Wynne government offers Ontario's doctors new fee deal

Kathleen Wynne's government is offering an improved compensation package to the province's doctors nearly four months after members of the Ontario Medical Association (OMA) voted down its previous contract proposal.

Health Minister Eric Hoskins said the proposed deal aims to make physician compensation fairer. It would sweeten the pot for most family physicians while clawing back payments to specialists who bill the Ontario Health Insurance Plan (OHIP) more than $1 million a year. 

However, the initial response from the OMA, which is still looking over the deal, was negative. 

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Senior officials from the Health Ministry met with the OMA on Wednesday morning to unveil the proposal, and provided details to reporters in a briefing.

"The OMA asked us for time prior to the resumption of any negotiations," Hoskins  told a news conference at Queen's Park on Wednesday. 

"However, four months have passed and we're still waiting." 

The key difference from the offer rejected by the doctors in August is a 1.4 per cent-per-year increase in funding for the 8,000 family doctors who work with family health teams. They are paid annual salaries or capped contracts, instead of billing the Ontario Health Insurance Plan for each patient they see.   

The proposal targets top-billing doctors with a 10 per cent clawback on the amount that an individual doctor bills OHIP above $1 million per year, plus a 20 per cent clawback on annual billings exceeding $2 million. About 470 doctors billed more than $1 million in 2015-16, according to the Health Ministry.

"The OMA will have an opportunity to review and respond to our plan and hopefully work with us on these proposals to reach an eventual agreement. But quite honestly, we can't keep going around in circles," Hoskins said. 

Ontario Medical Association reacts

The leadership of the OMA met Wednesday in Toronto to discuss the proposal, and their initial reaction was negative

"Large parts of it are essentially a rehash of what our members resoundingly rejected in the summer, so that's a problem," the president of the OMA, Virginia Walley, said in an interview with CBC News.

She declined to rule out job action. 

"No decisions have been made. but all options are open," Walley said. "Our members are frustrated. I can't predict what will happen."

Also included in the government's proposal are 10 per cent reductions to fees paid for such items as diagnostic x-rays and cataract surgery. Government officials say the fees have not been cut despite significant technological advances that have reduced the time it takes specialists to perform them.

"They're able to review more images in less time," said a senior government official involved in the negotiations. "With the improvements in technology, ophthalmologists are able to do more of these procedures in less time." 

The province had reached a tentative deal with negotiators from the OMA in the summer, and the organization's board recommended its members ratify the deal. Instead, more than 63 per cent of doctors voted to reject it. 

Going public with proposal is new tactic  

Releasing details of the offer is a new strategy by the government. The previous negotiations went on under a media blackout. 

Walley criticized the government for making details of the new offer public an hour after unveiling it to the OMA, saying her members want "meaningful and responsible negotiations with government. The Minister's actions today are the very antithesis of that." 

Hoskins said the OMA "insisted" on non-disclosure of the previous proposal and defended his move to go public with the new one. "This government believes that it's important to be transparent with OMA, transparent with Ontario's doctors and transparent with the Ontario public," he said. 

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Although details of the previous deal were never officially revealed, a copy of the rejected deal obtained by CBC showed it would have boosted the OHIP fee-for-service budget, which is $11.5-billion, by 2.5 per cent annually over its four-year term. This amount is the same in the new proposal.

Some doctors argued that this would effectively be a pay freeze. Since Ontario's population is growing and aging, the amount of services doctors have to perform each year is growing, they said. Government officials said the amount is sufficient to cover the additional demands on the health system.

"There are elements in the previous proposal that are no longer on the table," said the senior government official who briefed reporters.

The current contract under which doctors are paid expires on March 31, 2017. It was imposed by the government after it failed to reach a negotiated deal with the OMA.