The OMA Board of Directors has recommended that it’s members vote ‘yes’ in the upcoming referendum that will ratify a tentative Physician Serviced Agreement. I was one of two Co-Chairs of the OMA Negotiations Committee that brought a tentative agreement to the Board for consideration. I would like to explain why I think that this agreement should be acceptable to OMA members.
In January of 2015 the Government of Ontario made an offer to the physicians of Ontario that was rejected by the OMA Board of Directors. The government imposed unilateral cuts, followed by a second round of cuts later that fall. They also set an arbitrary cap on physician payments and reconciled or clawed back, an amount equal to any overages in the payment. An arbitrary annual growth rate of 1.25% was set for this base budget. That growth rate did not come close to meeting the needs of a growing and aging population. The inevitable result was conflict.
The OMA launched a Charter Challenge alleging two things. First that the unilateral cuts were unconstitutional and second that the government should offer physicians a process of binding dispute resolution to address the power imbalance between a group who could not strike or take other effective ‘job action’ and a government who was prepared to act unilaterally. The OMA also asked for the unilateral actions to be reversed and sought damages.
Naturally the relationship between government and Ontario doctors soured. Without consulting with the OMA the government proposed a platform of reform that doctors did not feel met their needs or the needs of their patients.
OMA Council directed the Board to demand binding arbitration from the government.
With this background the OMA Board sought to get back to the negotiations table to negotiate a Physician Services Agreement. They sent a small group of physicians, professional negotiators, lawyers, economists and other support staff to explore options for getting back to the negotiating table. In order to protect the OMA Charter Challenge, these discussions were held in confidence and without prejudice. That is neither party was free to discuss details outside a small circle and neither party could use the discussions as part of their respective court cases.
I was a leading member of the OMA side of this small group process.
Ultimately an agreement to get mediation-arbitration was not possible. But while exploring our differences and commonalities it became apparent that a tentative PSA might be possible.
Our side went back to our Board of Directors and gave detailed updates on a regular basis. We also got directions. That’s how negotiations work. The Board has complete control and directs the people it sends to the table.
Unfortunately we were unable to keep our members informed. To do so would potentially have damaged our Charter case.
The financial aspects of the deal we brought back will disappoint many of our members. There are no fee increases. However the budget growth will increase by 2.5% instead of 1.25%. This rate will support growth for an aging and growing population, estimated by ICES to be 1.9% and allow for some growth in new physicians and new technologies. Our economists are reasonably certain that with the 2.5% budget increases, some small one-time payments and active co-management of the physician service budget we will be able to stay under budget. If we do better than expected there will be an opportunity for investment in physicians services. If we don’t do well and go over budget there is the risk of reconciliation.
In primary care we have negotiated provisions that will allow new graduates, early career family doctors and other physicians with mature practices to enter FHNs and FHOs-capitated practice. Every family medicine in Ontario trains in such an environment and expect to be able to choose these practice models on a voluntary basis.
The OMA and government will jointly negotiate changes to Primary Care Contracts to address access, after-hours care and reporting on human resource issues. In return the parts of Bill 210 that speak to these issues will be removed.
I would much rather negotiate these items together than have the government impose changes.
Our Charter Challenge with respect to binding arbitrations continues. We have achieved very strong language to insure government takes no more unilateral action until our suit about arbitration is settled. External Counsel has written extensively about this so I will not give my own legal analysis on this issue. When the OMA hires some of the foremost constitutional lawyers in the country, I believe that doctors should listen to their advice.
We have dropped our challenge with respect to past unilateral action. Again our lawyers explain the reason for this. My own thinking is that we have traded a maybe for a certainty. A bird in the hand is worth two in the bush.
Finally I support this agreement because it restores a crucial relationship in the health care system. Doctors and government need to talk, they need to plan, they need to trust each other.
I know those kind of relationship cannot be written into a contract. Show me. I’ll be saying that, every doctor in Ontario will be saying that and frankly the government will be saying that.
OMA members are being asked to make a huge leap in accepting this agreement.
The alternative is conflict and chaos and that will hurt our members and that will hurt our patients.
Scott D. Wooder, MD