OMA and gov’t far apart in fee talks as binding arbitration begins

The Ontario Medical Association (OMA) and the Ontario Ministry of Health recently revealed how far apart their bargaining positions are for physician compensation for fiscal year 2024-25. The two “briefs” (both over a hundred pages) were released as three-day arbitration hearings began in Toronto on Monday. The current binding arbitration process is for year one (April 1, 2024 to March 31, 2025) of the next physician’s services agreement for 2024-28.Perhaps this distance isn’t surprising. “I realize that part of arbitration is for the payee (in this case the Ontario health ministry) to ‘lowball’ their position—but the position they have taken with (the OMA) is so low as to be insulting, demeaning and demoralizing,” wrote Dr. Sohail Gandhi on X.The arbitration board has two more days scheduled for June 5 and 6 with the board expected to rule by the end of the summer. “We have put together a strong and ambitious submission as we continue our fight to get a deal that you deserve,” said Dr. Cathy Faulds, OMA board chair, in a note to Ontario doctors.The OMA’s 473-page brief proposes a 22.9% compensation increase for physicians in year one. This includes a 10.2% “catch-up” adjustment, aimed at addressing inflation, increases given to other groups recently and the relatively low increases for physicians since 2012. Additionally, a normative increase of 12.7% is suggested, encompassing a 5% general price rise allocated across sections or groupings, and 7.7% targeted funding to invest in specific physician-related healthcare initiatives for 2024/25.The Ontario Ministry of Health’s 154-page brief recommends a 3% compensation increase for physicians in year one, without additional catch-up adjustments. The note justifies this on the grounds that the last Physician Services Agreement (PSA) was freely negotiated and ratified and physician income growth aligns favorably with other settlements where retention and recruitment are not major issues. The government argues that this is relevant because there is “no concern of a diminished supply of physicians” because the evidence shows that Ontario is successfully attracting medical graduates. Plus, it noted, physician supply is outpacing population growth.Read: Ontario announces it’s moving on two ideas to cut down on physician admin tasks“Family medicine in Ontario is not merely experiencing minor issues that can be easily fixed. We are in a crisis,” wrote Dr. David Barber, chair of the section on general and family practice, in a note to the section’s more than 15,000 members. “The (ministry’s brief) shows a remarkable unwillingness to make the changes the system desperately needs. It is more of the same blaming, dismissiveness and under-resourcing that got us into this mess in the first place.”The OMA will host an OMA Live virtual event on May 23, where OMA leaders will share more information on arbitration and address doctors’ questions.“Ontarians are experiencing a healthcare system that has become progressively worse over years of inadequate funding. Now we’re in a full-blown crisis,” said OMA president Dr. Dominik Nowak, in a press release. “We’re now counting in the millions the number of patients in Ontario who do not have access to a family doctor and that’s unacceptable. We have 2.3 million unattached now and that’s expected to balloon to 4.4 million in less than two years.”An OMA release noted that in the past decade, inflation has exceeded 25% while provincial funding for medically necessary services has failed to keep up with rising costs, causing many physicians, particularly in family medicine, to leave their practices.OMA summaryHere’s the OMA’s executive summary of its brief: “Our compensation ask has three components to it: An ‘inflationary catch-up’ of 10.2% designed to recoup losses and repair the damage done to physicians from rising inflation, increased overhead costs and the impact Bill 124 had on the previous PSA. A general increase of 5% funding for 2024/25 to reflect rising costs which will help preserve the healthcare system and sustain the physicians who are at its foundation. Targeted funding of 7.7% to address a variety of critical areas based on our comprehensive consultation and engagement process and ongoing dialogue with physician leaders. In addition to significant general and inflationary fee increases, many of the targeted fee increases would also apply across all sections, significantly improving fees in the OHIP schedule of benefits. This includes addressing the gender pay gap, medical innovations and technical advances, patient complexity and fee schedule modernization*. “The targeted funding areas include, but are not limited to, the following: “A funding proposal for family medicine, with areas including: Incentives for patient enrolment of unattached patientsIncentives to increase integration of walk-in clinicsIncreasing the after-hours premium feeIncreasing the family health groups premiumIncreasing the Comprehensive Care Capitation paymentEliminating negationQuality improvement stipendRural and Northern physician working group creation and fundingCommunity Health Centre expansion“In addition, we have included the following targeted areas: Overhead feesRetentionCMPAVirtual careAdministrative burden including MedsCheck and minor ailmentsHuman health resources including locum programs and continuing medical educationPhysician extendersRetirement and benefits “*Please keep in mind the allocation of funding for targeted investments will not be addressed in this initial phase of (year one) arbitration, but rather has been developed to provide the arbitration board with a general understanding of the many areas requiring additional funding beyond the catch-up and base increase. As future negotiations phases unfold, we may update or add to our targeted investment proposals.”Ministry summaryNear the top of the ministry’s brief, a chart shows that from 2019 to 2023, the number of physicians in Ontario has grown faster than the population. As well, the brief notes: "The growth in physician expenditures (with price removed) has increased more than the number of physicians. The total number of patient visits has not increased in the same proportion as the number of physicians or population. The number of unique patients seen (at least one visit per year) has not increased at the same rates as the number of physicians or the population.”The brief says this “shows that expenditures are growing per physician even without price increases. Second, it shows that the increase in expenditure is not due to more visits from patients or, for example, from a greater number of patients being enrolled under the care of a family physician (i.e. attached patients per physician). In fact, costs per physician are increasing while average visits per physician are decreasing. “It is self-evident to the policy makers in the (ministry) and government that additional solutions (including but not limited to team-based care), to meet the government’s policy objective of greater patient care and more attachment of patients to a primary care provider—all in the context of a high quality, patient-centered sustainable publicly funded healthcare system—must be found.”Note: An earlier version of this article incorrectly said physician compensation was constrained by Bill 124 but that is not so.

OMA and gov’t far apart in fee talks as binding arbitration begins

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