A Way Forward for Ontario’s Doctors: Shared Principles

We are a group of physicians, residents and medical students from across Ontario who share the following principles. We invite others to add their signature here.

We the undersigned (established physicians, residents and medical students from across Ontario) have watched with increasing concern the escalating tensions between the government and our medical association, exacerbated not only by the unilateral actions of the Ontario government but also the unwillingness of some groups within the profession to accept the critical and natural responsibility of physicians in the stewardship of our publicly funded health care system. We call on both the Government of Ontario and the Ontario Medical Association to find a way forward in the public interest, which we believe should be based on recognition of and support for the following five principles:

  1. A unified voice for the medical profession at the bargaining table

Despite its limitations, the Ontario Medical Association is best placed to represent doctors at the bargaining table, work with government on an ongoing basis, advocate on behalf of all physicians and the public interest, and reconcile the perspectives of all physicians in compensation negotiations. At the same time, while we respect the need for some level of confidentiality in negotiations, in future, the OMA cannot negotiate without engaging the profession, something it failed to do with respect to the tPSA. We commit, as members of the OMA, to work within its internal processes to make our perspectives heard, understanding that the role of a broad association is to balance the varying interests of different elements of its membership. Other physician groups are critical in addressing many issues relating to health care, but when it comes to negotiations our profession should strive to avoid damaging infighting, divisiveness and putting the interests of the few over that of the profession as a whole.

  1. A fair and binding arbitration process to resolve compensation disputes

As doctors committed to serving our patients within the public health care system, we believe that the government should not act unilaterally when it comes to matters of physician compensation. We object to unilateral across-the-board cuts to physician fees, to differential treatment of new doctors compared to established doctors, and to other coercive measures. We affirm the need for a fair and independent process to determine key elements of physician compensation, as is the case in most other provinces. For this reason, we support the universal call across the medical profession for a just and fair process, involving a third party, when necessary, for resolving disputes. 

  1. A medical profession engaged in system stewardship

We acknowledge that the province faces difficult fiscal and economic circumstances, with multiple priorities important to the health of Ontarians, including education, infrastructure, and poverty reduction. As frontline care providers, physicians have invaluable knowledge of the health care system. We owe it to ourselves and to our patients to use that knowledge to ensure health care funding decisions are rational, equitable and based on evidence. We want to see doctors working with government to ensure the best possible value for public dollars when it comes to physician services and health care, using transparent processes that bring more evidence to bear on decision-making and that de-politicize those decisions.

To do so, we need a reasonable and respectful partner in government that acknowledges the complexity of utilization increases, rather than simply offloading responsibility onto physicians. For this reason, we believe that government should commit to adjusting the physician services budget to account for population and demographic changes and net new physicians in the system, with reasonable compensation changes, where justified, from time to time. At the same time, we recognize the obligation of physicians to engage in evidence- based practices and to prudently manage the clinical services we provide so that the physician services budget is responsibly managed. We believe that most doctors are willing to take responsibility for our clinical activities and professional conduct, and to partner with government to ensure that funding decisions are made based on evidence. An important focus of joint stewardship should be on ensuring that the physician services budget is not exceeded. It is also necessary and appropriate to recognize and reward the profession for generating value to the health care system through improved quality of care, innovation and successful stewardship of public resources.

  1. A commitment to addressing inequities in physician compensation

We believe that all doctors should be fairly compensated, but we also acknowledge that technological and other changes over the last few decades have led to circumstances in which the fees for certain services do not appropriately reflect such factors as time, complexity, costs of practice and other clinical measures. While we do not believe it is constructive for the government to single out those who bill large amounts in an attempt to divide the profession and mobilize public opinion, fairness in net earnings across services, disciplines and specialties is essential. Neither our medical association nor our government serves the profession by ignoring this reality, or by failing to adjust for it. Moreover, given the province’s fiscal situation, it seems eminently reasonable that expenditures on physician services should be allocated efficiently and effectively. While bringing about fee or earnings relativity is a challenging exercise, we can neither avoid our responsibility as physicians to accept this challenge, nor can we leave it to others less knowledgeable to impose the changes on us.

  1. A restatement of our commitment to the principle of equity

We are privileged to work in a health care system where we can serve all our patients without worrying about their ability to pay for physician and hospital services. We reaffirm – and call on Government and the OMA to reaffirm – commitment to the principle of access to health care based on need, without Ontarians being required to pay out of their own pockets for necessary physician and hospital services. Indeed, there are strong arguments that this principle should be extended to other parts of the health care system, including covering medically necessary prescription medications and other reforms aimed at improving access for marginalized and disadvantaged communities. We unequivocally reject proposals from a small number of physicians to charge patients above OHIP payments in order to increase their own incomes (extra-billing) or to charge the sick for access to services (user fees). These proposals fly in the face of all evidence on health care systems and undermine the critical principle of equity.

SIGN THE OPEN LETTER

 

Ahmed Bayoumi, Internal Medicine, Toronto

Lesley Barron, General Surgery, Georgetown

Sandy Buchman, Family Medicine, Toronto

Melanie Bechard, Paediatrics Resident, Toronto

Claudette Chase, Family Medicine, Sioux Lookout

Ali Damji, Medical Student, Toronto

PJ Devereaux, Internal Medicine, Hamilton

Vlad Dzavik, Cardiology, Toronto

Avram Denburg, Paediatrics, Toronto

Cathy Faulds, Family Medicine, London

Ritika Goel, Family Medicine, Toronto

Gordon Guyatt, Internal Medicine, Hamilton

Brian Hutchison, Family Medicine, Hamilton

Nick Kates, Psychiatry, Hamilton

Stewart Kennedy, Family Medicine, Thunder Bay

Jonathan Kronick, Paediatrics, Toronto

Danielle Martin, Family Medicine, Toronto

Jamie Meuser, Family Medicine, Toronto

William Mundle, Obstetrics, Windsor

James Owen, Family Medicine, Toronto

Nan Okun, Obstetrics, Toronto

Alim Pardhan, Emergency Medicine, Hamilton

Kaif Pardhan, Emergency Medicine, Hamilton/Toronto

Nick Parle, Medical Student, Hamilton

Sunil Patel, General Surgery, Kingston Ontario

Meb Rashid, Family Medicine, Toronto

Danyaal Raza, Family Medicine, Toronto

Katherine Rouleau, Family Medicine, Toronto

Sarah Silverberg, Medical Student, Toronto

Ian Stiell, Emergency Medicine, Ottawa

Charles Yin, Medical Student, London

SEE FULL LIST OF SIGNATORIES