HEATHER BOA Bullet News GODERICH – Changes to the fee schedule for Ontario doctors announced by the provincial government this week amount to a claw back of 16 per cent over the next four years, says the president of the Huron County Medical Society, which represents about 100 doctors across the county.
“I find it frustrating and difficult to hear on the newscast that the government is imposing a freeze in funding because the very next sentence is that there are cuts to this and that in the fee schedule,” said Dr. Stan Spacek, a family physician who practices in Goderich. He has been president of the HCMS, one of the smallest medical societies in the province, for the past five years.
The province announced this week it is moving toward what it calls a wage freeze for the province’s 25,000 doctors in order to invest health care dollars in community care for families and home care for its seniors. It intends to update fees paid to doctors, which is how most of them earn their income.
The changes, effective as of April 1, 2012, are expected to result in savings of more than $338 million in 2012-13 in the $11-billion OHIP program.
“Our doctors are the best paid in Canada. Instead of another raise for doctors, we need a real wage freeze so we can invest in more home care. To hold the line on doctor pay, we’re making changes to fees for physician services to reflect advances in technology and the latest medical evidence on what helps patients most,” said Deb Matthews, who is minister of health and long-term care.
Spacek said a cap in the total funding for physicians’ services does not take into consideration inflation, increased use of services as a result of an aging population, and new physicians who will come on board to service the one million people in the province who do not have a family doctor.
“It falls on the physicians to find the money to pay for the aging population and the aging complexity of care. And I think that’s inappropriate,” he said.
According to the Ministry of Finance’s report Ontario Population Projections Update, 2010–2036, the number of Ontario seniors aged 65 and over is projected to more than double from 1.8 million, or 13.9 per cent of population, in 2010 to 4.1 million, or 23.4 per cent, by 2036.
By 2017, for the first time, seniors will account for a larger share of the province’s population than children aged 0–14.
By 2036, it is project that 30 to 35 per cent of Huron County’s population will be over the age of 65.
“There is a general increase in the amount of tests, procedures, medications that are used by aging population. That is a trend that is I don’t think arguable. And to have that trend, that extra increase, that is inherent in an aging population expect to have a flat cost is simply not feasible,” Spacek said. At the same time, he agrees there is room for review of some fees as a result of technological advances.
The Ontario Medical Association, which represents the province’s medical profession, predicts patients will wait longer for diagnosis for commonly required radiological services like mammography and ultrasound, and there will be reduced access to radiology clinics which will push wait times for CT and MRI scans back to 1990 levels as a result of changes.
“I think if you were to ask people what’s important in their lives, what they value, I think quality health care is a very important thing and it’s obvious when people see us that they want good care. And it’s important you don’t throw that away for the sake of a dollar,” he said.
He said a zero increase in fees for two years and $250 million in efficiencies suggested by the OMA during negotiations over the past three months were flatly rejected by the province.
He said contract negotiations between the government and OMA were set to start early in January. The government was not ready and did not come to the table until the last part of February. It refused to budge from its position and rejected bringing in a conciliator until Friday, May 4, when it also announced negotiations would need to wrap up just 48 hours later.
“In truth, there was never a willingness to negotiate. There never was a negotiation that took place. There was no give or take,” he said.
The average Ontario doctor bills $385,000 and many specialists billing twice that much. From that, they pay all the administrative and overhead costs associated with running a practice. Those costs are somewhere between 25 and 40 per cent, according to estimates.
“Being a physician is not a nine-to-five job. It is a job that, for the large part at least, takes place in the night, on weekends, usually unsociable hours. It is a way of life. So the remuneration that one gets, I think, is quite justified,” he said.
“And quite honestly, if one wants to get rich, medicine and health care generally not the fields to go to. You go to those professions because you like what you do. You have a certain value set and you wish to help people in various ways,” Spacek said.