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Province and doctors find healthier relationship with new deal

How to persuade an overpaid specialist to reduce cushy fees so that an underpaid family doctor might earn more?
July 14, 2016
By Martin Regg Cohn

The theory of relativity explains our universe.

It also underpins a new doctors’ deal announced by Queen’s Park this week, following two years of open warfare between the rival healers at the Ministry of Health and the Ontario Medical Association.

The appeal of relativity is that it offers certainty to physicists. Physicians and politicians, not so much.

Ontario’s “relativity gap” refers to the relative fees doled out to medical specialists at the top of the pay scale, versus family practitioners at the bottom end.

In theory, relativity means recalibrating stark differences in the OHIP fee schedule to reflect advances in cutting edge medicine and traditional primary care.

In practice (especially private practice), relativity spells trouble for highly paid specialists such as the 500 doctors earning more than $1 million a year in Ontario.

Think of eye surgeons who earn millions of dollars for slicing and dicing your cornea in mere minutes, thanks to advances in laser technology. Ophthalmologists like to play dumb on this point, but you don’t have to be a rocket scientist to see technological change occurring at warp speed while fees decline at a crawl - if at all.

How to persuade an overpaid medical specialist to give up his cushy fees so that an underpaid family doctor might be better compensated for spending more time with her patients? At stake is $11.5 billion in OHIP fees - the biggest single item in a $50-billion health ministry, which soaks up the biggest share of the provincial budget.

Divvying up those fees anew remains a daunting challenge. Especially for the Ontario Medical Association - a fractious, factionalized quasi-union with a membership of 33,000 physicians accustomed to calling the shots at work. Doctors don’t sing “Solidarity Forever” at OMA meetings.

Health Minister Dr. Eric Hoskins, demonized by his fellow physicians after imposing unilateral clawbacks to fees, realized that future health reforms required buy-in from doctors.

The OMA’s newly elected president, pathologist Dr. Virginia Walley, looked at the moribund process with a fresh set of eyes - and could see more clawbacks coming if she didn’t do a deal.

Despite its seductively soft advertising campaigns on bus shelters, and full-page appeals in newspapers, the OMA wasn’t winning much public sympathy. Hoskins put doctors on the defensive last April by revealing that hundreds of specialists earned more than $1 million a year - and sometimes much more.

That little bit of divide and conquer - putting the fat cats among the physician pigeons - may have paid off.

No one begrudges dedicated doctors earning a handsome income given their long years of medical training and indebtedness. It’s worth repeating that the oft-quoted average gross payment of $368,000 a year is highly misleading, because significant overhead expenses reduce net compensation to little more than $225,000.

But Ontario’s 500 ophthalmologists typically take home double what the province’s roughly 16,000 family practitioners do. Many might have wondered why 2 per cent of OMA members were earning 10 per cent of the fees.


We will see next month, when doctors vote on the tentative deal, whether proponents of relativity are in the majority.

“It’s not going to be an easy conversation by any means,” Walley said in an interview. “We know that some fees are overvalued. On the other end of the spectrum, there are other fees that are undervalued.”

Hoskins has long known that if he is to get a grip on rising health-care spending with a growing and aging population, he must extend a hand to doctors who act as gatekeepers in the system. Disclosing the deal, he went out of his way to be conciliatory after two years of rivalry.

No, this agreement is not a panacea, but it provides for a healthier process in trying to modernize an outdated health-care system. For all the propaganda emanating from both sides these last years - that doctors were selflessly fighting for their patients, while politicians were fearlessly protecting the public interest - we now have a fresh remedy from the rival doctors on either side of the battle.

Not just relativity, but a new resolve to work jointly instead of unilaterally. Physicians, heal thyself.