Increases, inflation and inequities: A western perspective for Ontario doctors mulling a new fee agreement

As Ontario doctors consider the new fee deal proposed by the province—and which the Ontario Medical Association has encouraged members to ratify—many are enraged by what they view as paltry yearly compensation increases that fail to account for rising inflation. On March 1, the OMA revealed the terms of the proposed physician service agreement, which among other things calls for a 1% increase in physician compensation in each of the first two contract years, and a projected third-year increase ranging from 2.1% to 3.6%. These numbers have not been well received by doctors, particularly in light of the fact that in January, Canadian inflation rose 5.1% from the previous year—the first time since 1991 that this economic indicator has seen a year-over-year increase of more than 5%. Ontario was among the hardest hit jurisdictions in the country, with inflation in the province registering at 5.7%, second only to Prince Edward Island, which saw its consumer price index increase by 7.1% from the previous year. Read: OMA urges doctors to vote for proposed fee agreement For doctors, this translates into higher costs of practising—regardless of where they are in the country. Dr. Eric Cadesky, a family physician in Vancouver who was president of Doctors of B.C. when the association negotiated a new master agreement for the province’s 12,000 physicians, said the financial challenges of running a medical practice have become more daunting today. “We know doctors are small business owners,” he told the Medical Post. “And we need all the help and support we can get. That includes support for providing infrastructure for the medical system, paying overhead and buying what we need to protect ourselves, our staff and our families.” Virtually every aspect of running a medical practice has become more expensive, said Dr. Cadesky. At the same time, clinical work today is more difficult, with patients needing care for more complex conditions. This means more pressure for doctors on all fronts, he said. “The pandemic has meant in general that it’s harder to find staff and I know doctors who are offering incredible amounts of money for staff with no experience but who are willing to work in-office,” said Dr. Cadesky. “But then after they get training and experience, they’re often poached by hospitals and other health authorities—and it costs a lot of money to train someone.” Read: Treating doctors and nurses fairly in these pandemic times Costs of clinic and office supplies have also been going up, largely as a result of supply chain issues. A recent report by the global consulting firm PwC noted that healthcare providers spend more today on staffing and safety measures. “Prices for personal protective equipment, infrastructure and staffing such as nursing also have risen,” the report stated. “Investments are also being made in infection control. Investments in remote workforces, such as technology, connectivity and cybersecurity, also could ensure the organization is ready, in part, for the next crisis.” Office lease rates have also gone up, even though vacancy rates in the country have increased during the pandemic. In Vancouver, where vacancy rates rose last year by almost 60% from the previous year to 7.2%, lease rates went up almost 13%, according to commercial real estate firm CBRE Limited. In Toronto, rental rates increased by 12%. A notable element of the 2019 B.C. agreement was a $7,500 lump-sum payment to each physician whose income exceeded $75,000 in previous years. This payment was intended to help offset rising overhead costs. The agreement also included premiums for doctors in urban areas such as Vancouver and Victoria, where the costs of setting up and running a clinic are higher. “This part of the agreement recognized that the most densely populated places in the province were also the hardest places to find doctors because they were finding they weren’t able to make a living wage and were moving elsewhere,” said Dr. Cadesky. “It was recognition that no doctor’s office is the same and that in certain locations doctors need more help.” Read: Newfoundland and Labrador Medical Association makes tentative agreement with province While he declined to comment on Ontario’s proposed physician service agreement, Dr. Cadesky said negotiations shouldn’t focus on across-the-board compensation increases. “We know the increases have to take into account the different challenges doctors face,” he said. Universally applied increases can also exacerbate commonly held views—justified or otherwise—of compensation inequities in the profession, said Dr. Cadesky. “There’s a sense within the profession that some get paid more than others, and that’s a sensitive topic,” he said. “An across-the-board increase will worsen those inequities so part of what we’ve built into every negotiation is a provision that every (physician) section can argue before an arbitrator why they deserve to receive a little bit more than others, maybe because their costs have increased.” Of the 4,000 Doctors of B.C. members who participated in the ratification process in 2019, only three per cent voted against the deal. Dr. Cadesky said that, in supporting the agreement, doctors “didn’t want to feel they were going backwards, that they were losing something.” “As much as the number of an increase might be important, there were other things that mattered, like (matching) contributions to an RRSP, insurance benefits, funding for continuing medical education and parental leave,” he said. “Doctors wanted to keep the benefits they already had, but they also wanted to have built into an agreement processes to continue working with government so we can build trust through collaboration.” Read: You can run but you can't campaign: New OMA election rules not winning votes with some doctors

Increases, inflation and inequities: A western perspective for Ontario doctors mulling a new fee agreement

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