July 15, 2016

Dear Colleagues,

RE:     PROPOSED PHYSICIAN SERVICES AGREEMENT

The Board of Directors of the Ontario Association of Gastroenterology (OAG) has reviewed the proposed Physician Services Agreement (PSA) between the Ontario Medical Association (OMA) and the Ministry of Health and Long-Term Care (MOHLTC) and unanimously recommends that the membership vote NO on the agreement in the upcoming member referendum, being held between July 27th and August 3rd. This is a very bad agreement for both patients and physicians. A bad deal can be worse than no deal at all so it is incredibly important that you make your position plain by voting.

A negotiation that has occurred in secret and has been approved by the OMA Board of Directors without consultation is extremely concerning. The agreement simply perpetuates the Ontario Medical Association’s ability to negotiate on behalf of Ontario physicians. It is self-serving.

There is nothing in this agreement that would benefit the Section on Gastroenterology, or any other sections, for that matter.

The proposed 2.5% a year increase is only for a global physician increase. No physician in the province will see an increase in income. The agreement starts with the 2015-2016 budget, enshrining as permanent all the claw backs and loss of fee codes we have seen since the 2012 agreement. We are, therefore, starting at -7% as the agreement commences; the situation is even worse for the Hepatologists and IBD specialists who are down 25% as a result of from the loss of the E078 code. We will never recoup the losses of the last four years.

There will be no increase in individual physicians’ income over the next four-year period. Inflation is estimated at 2%. So, over a six-year period, starting from 2012, the cost of living will have increased by 15% resulting in an effective decrease in physicians’ real incomes of 22%. This is unacceptable, especially as we know overhead costs will continue to increase.

We are very concerned about the two $100 million proposed scheduled reductions in 2017 and 2019. These cuts will be determined by a joint effort of the Ministry and the OMA (via the Medical Services Payment Committee, MSPC), with facilitation if necessary. The MSPC has historically always sacrificed GI with targeted cuts. This will have a clear future impact on the Section on Gastroenterology. We cannot vote for an agreement that will include unspecified reductions to come at some point in the future, especially when the decision is made by those who do not have our best interests at heart. The OMA will attempt to impose relativity through these cuts. Our high CANDI value puts us at risk. We have tried to point out the inaccuracy of the CANDI formula as it applies to gastroenterology, so far to no avail.

One of the main preludes to negotiation was binding arbitration. This was clearly left out of the agreement. This agreement may even weaken the ongoing Charter Challenge to acquire binding arbitration. The tentative agreement states we as a group cannot seek damages from the unilateral actions of last year.

The most important problem with this deal is the fact that all physicians will be on the hook for any growth in use of the medical system above 2.5%. The OMA's own analyses clearly show utilization increases by more than 3% annually. The Financial Accountability Office of Ontario estimates future growth at 5.2%/yr. Why should the physicians of Ontario be required to bear the incremental healthcare costs for an aging and growing population? This is why the OMA did not accept the proposal in 2014-2015 resulting in the unilateral imposition of fee cuts by the government. Why should we agree to this now? Clearly there are going to be cost over runs. We cannot control how hard we are being asked to work, nor can we control how hard our colleagues work. We will be immune from claw backs for one calendar year, but you can be certain there will be some form of overage repayment in the next three years.

To summarize, we would start off this deal down 7%. That will be made worse by eliminating increases for the next four years, while inflation and real overhead costs continue to rise. Add to that the inevitable overutilization claw backs, and whatever the relativity adjustments do to us and you should be very worried.

On a positive note, the agreement allows family physicians to re-roster in FHGs and FHOs. This was already in place and has now has been given back to the Section of Family Practice. There is a new sense that physicians are now working along with the government. There is also discussion about removing certain aspects of Bill 210. These aspects may have been put in place only to allow the government to negotiate them away. However, it is our feeling that the negatives of this deal far outweigh any potential positives.

Overall, this is a bad deal and the OAG Board of Directors recommends that the membership votes against the Agreement. We are a small group within the OMA, but, if this is a closed vote, every ballot will matter. If the referendum results in a NO vote, the OMA will be bound by the Ontario Corporations Act to reject the agreement. Please make the effort to have your voice heard during the referendum July 27 to August 3rd.

ONTARIO ASSOCIATION OF GASTROENTEROLOGY

Iain C. Murray, MD CM, FRCPC
President

/mh