Ontario doctors get new president, start tough round of negotiations

A Hamilton surgeon takes over at the helm of the Ontario Medical Association on Sunday, jumping into the top job just as negotiations between the province and the organization representing Ontario’s 25,000 doctors get underway.

New president Dr. Ved Tandan said his priority during his one-year tenure will be to break down the walls between hospitals, doctors’ office and the community health care sector. When patients fall between the cracks in the health system, it’s typically when they’re moving from one of these sections to another.

“My focus this year is on trying to move us to the health-care system of the future,” the Hamilton surgeon said, adding that patients deserve “truly seamless care” in an integrated system.

The baton was passed to Tandan by his predecessor, Dr Scott Wooder, at an OMA governing council meeting this weekend.

Talks between the OMA and province have a history of being rancorous. Before the last deal was reached in 2012 — it expired last month — talks fell apart when doctors balked at the province’s demands for a pay freeze.

The negotiations are important because have a huge impact on how health care gets delivered in the province.

This set of negotiations is expected to be particularly intense because the government is under tremendous pressure to rein in the cost drivers of health care — doctors being one of the biggest.

Roger Martin, former dean of the University of Toronto’s Rotman School of Management who now serves as the premier’s chair in productivity and competitiveness, recently released a report showing that doctors’ wages have jumped 51 per cent between 2002 and 2012.

But the hike did not buy changes needed to help keep the health system sustainable, he said.

The province spends $51 billion — or 42 per cent of its budget — on health and unless spending is reined in there will be less money for education and social programs, rationing of health services, a bigger debt or higher taxes, Martin warns.

His report notes that the average Ontario physician takes in $375,500 annually, an amount that includes compensation for overhead costs.

Martin and other observers hope the fee-for-service method of paying physicians is a main focus of the talks. The piecework model that allows doctors to bill OHIP for each service performed is essentially a “blank cheque,” he charges.

Health-care consultant Stephen Lewis and University of Toronto health policy professor Terrence Sullivan argue that fee-for-service creates “perverse incentives” that allow poor practices to be more lucrative.

“Conscientious and engaged family doctors who spend time dealing with the challenges of complex geriatric cases earn lower incomes for doing so. Others who refer every difficult case to specialists, see 60 patients a day and prescribe drugs indiscriminately make a lot more money,” the duo wrote in a commentary last year for the Institute for Research on Public Policy.

Arguing that collective agreements with physicians encourage them to practice more medicine at greater cost, they say the only way to contain health care spending is to “change the deals we make with doctors.”

They argue for the creation of a new deal for doctors that redefines their roles, relationships, and accountabilities.

Physicians need to take more responsibility for the fact that they influence spending in other parts of the health system, Martin says. When they write prescriptions, they have an impact on the volume and types of drugs used. They also have a big say in who gets admitted to hospital, who gets treatment and who gets diagnostic tests.

Martin says that if he was at the negotiating table, he would demand that doctors show more leadership in making the health system sustainable.

“I’m not at all interested in talking about how much more money (they) want,” he said.

Health policy analyst Dr. Michael Rachlis said he hopes the negotiations address significant disparities in the amount specialists get paid. For example, ophthalmologists make much more than geriatricians, a factor that contributes to a shortage of the latter specialists, he said.

“This is why you still can’t find doctors to deliver services to the most vulnerable who most need care,” Rachlis said.

“The negotiations are almost always limited to how much money goes to the OMA and then, internally, how much goes to different blocks of specialties,” he explained.

Representatives for the different specialties “meet in what is literally called bear-pit sessions where they are at each other viciously. There is nothing to do with the public interest in any part of that,” Rachlis charged.

He said the government is limited to negotiating around the edges and doesn’t have many levers to affect major change.

He said he hopes Tandan is mindful of this as he starts his term:

“The more thoughtful the leadership of the OMA is, the more cognitive dissonance there is for people to try to deal with the serious public policy issues that need to be dealt with.”

Heading up the OMA’s negotiating team is Dr. Atul Kapur, an emergency medicine physician from Ottawa.

Leading the province’s team are assistant deputy minister Susan Fitzpatrick and CEO of the Niagara Health System Dr. Kevin Smith. They are being assisted by negotiations advisor Bob Bass.

Related:

More Queen’s Park stories on Thestar.com