offering as much new money as the doctors are seeking. It currently pays physicians about $12 billion annually, or about 10 per cent of the entire provincial budget.
The OMA is seeking redress for pay freezes and cuts unilaterally imposed by the province in recent years.
The arbitration board is charged with determining how much more the province should pay Ontario’s approximately 30,000 doctors who bill OHIP, including part-timers. As well, it must also determine how the pot of money is to be divvied up among the 35 specialty groups.
Restoring fairness to the compensation system is a process known as “achieving relativity.” But progress on this has been glacial, despite repeated efforts over the decades.
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, according to the OMA’s Relativity Advisory Committee.
The OMA struck the committee earlier this year to come up with ideas on how to make headway on relativity.
Doctors on the OMA’s governing council approved the strategy proposed by the committee at Sunday’s meeting.
The OMA, in its statement, said: “Any new monies awarded by arbitration will first be divvied up according to relativity, and then if relativity had not been achieved, money could be moved from high-ranking (specialty groups) to low-ranking (specialty groups) to a max of 1 per cent per year.”
The recommendation also calls for payment top-ups of up to 4 per cent annually for 28 underpaid specialty groups.
The redistribution would take place over 11 years. At the end of this time, 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.
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 large measure 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.
Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle