A group of specialists trying to break away from the Ontario Medical Association is being called out by peers who charge that the discord is all about money.
“They don’t want to be the group that has to give up (some money) for other groups to increase their earnings,” general surgeon Dr. Nancy Baxter said in an interview Tuesday.
“Until the OMA started talking more about relativity, you didn’t hear about these specialty organizations wanting to break away,” continued Baxter, one of many doctors who has gone public with criticisms — many of them on social media — of a referendum the breakaway specialists held last week.
“Relativity” refers to big pay gaps between different medical specialties. The OMA, which represents Ontario’s 31,000 practising physicians in contract negotiations with the provincial government, has struggled recently to develop a recommendation on the issue for an arbitration panel charged with resolving a four-year-old contract dispute.
The stakes in the ongoing dispute are high. The arbitration panel must first determine how much extra money should be added to the physician services budget, which currently stands at more than $12 billion or 10 per cent of the entire provincial budget. The panel must then determine how the extra money should be divvied up between different specialties.
Radiologist Dr. David Jacobs, who is spearheading the breakaway efforts, served as an OMA board member until late September when he resigned and announced the need to form a separate specialist group. In an open letter critical of the OMA, Jacobs noted it was unable to reach a negotiated settlement with the new Ford government and charged its bureaucracy has grown while its accountability has waned.
He said 24 specialty sections recognized by the OMA (there are 49) had shown interest in forming a separate group, writing that they should be able to freely choose who represents them. He called for one bargaining agent to represent family doctors and another to represent specialists.
The timing of Jacobs’ resignation coincided with the release of a report from the OMA’s relativity advisory committee, which recommended narrowing pay gaps between medical specialties. It called for the pay of four top-billing specialties — radiologists, ophthalmologists, cardiologists and gastroenterologists — to be cut by up to 1 per cent annually for 11 years. Money saved would then be redistributed to lower-paid specialty groups.
Essentially, this means high-paid specialties would get a smaller piece of the pie and lower-paid specialties a bigger one.
While the word “relativity” was never mentioned in the letter, there was reference to an upcoming meeting of the OMA’s 250-plus member governing council at which a vote was to take place on whether to endorse the committee’s recommendation to narrow pay gaps. Jacobs, who is also vice president of the Ontario Association of Radiologists, warned the meeting would “further divide” the OMA and said he “cannot be party to this.”
Council members voted almost 80 per cent in favour of narrowing pay gaps.
But in an unusual move, the board then persuaded council to change its decision to one that would see each of the 49 sections make its own pitch to the arbitration panel on how to tackle relativity.
The OMA leadership then came under fire from doctors on Twitter, angry over what they called “copping out” on a difficult issue. Others interpreted the move as a strategic one aimed at weakening support for the formation of a separate specialist group.
Jacobs subsequently revealed the formation of the Ontario Specialists Association (OSA) and invited specialists to vote on a “referendum” in late November to secede from the OMA.
In releasing the results of that vote last week, the OSA issued a news release stating “Ontario Specialist Groups Vote Overwhelmingly to Leave the OMA.” The release stated the majority of voters from eight sections were in favour of separating, but there was very limited information released beyond that.
But upon further investigation by the OMA and others, it was learned that only 10 per cent of specialists and 5 per cent of all doctors voted in favour of a divorce.
The OSA also issued incorrect information, initially stating the majority of otolaryngologists (also known as ear, nose and throat doctors or ENTs) had voted to separate when in fact the opposite was true.
On Twitter, many opposing physicians are calling into question the motives and results of the vote.
Emergency medicine physician Dr. Ian Stiell, referring to why a majority of ER doctors opposed the split: “Emergency physicians are a very poor fit with the Ontario Specialists Association which wants to preserve income for the highest billing specialists without addressing relativity.”
Psychiatrist Dr. Javeed Sukhera: “Shame on (the OSA). Relativity is about valuing each and every physician. It is not about knocking each other down. If we help lift each other, we all win.”
Family medicine resident Ali Damji: “We are in an era where new money isn’t coming to us so we need to redistribute and invest in underfunded areas (primary care, mental health, elderly) … Which unfortunately also means that when we invest in that part of the pie, other parts become smaller. I don’t think doing so in an evidence-based and thoughtful way is a bad thing — and it’s needed.”
Baxter, adding to the growing chorus of female doctors calling for disparity in pay between male and female physicians to be addressed: “We need relativity within and across specialties to address the discrimination experienced by physicians in Ontario. (OSA) needs to figure this out as well.”
Pediatrician Dr. Mo Eltorki, questioning the results of the vote: “Sorry, please elaborate on your definition of success! This does not represent specialties in Ontario, not even close! You forgot to mention the large specialties that refused to split from the OMA: emergency medicine, dermatology, ENT, occupational therapy and plastic surgery.”
Asked earlier if the issue of relativity was behind the efforts of the OSA to separate, Jacobs would only say all doctors are facing fee cuts. He has repeatedly stated the Ford government is receptive to the idea of specialists forming their own organization.
The Medical Post last month quoted an unnamed Ford government source stating that the province would respect the results of the referendum. The source said if a “critical mass” of doctors voted to split, the government would be open to amending legislation to make that happen.
Since then, Health Minister Christine Elliott’s office has only said the government is seeking legal advice on how to proceed.
Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle