The arbitration award: The good, the bad, the ugly

On Sept. 12, Ontario Medical Association (OMA) board chair Dr. Cathy Faulds announced that the board of arbitration awarded Ontario’s doctors 9.95% for the first year of their physicians services agreement (PSA). Sounds straightforward right? Nope—it’s actually ridiculously complicated.I’ve looked at the award. I may have some of this wrong (copious documents found on the OMA website induced catatonia, hypersomnolence and cluster headaches). But this is my take:A simplified (I have a small brain) set of numbers first:Total award: 10%, approximate value $1.6 billion dollarsAmount for general fee increases: 7% or $1.12 billion dollarsAmount for “targeted funding:” 3% or $480 million dollars.In the past the OMA and the ministry of health (MOH) agreed one quarter of the raises would be across the board, the rest done with “relativity in mind.” If we do that again then $280 million (one quarter of $1.12 billion) will be in across-the-board increases. Every specialty would get a 1.75% raise. The rest of the money ($840 million) would be for raises based on relativity. So all specialties would get 1.75% + X as a raise. The “X” would vary. It would be more for low-income specialties, and the X would be lower or even zero, for the high-income specialties.Read: Dr. Sohail Gandhi: CFPC blows it AGAIN. Insults all Ontario physiciansThe goodThere’s a raise. The MOH team stated that Bill 124 should not impact the deal. The arbitrator disagreed and felt that we were unfairly treated because of Bill 124 stating:“Bill 124 directly impacted the bargaining, even though physician compensation was not subject to its terms.”Hence, the MOH team completely lost their argument that there should be no redress, and there was a 6.95% redress given.There was a recognition that family practice is in crisis. In his ruling the arbitrator chair William Kaplan said:“We accept on the evidence that there is a physician shortage. Somewhere between 1.35 million and 2.3 million people in the province are not attached to a family doctor. These are real numbers. The ministry’s own documents—which we ordered disclosed—demonstrate that there is a problem to address.”The arbitrator had to order the ministry to disclose this? Jeez. Additionally, the arbitrator noted:“Clearly, more family doctors are needed as are more doctors practising comprehensive longitudinal medicine . . . it is obvious that the citizenry is aging—the government acknowledges this brings with it increased complexity.”Contrast this with the ministry’s absolutely laughable position that there is “no concern” about a shortage of doctors. This is frankly a warning shot, and a welcome one, to the MOH’s negotiations team to not say such stupid things again, and to change their position in future rounds of negotiations.In another shot to the now obviously inept MOH negotiations team, the arbitrator agreed that admin burden also needed to be addressed with, you know, money. He stated:“We have reached the conclusion that targeted increases—not necessarily baked in—should be allocated to the reduction and redeployment of administrative work that can best be performed by others or through digital or other measures.”Finally, it was quick. Dr. Faulds had told us not to expect an award until the end of September. Who knows why Kaplan put the award out so quickly.The badThis will not be enough. The OMA asked for a 22.9% increase. They got less than half of that. This is not really the big win the OMA is portraying it as.A 10% increase in gross billings for family medicine will not be enough to stop the haemorrhaging of doctors from comprehensive family practice. The “X” for family medicine (see above) needs to be high, and much of the targeted funding needs to go to family medicine too.And, while it’s true that the arbitrator recognized there was a crisis in family medicine, the award given did not really do anything in and of itself to stabilize family medicine. It’s true that was not part of the scope of the arbitrator for this round (this round was for a fee increase). The fact that some practical guidance in how to resuscitate family medicine is missing is still bad for all Ontarians.The uglyThe implementation of this award is going to be a nightmare. As I write this, there is no indication that the MOH and OMA have agreed on how to divide up the $1.12 billion in general fee increases based on relativity. In fact, indications are that the MOH will continue to fight the methodology, meaning it could be a very long time before fee increases for specialties are set.Worse, the OMA and MOH have not been able to agree on how to distribute the $480 million in targeted funds. Which means . . . more mediation and arbitration. I continue to concede that the OMA states arbitration and mediation will be done by mid- March 2025. I continue to not hold my breath.Even uglier is that one solution being proposed would be to give “everyone” a 9.95% increase right now, until the relativity and targeted funding is sorted out. But that would mean that some of the higher paid specialties would see a 9.95% for a bit, only to have a relative cut once the final fees are sorted out (also to be arbitrated by March 3-7, 2025). No matter how you message this to warn people—this will cause problems when people see a decrease in income after a rise.All of which means that the retroactive pay for this year may not come for over a year. If you are a physician who has some decisions to make (e.g. do you renew the lease on your office at the higher rates the landlord is demanding)—you are going to be awash in uncertainty.The ugliest part of all of course, is that a bunch of lawyers are going to get really rich as their billable hours go through the roof during this process.There is a better wayThe government’s main concern should be about expenditures. That decision has now been made for them. The physician services budget will go up by $1.6 billion. That money will have to be paid one way or another. The government can now, especially after being told off by the arbitrator to back off from their polarizing and obstructionist path, accept the OMA proposals for implementing the award. They cover what the government states it wanted (pay lower paid specialist more of an increase than higher paid ones). They also covers issues around admin burden which the arbitrator acknowledged exist, and the shortage of family physicians (which the arbitrator also acknowledged). The total amount spent by the government is going to be $1.6 billion regardless. Getting rapid agreement on the distribution of those funds will decrease the uncertainty about how much goes where and will shorten the time it takes doctors to get paid, which will stabilize the healthcare system.Then, for the love of Allah/God/Yahweh/Great Universal Consciousness—the government now needs to realize that you can’t fix healthcare without working co-operatively with your doctors. Go look at other provinces. Copy them and get a fair deal for years two to four of this agreement.Or the government can continue to obstruct, obfuscate, delay and impede any real progress towards working together with more protracted, internecine mediation and arbitration. The ball is in their court.What should doctors do?The above represent my personal interpretations of the documents I read. I encourage all Ontario physicians to register for the OMA live session tonight (Tuesday Sept 17) from 7:30 – 8:30 pm to hear more details about this agreement.Dr. Sohail Gandhi is a former president of the OMA and opinions are his and not necessarily the opinions of the OMA board or of anyone at the Canadian Healthcare Network. This article is a reprint from his blog: justanoldcountrydoctor.com.

The arbitration award: The good, the bad, the ugly

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