Throwing down the Iron Fist in a public healthcare system.

In Featured by Edmund Kwok3 Comments

After two months of “negotiating”, Deb Matthews and the Ontario government has finally showed their hand. They got up, walked away, and unilaterally made the cuts they wanted to make without entertaining the OMA’s offers of cost-saving, or even the idea of having a third-party conciliator. In hindsight, it is clear from a political point of view that this was a crucial first step in the government’s efforts to curb overall public spending – how better to negotiate with other public workers like teachers, etc., than to show the world that even doctors must submit to their iron will?

The cuts proposed actually sound reasonable…on the surface. The OHIP fee schedule is in desperate need of a complete overhaul (and has been for some years); technological advances have indeed made certain procedures much more efficient, such as cataract surgeries. Adjusting how providers of these services are paid makes sense. On the flip side, other services have gotten exponentially more complex and time-consuming – take for example, a “simple” family doctor visit. A primary care physician is supposed to be the quarterback of a patient’s multi-faceted healthcare, coordinating an ever-increasing avalanche of specialist referrals and follow-ups. This job has gotten much more difficult over the years, and yet the government has failed to adjust the fee schedule accordingly.

But the current haphazard cutting of selective fees isn’t the biggest problem. It’s the iron fist method used that’s so disturbing.

Physicians are not like any other public sector employees/group because, well, they’re not. Canadian doctors are individual private-practicing entities, who just all happen to be billing the same payer. They have no unions, and the way they are paid are dictated by regulations and not legislations. So unlike dealing with nurses or other health professionals, the government can indeed very easily negotiate in bad faith: “This is how it’s gonna be, too bad“.

And that’s exactly what’s happened. The Ontario government has drawn its line in the sand, telling physicians “we want the same quality of care, but we’ll pay you less for it. Take it or leave it“. The problem of course, is that as individual private entities physicians can indeed just leave it; or equally undesirable, downscale quality service delivery proportionally. The government has no control over physician employment or workflow beyond setting of the fee schedule. Potential consequences include physicians leaving the province for richer lands – here’s OMA’s official statement outlining concerns over potential impact on patient care.

And we’re not just talking about the targeted specialties mentioned in the announced cuts. The future threat of similar iron fist moves by the Ontario government is certainly leaving a bad taste in the mouths of all physicians. Here’s one comment by a GP in the Toronto Star:

I am a 65 year old GP who has 3000 patients. I was planning to slowly retire as I found those patients new care providers. Now, since you and the patients of Ontario feel that I am a weakling to be pushed around, I am not re registering with the CPSO in June. My patients will be given a copy of their medical chart on CD. They have been given Deb Matthews constituency address and phone number as a source of future health care.

There is no question in my mind that more efficiencies must be found in healthcare delivery. But the manner in which the government made an example of the physician group is bound to have negative consequences…let’s just hope patient care isn’t one of them.

What would you have done if you were the Health Minister?

Edmund Kwok

Edmund Kwok

Emergency Medicine. Quality Improvement. Patient Safety. Change Management. Healthcare Administration.

Frontdoor 2 Healthcare

Frontdoor2Healthcare, founded by Dr. Edmund Kwok in 2012, provides editorial and commentary on issues affecting Canadian healthcare from the emergency department’s “front door” perspective. Frontdoor posts allow for open sharing of the diverse opinions and perspectives of emergency physicians from across the country.

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