Beyond negotiations: What the OMA should do

It is undeniable that the situation in Ontario for family physicians is deteriorating, with financial pressures being a significant contributing factor. This is impacting family medicine and the provision of longitudinal patient care. As a result, more family physicians are leaving the profession, and there is little hope or perhaps no hope that this trend will improve in the near future because policymakers do not truly understand the real problem, and therefore, they are unable to offer the correct solution.With many doctors retiring or downsizing their practices, an increasing number of patients are left without a family physician. But I want to clarify that we do not have a shortage of family doctors overall; the issue lies in the shortage of doctors who are willing to provide longitudinal patient care.Read: Dr. Jabir Jassam: Turning off this wrong pathWhat will count as success for the Ontario Medical Association during their negotiations lies in whether it brings those doctors who have left back to practice and to do longitudinal care and in motivating new graduates to apply for family medicine and take up longitudinal care by granting them a good reasonable deal. Relying on expanding the scope of other healthcare professions is not a sustainable solution, as it may eventually lead to more burden on emergency departments. This is due to the quality of care provided by non-physician healthcare providers and it is not the responsibility of family physicians if this quality falls apart, and this in turn will exacerbate the whole primary health care crisis.While the OMA secured a 10% increase in compensation for doctors in year one of a new fee deal based out of the arbitrator’s ruling, the details of how this will be implemented remain unclear. Furthermore, this increase does not represent a significant victory, as the healthcare system is still far from achieving the necessary goals for sustainable improvement.I believe the OMA likely did its best in the marathon of negotiations but was unable to secure more for physicians.The OMA’s schedule of fees for uninsured patients is different and higher than the Ministry of Health’s Schedule of Benefits for the same service provided. However—as I understand it and tell me if I’m wrong—the OMA fee schedule applies to all Canadians except those in Ontario. For example, if a physician in Ontario sees a patient from Quebec (or any other province), they are able to bill according to the OMA’s fee schedule, even though these patients are Canadians and should be protected by the Canada Health Act. This means it is not illegal for physicians to bill for the OMA’s fees for Canadians. Since the OMA is unable to close the gap and make the Ministry of Health’s schedule of benefits match the OMA’s fee schedule, I strongly believe the OMA should step forward and advise its members that they have the right to bill for the difference.This approach would not violate the rules of the Canada Health Act, as all Canadians should be treated equitably.For example, the fee for an intermediate assessment (A007) under the OMA fee schedule is $102.50, while under the ministry’s schedule of benefits, it is $37.95. Physicians could bill the patient directly for the difference, which would be $102.50 - $37.95 = $64.55, or at least a certain percentage of the difference.If the OMA were to support physicians to bill the difference between the Ministry’s and the OMA’s schedule of benefits or part of it, it would make members feel more supported and valued by their association. This action would also demonstrate that the OMA is actively advocating for the rights of its members and not to mention the financial impact on its members. Finally, I hope the solution won’t involve simply making the OMA fee schedule equivalent to the ministry’s Schedule of Benefits. Dr. Jabir Jassam is a family physician in Ottawa.

Beyond negotiations: What the OMA should do

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