New OMA notice - cuts to fees

[lostintime]

What do you guys think?

 

 

PRESIDENT’S UPDATE

 

Vol. 17, No. 13

 

April 24, 2012

 

 

 

Negotiations Impasse

 

 

 

Negotiations with the Ministry of Health and Long-Term Care for a new Physician Services Agreement have reached an impasse.

 

 

 

As members know, we have been at the table with the Ministry since late February. The OMA has presented a very reasonable and flexible position, mindful of the province’s fiscal challenges, and recognizing the vital importance of maintaining improvements in the health-care system during the last eight years.

 

 

 

After much deliberation on the part of the OMA Board, and guided by the input of our member consultation, we proposed to government what we considered to be an unprecedented and very fair offer:

 

 

 

• No fee schedule increases for the next two years;

 

• Savings of $250 million over two years; and

 

• A commitment to work with government to find more efficiencies and savings in the health-care system.

 

 

 

To date, the OMA and government have already identified almost $300 million in savings, with no risk to patient care.

 

 

 

We have asked for government to continue negotiations with the assistance of an independent third-party conciliator to help the parties resolve our differences.

 

 

 

While we have demonstrated good faith, and made every effort to advance a constructive dialogue, the government remains fixed on a “take it or leave it position” — the same position it presented on the first day of negotiations.

 

 

 

The government has proposed that the doctors of Ontario accept cuts to fees and programs that total more than $1.1 billion over the next four years.

 

 

 

While the impact across specialties would vary, we estimate an average reduction in payments of 16% over the course of four years (the traditional length of our Agreements).

 

 

 

The government intends to freeze the medical services budget at the 2011 level for the duration of the next Agreement.

 

 

 

Within that capped budget, the medical profession would be expected to absorb the impact of billings by any new physicians joining the OHIP pool (an estimated 700 new doctors next year alone), and all costs associated with the increased provision of medical services to our growing and aging population (utilization). Ontario’s overall population is projected to increase by 1.2% annually (or about 170,000 persons per year), and the number of seniors will rise by 3.8% per year (or about 80,000 persons per year).

 

 

 

To achieve its targets, government has declared its intention to unilaterally impose income thresholds and clawbacks on physician earnings during the second, third and fourth years of an Agreement.

 

 

 

Also, government intends to apply a series of targeted cuts to X-ray, ultrasound, cardiac care, colonoscopy, vision care, chronic disease services, basic visit fees for family physicians, and the elimination of the Comprehensive Care Model (CCM) fee.

 

 

 

And, government has proposed that it would significantly reduce the CMPA malpractice insurance reimbursement program.

 

 

 

The result going forward, no matter how you analyze it, is a substantial reduction in payments per physician, and not a “wage freeze” as government has attempted to portray it.

 

 

 

Meanwhile, as members are fully aware, practice overhead costs continue to increase.

 

 

 

Our Negotiations Team has briefed the OMA Board and Executive Committee regularly.

 

 

 

We have made every effort to work with government at various levels to encourage progress at the bargaining table. To no avail, it is clear that government has no interest in negotiating a new Agreement with physicians at this time.

 

 

 

So where does this leave us?

 

 

 

Today, the OMA will host a press conference in Toronto to inform the media and the public of the current status of negotiations.

 

 

 

We will reinforce the OMA’s desire to negotiate a fair and reasonable Agreement with government that maintains a strong partnership between the Ministry and the doctors of Ontario, and provides a collaborative framework for the effective management and delivery of health-care services in the province.

 

 

 

We will outline our offer. And, we will explain the true impact of the government’s unilateral position for patients, physicians, and the health-care system.

 

 

 

The OMA is organizing physician information sessions across the province and an online presentation for members to learn more about the status of negotiations and potential next steps.

 

 

 

We will seek face-to-face meetings with MPPs from all parties and government officials to encourage their support to revive negotiations, and to ensure that they appreciate the ramifications of a legislated Agreement.

 

 

 

And we will employ various communications measures, including television and print advertising and social media, to advance our position with the public, media, our patients and other audiences of influence.

 

 

 

We may call upon members to assist with this action plan as events unfold. Through this sensitive time, it is imperative that we maintain the trust and confidence of our patients. We need their help and support through this challenging time.

 

 

 

We remind our members that our disagreement is with the current government and not with our patients. We must continue to provide the same excellent care to all of our patients.

 

 

 

It is unfortunate that we have reached this position. At the same time, we remain determined to achieve an outcome that is in the best interests of our patients and our members.

 

 

 

We will provide a further report and update our action plan in the coming days.

 

 

 

Thank you for your continuing support.

 

 

 

Dr. Stewart Kennedy

 

OMA President

[futureGP]

Doesn't sound good.

 

Is it the mcguinty government that is closely tied with the nurses?

 

I'm not quite familiar with the history behind Ontario and health care, but is the reason why Ontario is running out of money because of something else other than how health care is run?

 

Other provinces seem to do much better than Ontario in health care... Is it just the fact that Ontario is now the not-have province? (how about Manitoba? Saskatchewan?)

[lostintime]

I just love how I keep reading about scandals of how they mess up and waste money like ORNGE and then take it out on services/individuals who have nothing to do with any of this.

[future_doc]

There is a history of greed/corruption of those connected to politicians. Government is trying to play power politics believing it will win and physicians will cave.

[aaronjw]

There is a history of greed/corruption of those connected to politicians. Government is trying to play power politics believing it will win and physicians will cave.

 

Yeah, as if physicians have no history of greed...

[future_doc]

You cannot tar physicians with the same brush, although some are expert at playing the system not interested in their patients.

[NLengr]

Doesn't sound good.

 

Is it the mcguinty government that is closely tied with the nurses?

 

I'm not quite familiar with the history behind Ontario and health care, but is the reason why Ontario is running out of money because of something else other than how health care is run?

 

Other provinces seem to do much better than Ontario in health care... Is it just the fact that Ontario is now the not-have province? (how about Manitoba? Saskatchewan?)

 

Ontario is running out of money because they built their economy on

Manufacturing. A huge portion of that industry left or died in the latest recession.

[aaronjw]

You cannot tar physicians with the same brush, although some are expert at playing the system not interested in their patients.

 

There is no tarring. All groups pursue in their self-interest. This is a fact and Physicians are no different. There is history of greed and leveraging their power base.

 

I jist wish we could cut the crap and call a spade a spade but instead we have to endure nonsense after nonsense to show they care about the public.

 

NPS indicates that physician work hours around 53 hours per week. Given their salary, politicians can paint a pretty picture of justification to reducimg physician fees and it's one the public would likely buy.

 

The flip side is an Ontario gov't that has completely and utterly mismanaged finances and spending. Their screw ups are being forced upon others to deal with the problems they created. Their screwups offer no accountability to those who created them.

 

I don't know what the solution is but I am tired of the games. Do Physicians deserve more money? On one hand I tend to think yes but on the other hand I know of no starving physicians so what will giving them more accomplish?

 

I'd rather see physicians use their I credible leverage and push for system wide changes. If they have to accept reductions or freezes, fine but use their clout to force change for the future.

[aaronjw]

Ontario is running out of money because they built their economy on

Manufacturing. A huge portion of that industry left or died in the latest recession.

 

Lets not forget a completely incompetent Liberal party.

 

I'd say their excess spending was a far worse problem then our manufacturing economy and if spending had been tighter, we might have been able to offer innovation support to the manufacturing sector which might be paying dividends today.

 

God I hate my gov't lol

[lostintime]

I dunno, sure every group lobbies for their own interests (obviously), but at least there is a regulatory body for physicians (yeah could be argued punishments are not harsh enough blah blah), whereas for politicians, there is very minimal accountability for corruption and the only thing voters can do is not vote them in FOUR years and even then, the next group of politicians suck too.

 

Sure, maybe I'm biased as a future physician, but I would rather see the money going to doctors than politicians. This is going to cause a brain drain (and yeah yeah it's selfish of physicians blah blah, but that's basically what's going to happen).

[aaronjw]

I'm working with a political scholar and lawyer right now to come up with case law that allows a class action law suit against the Ontario gov't for malfeasance and mismanagement.

 

The public NEEDS to have some sort of accountability from their leaders and elections aren't it.most politicians are set for life in one fashion or another their fore their policies have no affect on their livelihood in the future.

 

So in thst essence I absolutely agree with you.

 

I dunno, sure every group lobbies for their own interests (obviously), but at least there is a regulatory body for physicians (yeah could be argued punishments are not harsh enough blah blah), whereas for politicians, there is very minimal accountability for corruption and the only thing voters can do is not vote them in FOUR years and even then, the next group of politicians suck too.

 

Sure, maybe I'm biased as a future physician, but I would rather see the money going to doctors than politicians. This is going to cause a brain drain (and yeah yeah it's selfish of physicians blah blah, but that's basically what's going to happen).

[aaronjw]

 

Cutting physician fees will reduce the quality of medical treatment in Ontario. Doctors simply leave to where they will get paid more. This is going to harm the Northern, rural communities more than anyone - the people in the greatest need will suffer the most. This will increase the already astronomical wait times and have other deleterious effects upon care. But the government doesn't give a **** about this. They'd much rather hire a few thousand more paper-pushers and build a new office building for the health care "administrators."

 

So it IS about the money? If it was about ensuring longevity of a system then physicians would take a freeze or cut and use their clout to force system-wide fixes.

 

Physicians have one hell of a bargaining position: reduce workload to traditional 37.5hr weeks. Want to see the public outrage and uproar, this will do it. But instead of coming across as greedy, physicians can use their bargaining power with the Gov't to work on system improvements instead of *****ing about finances.

[lostintime]

I love this amazing cycle - brain drain round umpteenth leading to increased med enrollment leading to saturation in the market leading to decreased med school enrollment leading to shortage leading back to where we all started. Yay for low quality care at the public's expenses. Who are the winners? Certainly not the public. Physicians SOMETIMES win, rarely. Politicians always win though ha.

[lostintime]

So it IS about the money? If it was about ensuring longevity of a system then physicians would take a freeze or cut and use their clout to force system-wide fixes.

 

Physicians have one hell of a bargaining position: reduce workload to traditional 37.5hr weeks. Want to see the public outrage and uproar, this will do it. But instead of coming across as greedy, physicians can use their bargaining power with the Gov't to work on system improvements instead of *****ing about finances.

 

Reducing workload is also kind of greedy. You're essentially getting less amount for less work, so your actual work-for-income ratio hasn't changed. Still kind of "greedy".

[aaronjw]

Reducing workload is also kind of greedy. You're essentially getting less amount for less work, so your actual work-for-income ratio hasn't changed. Still kind of "greedy".

 

Right. Doctors get paid based on them actually working and seeing patients. My proposed concept wasn't about fees. It was illustrating to gov't that if physicians don't work well above and beyond a traditional work week then the system grinds to a halt. Wait times explode, dissatisfaction increases, media fire storm.

 

The point? Physicians are willing to do their part to ensure the finances are in order by working less thereby being paid less but the backlash from the public towards gov't would be huge.

 

Physicians can use this as leverage. Not to ensure their financial rewards but to address real change that's needed. They can demonstrate, to the public, they care more about the system than their already high incomes and are trying to do something about it because gov't solution is simply to cut, not to improve.

[aaronjw]

 

Of course, there's no talk of cutting the ridiculous universal babysitting service, or pruning redundant government positions; I've never met so many useless people who provide nothing of value to society as when I was in Ottawa.

 

Try living there for 3.5 yrs and also doing consulting for various agencies. It's about to make a person want to bomb the entire fing place.

 

A lot of times I've get a call by a contact asking if I had time for a project. They were coming up on year-end and needed to exhaust their budget. We'd discuss the project, etc, etc and the only way I felt comfortable taking the project is if I had written into the contract that they'd implement recommendations within a 3-6month window.

 

I had other employment during these periods but I'd make a KILLING doing these projects all because they had to spend their budget or they wouldn't be entitled to it the following year. I didn't sleep for 3 months during these periods lol.

[aaronjw]

This is a big gun but would be very challenging to enact. What services can physicians ignore enough to do tomorrow after the day is done? Who will staff the ERs or do call for emergencies? Our professional oath does not allow us to just stop work en masse. There needs to be someone there just in case.

 

The most we can do is work to our greatest capacity but not stretch ourselves thin. It is this kind of obligation we have to our patients that politicians love to take advantage of: we can't really fight back from an employed labor perspective. The only card we have is to practice elsewhere.

 

It is not the job of administrators to fill the positions? A doctor has every right to not work beyond their capacity as a private contractor, do they not? So before schedules come out, do they not have the ability to tell administrators that they are only working 37.5hrs?

 

A FM can choose to work a regular 35.7hr work week.

 

I'm curious about this because I actually think its a viable solution to "fight b ack" against political scum.

[lostintime]

This is a big gun but would be very challenging to enact. What services can physicians ignore enough to do tomorrow after the day is done? Who will staff the ERs or do call for emergencies? Our professional oath does not allow us to just stop work en masse. There needs to be someone there just in case.

 

The most we can do is work to our greatest capacity but not stretch ourselves thin. It is this kind of obligation we have to our patients that politicians love to take advantage of: we can't really fight back from an employed labor perspective. The only card we have is to practice elsewhere.

 

The public unfortunately doesn't get it. Physicians are known to be high earners but are also expected to be forever ascetic. This dissonance sits uncomfortably with the public, and the politicians use it to their advantage. Furthermore, physicians are pretty bad lobbyists, and physicians rarely donate significant contributions to political parties, which lowers their influence. Contrast that with businesses and lawyers, who all have friends in high govt and the senate.

 

Yeah physicians aren't unionized so that's never going to fly. OR we could go on "strike" again, because that went so well the last time and was awesome for patient care.

 

Yeah I agree that's the biggest difference, doctors although "greedy" generally do care and do get punished if they are "too greedy" by self-governing organizations. Whereas politicians, the public is so power-less for stopping them. All people do is complain, but no one really has much power to bring them down because they use gimmicks to win the next election. And the issue that really there are no for-the-public's interest politicians that exist period. I feel discouraged to go vote every time, the options suck all throughout.

[aaronjw]

I feel discouraged to go vote every time, the options suck all throughout.

 

If I feel there are no options, I spoil my ballot.

 

I wish there was a 'none of the above' option. That would be a true indicator of voter apathy.

[lostintime]

That has almost no impact right. Unless EVERYONE did it. And most people unfortunately are not that united and SOMEONE has to go lead the country/province/whatever.

[aaronjw]

http://www.thestar.com/news/canada/politics/article/1167482--doctors-warn-of-shortage-longer-waits-if-fees-are-cut?bn=1#comments

 

Love the comments lmao

 

Makes you realize just how little people thinkmfor themselves

[aaronjw]

If high salaries attract the best then explain:

 

Politicians

Professors

CEO's that destroy their businesses

Just to name a few

 

 

If anything, high salaries attack leeches.

 

 

It's very sad, because physicians DESERVE the money they get.

 

Typically 3-5 years of undergrad science

Typically 3-4 years of medical school.

Typically 2-5 years of residency.

Typically 0-2 years of fellowship.

 

That adds up to a 8-16 years of school.

 

That's no ****ing joke.

 

You're busting your ass for the first half, making NO money, and going into DEBT. Meanwhile, the typical unionized ass hat screaming for lower doc salaries is making $20 an hour - actually getting ahead.

 

For the second half, you're making basically minimum wage, and again busting your ass for 80 hours a week.

 

All the while, missing out on the best years of your life. When you're done, you have no money, no social skills, have f*cked few women (could have f*cked more if you weren't in the library 24/7), etc.

 

Physicians DESERVE that money. If you believe in fairness, then you also must go as far as to say that physicians are ENTITLED to that money. And yet people are saying that physicians don't deserve the $150k per year, because it's not fair. WHAT A ****ING SHAM.

 

Being a doctor is an important job. If you screw around at any time during medical school or residency, people are going to get hurt. Not everybody can be a doctor, because not everybody has what it takes to make sure nobody gets hurt. High salaries attract the best people to perform a critically important task.

 

What the McGuinty government is saying by lowering salaries is that they don't give a rat's ass about your health. They don't care if they have the best people for the job. They'd take a bunch of desperate FMGs to cut costs, even if it means you get communist-Cuba quality care in the end.

[Real Beef]

All the while, missing out on the best years of your life. When you're done, you have no money, no social skills, have f*cked few women (could have f*cked more if you weren't in the library 24/7), etc.

 

LOL ... could relate to this ... hahaha ... Thursday day night pub night --> University friend: "Hey you wanna hit the bar tonight?", Beef: "Nah, I got to study tonight and be fresh to volunteer tomorrow." ..... = missed opportunity to be a 20-something male pig. Those could have been the days.

[futureGP]

This is good advice, but it's not advice that suits everyone. E.g. I spent all my free time studying and barely got by in terms of marks. If I chose to have a life, I would have been a low GPA scrub applying to the Caribbean.

 

yeah, not for everyone.

[japlanet]

 

Let's say medical schools were composed of a bunch of morons. One guy gets drunk on a Tuesday night, and is too hungover to come to class on wednesday when they learn about Rickets for example. He ends up passing the test anyway, and later on in his career, a kid with rickets ends up in his office. Does this sound like a good situation to you? That's why we need solid people doing the job.

 

 

Lol because this would describe at least 25% of my med school class. Luckily everything we are taught gets taught multiple times in multiple ways and so sleeping through one class doesn't mean you will miss something.

 

Not everyone can be a doctor. But there are many more people who could than are. I would be fine with doctors making less if there wasn't $150-300K of debt that is generally required to go through the training.