A Way Forward for Ontario’s Doctors

Just over a week ago, 31 doctors proposed five principles to provide a way forward for negotiations between Ontario’s doctors and the provincial government.  That number has quickly grown to over 400 doctors signing on to the document in hopes of delivering a way out of the recent bargaining impasse.

At issue is Ontario’s Physician Services Agreement (PSA), which determines not just the amount doctors are paid by the province (fees for service), but how physician payment is distributed, as well as special programs for rural practice and physicians new in practice.

A recent tentative agreement between the Ontario Medical Association, on behalf of doctors, and the provincial government was hotly contested and ultimately voted down by doctors in a flurry of in-fighting, recrimination and finger pointing. Some doctors made calls for withdrawal of services or the imposition of user fees, while the government threatened unilateral and punitive action.

Nobody won, in other words.  And Ontario patients continue to be caught in the middle.

What’s at stake? Plenty.  A renewed agreement between doctors and the province will affect the cost of health care, and some worry that poor choices could affect quality and availability of care as well.

In this contentious environment, a bit of calm, practical thinking has been welcome in the profession. Since last week, hundreds of physicians have gone online at aWayForward.ca to urge doctors and the government to move ahead using five practical principles as a core of the discussion.  The signatories include doctors from every corner of the province, doctors from a broad range of specialties, doctors who voted ‘yes’ on the last proposed PSA and others who voted ‘no’.

This expanding consensus is a welcome break from the tumult of the last two months.

As a first point, the letter calls for clarity in the process, and an end to pronouncements about who does and doesn’t speak for the profession.

The fact is, despite its limitations, and the gaffes made in the creation of the last proposed agreement, as the elected body representing the province’s doctors, the Ontario Medical Association is best placed to represent doctors at the bargaining table, and represent the wide range of views doctors hold. Splintering doctors into specialist and family practice factions at this critical juncture serves no one.

To make negotiations work, though, the government needs to abandon any idea of unilateral action or coercion, while doctors need to regain confidence in the mechanisms that address real sticking points.  For this reason, all parties should accept the widespread call for a binding arbitration process, when necessary, for resolving disputes.

Conversely, doctors have to face the real constraints affecting these negotiations, and accept their role in managing within them. Doctors have invaluable knowledge of the health care system. We owe it to our patients to use that knowledge to ensure health care funding decisions are based on evidence. We can only do that if all doctors work together and with government to help make the tough choices about where to restrain spending, where we can find operational improvements and where medical evidence points us to better ways of doing our work.

Doctors won’t and shouldn’t support hurried cuts, or spending constraints that ignore the needs of a growing and aging population. However, a shared stewardship approach, that recognizes all the realities of health care finance, on both sides, could genuinely benefit patients.

Part of facing those realities requires acknowledging the changes that have happened in technology and techniques that have made it easier, faster or less expensive to perform some procedures.  Fee schedules should be adjusted to accurately reflect the current state of medical science. Only a modernized fee schedule can accurately reflect the appropriate distribution of resources and fund the services people need in a rational and balanced way.

Finally we, as physicians, have an obligation to reassure a public rightly concerned by talk of service withdrawal and user fees. As Canadians, we are justifiably proud to have a system that is accessible to everyone, and as doctors, we should reaffirm that we will be there to care for our patients, regardless of their means.

Despite the challenges of the current process, we are, as a profession and a province, lucky to have a high quality health care system that is worth doing hard work to preserve. It will require a system that respects physicians, a process that accepts the real limitations of the government and, most importantly of all, ongoing commitment to ensure that every Ontarian has access to top quality care.

The five principles at aWayForward.ca will help achieve those goals — and we hope the surging support of the profession for such guidelines will help advance negotiations, beyond posturing, and into practical progress and resolution.

Dr. Vlad Dzavik is a Cardiologist at the University Health Network and voted ‘Yes’ on the recent proposed PSA.

Dr. Chetan Mehta is a Family Doctor at the Queen West Community Health Centre and voted ‘No’ on the recent proposed PSA