The Ministry of Health (MOH) says it’s not concerned about the supply of family doctors in Ontario as negotiations with the Ontario Medical Association (OMA) enter binding arbitration.
The MOH and OMA began talks over compensation for family physicians in the province this morning.
Both the OMA and MOH have submitted written arguments outlining their respective positions.
In the arbitration document, the MOH says doctors enjoy freedoms not experienced by other health-care workers and therefore are not entitled to the same employment rights as their professional counterparts.
In addition, the MOH says it will “illustrate that there is no concern of a diminished supply of physicians.”
It also told Now Toronto that reports claiming recruitment and retention of family physicians were “not a major concern” are inaccurate.
The ministry says the section of the brief in question was referring to agreements where retention and recruitment were not major factors in allocating compensation for doctors in 2024.
It also said Ontario has the best record of attracting medical graduates across Canada.
“Ontario has enjoyed a growth in physicians that far outstrips population growth. Evidence will show that Ontario is not losing physicians to other provinces,” the MOH state in the arbitration brief.
But, according to the OMA Section on General & Family Practice (SGPF), the MOH’s proposal sidesteps the need for urgent changes to the system.
“The MOHs brief outlines a deeply inadequate proposal which, if implemented, would further erode the ability of family doctors in Ontario to build viable practices, and continue to put access to family medicine out of reach for a growing number of Ontarians,” the SGPF said in a media release on Monday.
Since 2012, doctors have seen significant fee cuts, including imposed caps on the Physician Services Budget as well as targeted reductions to physician compensation, which reduced the average billings per physician by over six per cent from 2012-13 and 2015-16, the OMA said in its brief.
“At the same time, average physician costs of practice have increased by 8.1 per cent and inflation in Ontario by over 5 per cent,” the OMA continued.
Furthermore, government payments made to doctors are gross payments from which significant portions are deducted to cover the costs of running a medical practice.
As a result, the OMA is asking for a five per cent general price hike for the year, and a 10.2 per cent increase to account for inflation and clinical overhead cost increases. In comparison, the MOH is proposing an overall increase of three per cent, according to reports.
HOW DIRE IS ONTARIO’S FAMILY DOCTOR SHORTAGE?
A study released by the Ontario College of Physicians in March says 2.3 million people in Ontario are currently without a family doctor, and projects that number will rise to 4.4 million by 2026 if circumstances do not improve.
Family doctors represented by the OMA have long warned of the crippling state of their profession in Ontario, and that doctors are increasingly considering leaving their practices.
“Underfunding in OHIP revenue, complicated with rising inflation pressures, have made family practice unsustainable,” the OMA told Now Toronto in an email statement.
So has medically unrelated administration that leaves family doctors spending 40 per cent of their work week filling out forms and guiding patients through a fragmented system, the OMA explained.
A survey by the Ontario College of Family Physicians found that two-thirds of its members plan to change their practice model, reduce their hours or retire in the next five years, the OMA told Now Toronto.
“Simply put, we must do everything we can to retain those physicians who are considering leaving early due to burnout,” the group concluded.
Dr. David Barber, chair, section on general and family practice for the SGPF, which represents the 15,000 plus general and family practice physicians of Ontario in negotiations and advocacy, echoed those sentiments in a statement.
“The Government has known of this for many months and has chosen not to act. Family doctors in practice report unhealthy workloads, stress and burnout,” he said.
The MOH says it is working with various partners to tackle the administrative burden on physicians through the Bilateral Burnout Task Force, which has “significantly accelerated work to simplify forms,” it told Now Toronto in a statement.
“Our government has also launched an initiative called Patients Before Paper Work (PB4P) to further tackle the administrative burden on physicians while reducing the risk of delays in diagnosis and treatment,” the government ministry continued.
The program includes the launch of an eReferral system to automate referrals, consults, prescriptions and central intake and has begun replacing fax machines with far more efficient digital alternatives across Ontario.
But Barber claims the MOH’s arbitration brief blames doctors for the systematic flaws in Ontario’s health-care model and is dismissive of its under-resourcing that he says created the current issues.
As a result, millions of people in Ontario have to rely on inconsistent ER treatment, walk-in clinics, or have no access at all, he said.
“Ontarians need to let their government know that they expect better, and they expect more from the people we’ve elected to lead us,” Barber concluded.
HOW ARE DOCTORS EMPLOYED IN ONTARIO?
Physicians in Ontario are independent contractors, not government employees, and the government compensates doctors for their services through OHIP. Unlike other health-care providers, including nurses and nurse practitioners, family doctors can determine their working hours, and are free to alter and supplement their practice.
In its arbitration brief, the MOH claims that because of the “materially different” nature of physicians’ employment, doctors in Ontario should be distinguished from other health-care professionals by the board when considering evidence.
“The Board should, in our respectful submission, recognize the benefits to physicians of this independent contractor status,” the MOH said, before adding that the current model creates a “distinct lack of direct control over choices made by physicians that impact health care access, quality and efficiencies and cost.”
A decision from the three-day arbitration hearing is expected later in the summer, according to the SGPF Executive Committee.
