Reconciliation-The Trojan Horse of Ontario Health Cuts

In the Aeneid, Vigil tells the story of how the Greeks finally conquered Troy after a siege that lasted more than a decade. The Greeks built a giant horse and left it outside the walls of Troy. They then pretended to leave. The Trojans brought the horse inside the walls of their city as a trophy. However the horse was crammed full of Greek warriors and they opened the gates for the re-assembled Greek army. As you all know, Troy fell that night.

This story has become a metaphor for a hidden trap, with danger lurking beneath the surface of an innocuous looking event or object.

Unless you are a physician, you may not have too many concerns about the unilateral cuts that the Government has made to doctor’s fees. At most you likely shake your head in wonder when you learn about the fact that the Government has targeted new family medicine graduates and has banished them to apparently outmoded fee-for-service practices.

However the Government has raised the stakes by putting a hard cap on the physician services budget. They have declared that if spending on physicians goes above a pre-set limit, the doctors will have to pay back the excess. This process is called reconciliation. Such a friendly sounding word that is a Trojan Horse of unfairness.

One might make a case for reconciliation if all spending was under physician’s control or was all of marginal value but this is clearly not the case. Physicians provide medically necessary services to patients and bill OHIP. Services that are not necessary are not insured and are not billable to OHIP.

We are really talking about clawing back money from physicians who have providing medically necessary services in good faith.

What happens if there is a serious public health disaster that effects the water supply of a major city? What happens if there is an influenza pandemic? Or Ebola? What happens if an evidence based intervention is shown to significantly improve the health of Ontarians? Any of these events would cause a spike in spending and it would be paid for not by the Government of Ontario as one would expect, but by the Doctors of Ontario.

Really?   We think it’s fair that doctors pay for another SARS?

The Government has an obligation to manage the health care system and that includes paying for growth for new patients, new doctors an aging population with increased chronic health care needs and unexpected emergencies.

Scott Douglas Wooder, MD


4 thoughts on “Reconciliation-The Trojan Horse of Ontario Health Cuts”

  1. Hello Scott,

    Thanks again for a very well written piece. I’ve been confused with the concept of reconciliation for some time. I too agree that it is inherently unfair for physicians to be penalized for seeing a patient that needs to be seen. It is odd that we in certain medical specialities have no choice but to see a patient (life or death services such as acute dialysis, ICU services, ER services, etc.) but may then be penalized for it. If the government wants us to make less money, they should tell patients to stay home (obviously kidding). I’ve written the OMA about these issues where we have forced utilization. This has to be a legal issue or at the very least a constitutional challenge. Where can we force people to work without pay? Why are we not mobilizing with this argument in hand?


  2. Hello Scott, I left a reply yesterday for this post and am surprised it has been deleted. It was a very balanced response to the reconciliation issue. Thanks.


    1. I haven’t deleted any posts Mark. I’m not sure what happened.

      I am new to this but I would approve any response that was not abusive, even if it expressed an opinion opposite to mine.

      So far I’ve approved everything


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