Physicians frustrate governments. Doctors think too little about how much care costs and too much about patients who need help.
The Government of Ontario and the Ontario Medical Association arrived at a mediated Proposed Physicians Services Agreement (PPSA) this month. Doctors vote on it on March 22 – 27.
On March 28, we find out whether doctors will accept the agreement or send it to arbitration.
Labour negotiations give government its best chance to manage the $14 billion spent in Ontario on medical services (2020-21). Contracts offer a way to control doctors’ behaviour. Medical services agreements are the heart of central planning in Canada.
A Mediated PPSA
Government does not care about doctors’ incomes, nor should it.
When it comes to medical services, government cares about spending and access. When it comes to negotiations, politicians care about labour peace and avoiding awkward headlines.
Doctors and government negotiated (fought) through much of 2021 to arrive at a mediated labour contract, which covers April 1, 2021 – March 31, 2024. The PPSA throws another $1.1 billion at doctors over the next three years. Total spending on physician services should reach $16.2 billion by 2024, an estimated 4.8 per cent increase.
Spending always takes centre stage in negotiations. Government demands predictability. Doctors demand spending based on patients’ needs, not budgets. The two sides rarely agree.
After fighting about funding, labour talks turn to focus on how fees direct care.
Government does not care about doctors’ incomes, nor should it. When it comes to medical services, government cares about spending and access. Click To TweetConsider Virtual Care
Pre-COVID, government refused to pay for virtual care except on its clunky, time consuming Ontario Telemedicine Network platform. Very few doctors bothered with it.
COVID forced government to pay for virtual care beyond government’s preferred platform. As expected, patients loved being able to speak with their doctor on the drive to work instead of taking a day off work to meet in the clinic.
Government hates the idea.
Calling your doctor anytime from anywhere is far too easy. Canada rations care with wait times, limiting investment in technology, and by using family doctors as “gatekeepers” to service. Virtual care not only removes essential brakes on spending it adds grease to the rails.
But now the public has a taste for virtual care, and government knows it. So instead of blocking virtual visits, government took steps to limit access and put the brakes back on the spending train.
Virtual visits must be by video to qualify for full payment. Telephone calls only receive 85% of the posted fee. No more convenient calls while commuting to work.
Government insists that video adds value – never mind the camera could be out of focus or pointed at the ceiling. During the pandemic, many elderly patients could not figure out how to allow incoming calls from a ‘No Caller ID’ number, never mind managing an iPhone.
Virtual care not only removes essential brakes on spending it adds grease to the rails. Click To TweetGovernment’s Trump Card
As inflation runs over 5 per cent, the PPSA might be one of the worst offers doctors have ever seen.
Just before the pandemic, government passed Bill 124. Public sector salaries remain capped between May 1, 2020 and April 30, 2023. Protecting a Sustainable Public Sector for Future Generations Act, 2019, has a “moderation period [which] mandates increases be limited to 1%.”
Bill 124 does not mention physicians. However, physicians do fall into the public sector.
Upside-down Labour Law
Physicians run small businesses. Office overhead consumes around 40 per cent of total billing. General inflation runs at 5 – 7 per cent currently, but inflation on medical office overhead has outpaced general inflation for several decades.
Boards of arbitration care about perceived labour fairness, not office overhead.
Medical contracts turn labour negotiations upside down. In other sectors, labour contracts centre on salaries and benefits. Salaried workers want more money, and management wants to give workers less. Overhead is irrelevant.
In Canada, the tables are flipped. Management (government) is salaried, and labour (doctors) are self employed. In medical negotiations, labour cares about overhead, and labour lawyers don’t seem to know what to do with it. It seems to short circuit their usual mindset.
The government’s response to any mention of overhead has always been the same: doctors can work harder, if they don’t like the contract. This is like telling workers to get a part-time job — absurd in any negotiation outside medicare. Arbitrators seems to think it makes good sense for doctors.
Micromanaging medicine
The PPSA offers too much for one post. In the next blog, we will look at how the PPSA attempts to direct how doctors run their private clinics.
For example, government wants to control whether doctors provide online booking for appointments.
Government also wants to dictate whether doctors deal with a patient’s whole list of problems in one longer visit. Longer visits mean fewer appointments: how do we know doctors aren’t slacking off? Better to drag patients back for multiple visits — much easier to measure.
At some point, voters need to break the iron triangle between government, the medical profession, and labour groups. Patient care seems too important to suffer under central planning. Change starts with realizing that contracts are about control, not incomes.
Photo credit: Pixabay The Labour Code
PS. In the next post, we will also tackle whether doctors should vote YES, to stop the beatings, or NO and risk even worse at arbitration.
Right on as usual Shawn. This so called agreement comes with dire warnings than arbitration will yield a worse result when every rejected agreement I have ever seen has resulted in a better contract
Hey Ernest
Great to hear from you. This you-better-support-it-or-else approach bothers me too. They blame it all on Bill 124. Well, if the pre-pandemic bill is stupid, why should we continue to support stupidity in fear that the board of arbitration will support stupidity?
The OMA knows about public relations campaigns. So does the government. It seems we would be in a powerful position to ask the Ford government for a 0% increase — just match inflation. Doesn’t that sound reasonable?
Too much to say… more to come.
I delayed saying anything until the last minute. That way, no one can blame me for being unsupportive. 🙂
Hope you are well!
Cheers
The “ We must support this or else” approach is what led our profession into the 2012 debacle from which our profession never recovered .
We have learned nothing, this latest “ deal” merely compounds our profession’s misery.
Exactly, Andris. It is 2012 all over again.
This is not fair bargaining. Doug Ford used legislation before negotiation to do exactly what Kathleen Wynne did at the negotiation table. Ford seems smarter, but it is still an unfair approach to so-called good-faith bargaining.
Thanks for posting!
“But now the public has a taste for virtual care, and government knows it. So instead of blocking virtual visits, government took steps to limit access and put the brakes back on the spending train.
Virtual visits must be by video to qualify for full payment. Telephone calls only receive 85% of the posted fee. No more convenient calls while commuting to work.”
It will be interesting to see how much push back there will be, from doctors who may decrease phone calls to patients who may complain. The 15% cut may seem fair (no office overhead) but the overhead doesn’t go away just because you spend an afternoon on the phone. And as always, voters won’t know who to blame.
Great point, Dave.
They argued for the cut because video “adds value” compared with phone. I believe the team also said that video required more effort.
In the end, patient frustration flows directly at clinic staff and doctors themselves. As we all know, frustration decreases trust, increases complaints, and diminishes the patient’s experience of care overall.
Hey, thanks for taking time to read and share a comment!
Cheers
Thanks Shawn. Re: the video vs phone thing… no one, neither the OMA nor government seems to consider the OTN study on primary care enhanced visits (Enhanced Access to Virtual Care – Novari platform, vs phone) that showed 94% of the time, when offered the choice PATIENTS chose telephone over video. Even in my own urgent care practice in a teaching hospital, when given the option of either modality with a single click of a button, almost ALL our virtual visits are on the phone. If I need a photo, a high def smartphone image with good lighting is much much better to look at than the poor quality video cams of most computers. Patients text the photo to me, and it arrives directly into my EMR via my mobile EMR app. Instant and secure. Also, what about those who have no computer, or have limited bandwidth for video visits, or rural remote communities with no high speed internet at all? Where is the equity conversation in all of this??
Much more to be explored in this topic, in my opinion.
I feel like this may be the best contract we are going to get given the financial situation of most provinces post covid, but there are still so many policy gaps in place here that I worry.
Hey Darren,
Thanks for sharing this! Very interesting. My sense is that phone calls work well for a ton of busy parents, self-employed people, and people who have better things to do than book a morning off to go to see their doctor. Fantastic comments about image quality too.
I really hate the threat explicitly stated in the offer. Take this or get worse at arbitration. What kind of free vote is that?
Thanks again for sharing! Super valuable. Great to hear from you!
Cheers
Interesting piece Shawn
Maybe the answer is to reject the PPSA, defeat the Ford government and put in a pro-labour / collective bargaining NDP government which will repeal bill 124. Then in Arbitration the 1% cap will not be a factor.
Just a thought.
Hal!
I almost agree … Yes, we should defeat a government stupid enough to advise its team to try to push through a pre-pandemic spending restraint during post-pandemic inflation.
Before covid, we were discussing negative inflation — negative interest rates. Surely, everyone agrees those days are long gone?
My quibble with you is on voting in the NDP. They were especially cruel to doctors, as you recall.
Really great to hear from you! I always smile at your willingness to speak up and go for the opportunity. Love it!
Talk soon,
The NDP under Bob Rae were terrible to doctors in Ontario when they were in power.
I kinda thought so too. By definition, doctors are the enemy to the NDP, The Toronto Star, and socialists in general, no?
Anyone who can pass a test and work hard is, by default, a bad person, unless they give up most of what they produce … for the greater good, no?
Sorry, I’m just being petulant now.
😀
OMG ….
Remember the Rae NDP govt in 1995 ?
I do ….. doctors got screwed,province nearly bankrupt.
Socialism only works until you run out of other people’s money.
Thank Ram!
I’ll let Hal take a swing back on that one … 🙂
How does the political party in power make cuts to healthcare and still manage to bankrupt the province? At least the austerity measures of the conservatives seem to result in a healthier fiscal situation. The NDP will always consider doctors to be part of the greedy and oppressive capitalist class, regardless of how much money we make and how little autonomy we have.
Well said.
I wrote a long comment then realized I was writing a whole separate blog — you inspired me! 😀
At some point, we have to start rebuilding the social institution of medicine: the weird guild that grew over several thousand years as doctors tried to help patients.
Thanks again
Remember the Rae days? As in former federal LIBERAL interim leader Bob Rae?
That jibe aside, I have a lot of respect for Mr. Rae. And I would stand by the statement that he led an NDP government, and another leader would not have made a difference in the general tone of that government.
The outgoing Liberals left the books a mess I recall, right as we went into an economic downturn.
As to screwing doctors, it did not seem to be that bad to me at the time, but I was just entering medical school. The Harris Conservatives who replaced them sought to remove the OMA as the bargaining unit for doctors, who gave up the income of their most recent grads for three years to keep that designation. THAT I remember well, and it was a reason I did not join the OMA until I started billing OHIP after residency.
But I wonder what alternatives we have. And how far back in history do current parties have to be held accountable?
Will we demonize the current PCs for the evils of Ernie Eves? No, we have a more recent villain. And his government’s mashup of COVID 19 is reason enough to give Ford the boot. Is Del Duca to be blamed for the scandals of McGuinty? Wynne? Perhaps.
Should any political party that had even one rough time in govt be barred from holding office ever again?
If you don’t agree with the platform of the NDP, please don’t vote for it. That is the essence of democracy. But if the only reason you would not vote NDP is the tiresome excuse of the performance of a government that left office over 25 years ago, then that’s a pretty strong endorsement for electing that party in the present.
Well done, Hal. Well done, indeed.
Aristotle would be pleased. He said that to win an argument we need to shift the conversation into the future tense — the deliberative mode. Past tense assigns blame (forensic). Present tense works for values (demonstrative).
I agree. We have to form our opinions by how people behave today. We should look at what sorts of policies they promote now.
I would push back if you were saying that history does not matter. But I didn’t hear that. I think you said we need to move forward.
I have not paid much attention to this PPSA (as compared to last time, when I wrote a song about it LOL!). But I am innately suspicious when the OMA starts using dues to fund “Cheerleading Town Halls” to tell busy doctors, “Wow, guess what we came up with this time? PURE AWESOME!” It’s like comparing the different types of colonoscopy cameras and getting to choose which one gets rammed up your rear. Sigh….. here we go again, Shawn!!!!
Ha! Jodie, your song and your daughter’s fantastic singing were the tipping point in 2016. Seriously, when regular people make satirical videos about the elites, the end is near. That was so awesome.
We have a choice: lose a finger by voting yes, or lose two at arbitration.
Either way, people can see that it’s a bloody mess. Unfair is still unfair even when government follows proper process.
Hey, great to hear from you! Thanks for reading and posting a comment.
So tired of the vote yes or else narrative.
The membership has to expend so much energy to get the board out of bed with gov’t and push harder.Are they afraid govt will rescind Rand ?
The OMA board continues to disappoint,and doesn’t push new initiatives like privately managed surgicentres hard enough.
Ontario docs need bold reform, or will be doomed to much of the same for years.We have watched this movie over,and over,and over ….
Agree.
When times are bad, doctors who generally focus solely on patients rise up and say, “Enough! I’m getting involved in medical politics.”
They storm the board and demand an outcome-focussed mindset. They drive out divisive, partisan nonsense. They insist that the OMA focus on supporting doctors so that doctors can focus on patient care.
These new board members serve their term. They may even serve a second. But soon enough they go back to seeing patients — their first love.
Their vacancy leaves a vacuum to be filled by others who are more like Trudeau or Bob Rae. Divisive. Disdainful of regular working docs. They pick winners and losers. They feel ashamed of the medical profession and seek to bring it down. They use emotion in the service of power.
To be clear, not ALL of the new members are thus. But a significant portion are. They do not seek to serve but to control.
The sort I’m describing seek to multiply committees beyond imagination. In their pursuit of so many good and worthy causes, they completely lose sight of why the OMA exists.
Then a new crop of docs rises up and storms the board … at least they used to.
Now things are FAR worse. We have much less power to expunge the do-gooders when they do nothing for doctors and patients.
Sorry for being so dour! I see the end of the OMA monopoly coming soon. If the OMA was able to negotiate on behalf of 10,000 doctors, surely we could have two or even three organizations negotiating on behalf of close to 25,000 practicing docs (never mind advocating for the close to 20,000 retired docs).
In the end, government will stop wasting time negotiating with the OMA if it shows it does not represent doctors. A bad offer is VERY bad for the OMA.
Thanks again!
Once upon a time, OHIP was simply a provincially run insurance plan paying invoices submitted by docs for services rendered.
Now, the insurance plan wants to tell docs how, when and where to work… Or else they don’t pay.
All the benefits of being an employer without the obligations that employers have to employees.
Do we have ANY way to change this narrative? Is it the Canada health act that hobbles our ability to change things, or is there something else?
Either OMA needs to pull right out of the MOH and reject their fiction… Or dive in completely and insist on all of us becoming full employees..
I think I’d have better luck selling this to the syfy channel than seeing such change become reality.
Rob
Well said and I agree entirely. OHIP became managed care sometime in the late 1980s and early 1990s. It has added HMO features ever since.
We are trapped in the middle. As you say, we are left with all the pain of being independent contractors without the ability to control the care we deliver and for which we are held liable.
OMA does not get it. Considering all revenue from dues and through their subsidiaries, they pull in closer to 100 million each year. No one will compromise that by fighting government.
It will end when the iron triangle breaks. How much longer can it last?
Thanks for reading and posting a comment!
Cheers
I agree with you. There is precedent with regards to docs being government employees. The “Montreal locomotive” Supreme Court judged that ownership rested on four pillars: risk of loss,”; chance of profit; ownership of tools; ability to set hours of work and working conditions. I would argue that docs have control of none of these….the government does. Ergo, as our employer, they should be providing pensions, benefits, paying our assistants, etc. we have been their employees for decades. We’ve just never held them accountable.
Fascinating comment, Martin. I was not aware of these four pillars. Very useful.
Thanks for posting this!
Shawn:
Thanks for stimulating discussion on this topic.
As someone who quitted the Board and then became OMA President, you surely know the politics of OMA and its relationship to the government and ” Take this or get worse at arbitration. What kind of free vote is that?”.
I just want to point out the subtle difference between accepting the PPSA vs being arbitrated a “worse” or same deal is that I did NOT agree to a bad deal. Voting yes means I agree to accept a deal, good or bad. For me, I rather tell my patient I do not accept a rotten deal and that is the final straw for me. I decided to retire this year and staying away OMAinvolements/politics.
I just feel sorry for all my colleagues that has to carry on working in such unhealthy environement. Good luck to you all.
Michael!
Great to hear from you. I am sure many of us envy your ability to sail away. 🙂 You earned it!
I agree: a really bad deal and a bad-but-not-as-bad-as-it-could-be deal are both bad deals. Clear heads will see the insanity of it all.
Thanks so much for taking time to post a comment. I hope you are well! I have fond memories of seeing you at meetings for many, many years.
Happy retirement!
Shawn
Love the way your mind works, Shawn …. and am salivating at your tease for your next essay …
I would vote against this if I were still working …. because CPI at 5% will make a mockery of such parsimonious small minded spawn of the great god of mediation, masquerading as “Fair Representation” ….
so just a small thought here to complicate your calculations, young man …. and I apologize for mixing many metaphors ….
Where, exactly, does the the OMA’s persistent clinging to the leaky self serving life- raft called a Corporate Structure figure into this dogs breakfast which you so rightfully call an iron triangle?
Hello Mike,
Very kind of you to share some encouragement. I tried to start softly and waited until right before the voting so as not to seem like an ornery crank.
This PPSA bothers me at a fundamental level. It seems every time we get a chance to vote we have to hold our nose. It doesn’t seem to make the Ministry want to decrease the stench of their offers.
I’m glad you turned to the OMA. Of course, the board gave us this deal. The board voted for it. The board fostered the negotiations along. The board said, “Sure. Please negotiate with one arm tied behind your back (Bill 124). Great idea.”
As soon as the board learned that Kaplan (the professional mediator who will become Chair of the board of arbitration) would abide by Bill 124, the board should have bailed.
THIS was why we fought for a binding dispute resolution process in the first place! Kathleen Wynne ‘negotiated’ for a whole year using a take-it-or-leave-it approach from day 1. She instructed her team to offer 0.25%, or some other silly number. She set the terms of negotiation BEFORE negotiation started.
Doug Ford did the same. He set the terms of negotiation before it began. This is NOT fair bargaining. It is blackmail.
The OMA board now has non physicians on it. Non physicians know that the OMA risks its $50-60 million in forced dues, $25 million in Ontario MD funding, and it compromises its Insurance company — well over $100 million in flow-through revenue, last I recall.
Conflict of interest?
Then add a few doctors fresh out of residency, who have almost zero experience with running a small business. Add another few who work in hospitals and do not have employees of their own. Then round out the group with a few semi- or close-to-retired docs from downtown Toronto, who feel guilty for their ‘unearned privilege’, and you have a board that will NEVER fight for doctors so that doctors can focus on patient care.
Ok, this is turning into another blog. I hope to turn my sights back onto the OMA also. It’s been 5 years since I was president — there must be a statute of limitations on when it’s okay for me to start critiquing OMA performance again?
Always great to hear from you, Mike. From day one, I learned to listen when you speak. Always wise. Always provocative. Never easy to ignore.
Thanks so much for taking a moment to read and comment!
Cheers
“This above all: to thine own self be true
And it must follow, as the night the day
Thou canst not then be false to any man” Polonius, Hamlet
Two years is a fair Statute of limitations …. when criticism is constructive …. and also fair.
And I agree …. the Board’s decision to proceed with negotiations against the background of Bill 124 is quite inexplicable.
If this ratification vote fails, it becomes ever more obvious just how out of touch the Association has become with its membership. Again! So then, do we have more Board resignations …. and do doctors have to start rebuilding …. again …. in some sort of never ending groundhog day?
Last time around, and in my almost final act in the OMA as a doctor, back in 2017 when we were discussing the “Binding Arbitration Agreement” before the vote, I argued quietly at SGFP meetings for Labour Board Jurisdiction over the OMA. Goldblatt and Barrett shot me down …. “it really wasn’t necessary “… “we have all the clout we need with the Arbitrations Act, etc” …. and, I admit, the reassurances left me uneasy.
But here we are again. With Labour Board supervision, at least the ffs family docs who wanted to join FHOs could have brought a “duty of fair representation” grievance against the OMA at the time of the last “arbitrated” settlement … and received a decision on the matter. As things currently stand in our experimental nether world, the only way to raise complaint against the OMA (however justified) is to initiate a civil action …. and good luck with that …. you’ll need a huge war chest.
It’s really sad when we have to keep waiting for the OMA to do the obviously right thing, over and over and over ….
2 years … well, let’s get on with it then 😀
I had no ideas about the Labour Board Jurisdiction. This makes sense. I’m embarrassed that I did not know about it given my involved during that time. I must look into this more. Fascinating and infuriating to think legal counsel didn’t think the oversight was worth the bother!
Thanks again, Mike. I’m certain members have no idea of all the value you added over the years (and still do!).
“I argued quietly at SGFP meetings for Labour Board Jurisdiction over the OMA. Goldblatt and Barrett shot me down …. “it really wasn’t necessary “… “we have all the clout we need with the Arbitrations Act, etc” …. and, I admit, the reassurances left me uneasy.”– Wow!
Yes, this has been eating at me also, Gerry.
I asked around and apparently the labour board only has jurisdiction over employees. Will try to double check.
Mike, have you heard this response already?
The Ontario Labor Relations Board certainly HAS jurisdiction over both employers and certified Unions (plus union members), and can address, and, where necessary, enforce decisions on issues brought before it which arise out of Collective Agreements.
Our employment status …. whether we are employees or independent contractors or dependent contractors …. is invariably brought up by government (and sometimes the OMA) as a smokescreen or red herring …. to confuse the issue and try to convince us that we don’t really have any right to bargain collectively in any meaningful way. Other professions, like lawyers or dentists or architects, are still truly independent contractors. They can negotiate directly with clients for their compensation. Doctors can’t do that any longer in Canada …. well technically you still can, but it usually doesn’t go well ;-))
An old friend, also a prominent Labour Lawyer, has opined that we are actually “dependent contractors” because of the many employment restrictions imposed on doctors by government. And dependent contractors are the same as employees and permitted to unionize within the terms of the Ontario Labour Relations Act.
To get back to 2017, what bothered me was that after those several hard years of cutbacks we finally had government where we wanted …. with its back against the wall of an election …. and the OMA was snatching defeat from the jaws of victory once again by not insisting on a package which also protected doctors from self serving shenanigans by their own union.
To get BA individual doctors had to agree to significant limits on their individual employment rights …. but yet Government was not imposing any parallel concomitant duties in law upon the bargaining agent. Gee, I wonder why?
No other bargaining agent that I know of gets access to “compulsory dues checkoff” plus “exclusive right to represent” without having the multifaceted Duty of Fair Representation to members imposed in some sort of legislation.
Excellent comment, Mike. This seems clear and obvious.
Now, let’s see how the OMA responds. I’ll email the board chair and ceo.
Thanks again!
so Shawn, which one of the “Then add a few doctors ” paragraph am I?
You are the superstar, of course!
Hope you are well. Great to hear from you, Hiro.
Cheers
Thank god that I retired (ex FHG ) in January 2022.
That the FHO/ FHT doctors must live within a 5km radius of each other interests me, it’s the thin edge of the collectivist wedge.
In 1940 , my country of birth was “ liberated” by Stalin under an agreement with Herr Hitler and we were collectivized, I was born in a German National Socialist occupied Soviet collective farm…under one , our products were sent to Moscow, under the other to Berlin, otherwise no difference.
Pre 1940 the region was featured by scattered private farms scattered in forest clearings ( land reforms handing out farm land occurring with independence from Germans and Russians post Versailles)…with collectivization, the central planners ordered the farmers and their families to relocate to the village a few Km in radius , their abandoned original homes going back to nature…no one forgot their original properties and in 1991 they flocked back to reclaim and revive them.
Moscow sent in all knowing managers in, one could not leave one collective to visit the next without a pass, let alone the cities.
Orders came from Moscow when to plant and what to plant regardless of local experience and knowledge…seed was sown while there was still frost in the ground…the harvest reaped while still green …not to do so was considered “ wrecking” and “sabotage”…resulting in deportation , productivity and quality dropped like a rock…but that’s another story.
It is the central planners’ urge to concentrate their farmers and doctors for theoretical text book benefits and supposed efficiencies that interests…the 5 km radius caught my eye.
Post ‘91 my mother and I having claims in the “ old country” went to reassure our surviving relatives that we would not be making claims on farms and properties…buying a tractor there , building a greenhouse for flower growing there.
They are now arming themselves and forming a home guard…they lost everything before and have no intention of losing everything again.
This is really fascinating history, Andris. Wow. You need to keep sharing these details.
I mentioned the Ukraine famine (Holodomor) to a socialist colleague once. He insisted it had nothing to do with collectivist thought — simply bad weather. We all lose when we choose to ignore history.
Thanks again. Love it!
Government doesn’t care about access – it cares about the PERCEPTION of it caring about access. It cares about controlling spending and maintaining the budget line and the perception that it cares about access. (And it doesn’t care about quality one bit. This is the main reason for needing the return of user fees / copays. That way doctors can again have some control over their businesses and be able to innovate to serve patients and communities.)
Clay
I find your lack of faith … enlightening (apologies to Darth Vader).
At some point, we need to stop assuming the best of the other side. It just feels uncomfortable to assume such a mercenary approach.
Brilliant comments. Thanks for taking time to share! Hope you are well … haven’t chatted in a long while.
Having gotten Binding Arbitration that we thought would be determined by economic situation too, we now see that is not what the Binding Arbitration negotiated is. Time for doctors to wield their power again and do better this time.
Agree. Not sure docs will though. It took Wynne’s fee cuts to wake docs up.
Hiding MUCH larger cuts behind inflation and calling them raises should lull docs into accepting the offer.
Are we really that dumb, Shawn? I recall Deb Matthews saying ophthalmologists got a raise after my section increased volumes TO CUT BACK THE BACKLOG IN CATARACT SURGERY AS THE GOVT WANTED.
Oh man. Gerry. I had forgotten this. Brutal, simply brutal. And yet SO CLASSIC. I’ve heard this about other docs too.
What’s worse, The Toronto Star believes the Ms. Matthews of the world.
I think it’s important to clarify that virtual care has been seriously cut by a sneaky caveat within the ppsa: that a patient must have had a consult by video or been seen in person within the last 24 months in order for the physician patient relationship to be valid for remuneration under virtual care services. Otherwise even video followups will be limited in remuneration to $20 per visit.
Therefore any continuing care patient the physician has treated for years, or patient who had their initial consultation during the pandemic by telephone, will need to be brought in, in person, before October 1st for virtual followup to be remunerersted at 85% by phone or 100% by video. And doctors will need to bring in ALL continuing care patients thereafter every 24 months going forward. No matter whether rural, remote, underserviced subspecialty care across long distance, what the patient wants etc etc. They need to come in to give their doctor a crisp high five in order to satisfy criteria for a “patient-physician relationship” under the comprehensive virtual care agreement. Paul Conte has confirmed this multiple times for psychiatry section as well as in town halls.
Rural/remote, addiction medicine, child and adolescent psych services among many others, will lose access to the physicians several hours away whom they have always worked with. As well as psychiatrists providing group DBT/CBT/eating disorders treatment from afar, who have up to now relied on a nurse or social worker to assess for placement (hence no virtual consult on the books).
This 24 month criterion is going to limit care for the most marginalized psychiatry patients, including those who had been receiving care in Northern Ontario for many years prepandemic.
Brilliant comment.
Hadn’t thought of that, Lana. Of course, I know many specialists who maintain connections with patients living hours away to the north.
Thanks for presenting this so clearly. As usual, patients pay the price.