The Tentative Physician Services Agreement:
Why I Am Voting YES
by Dr. Doug Weir
Chair OMA Physician Action Working Group
OMA Past President, OMA Negotiations Team (2004, 2008)
I am writing to urge you to vote Yesto the tentative Physician Services Agreement (PSA). Please feel free to forward this email to your colleagues.
First let me tell you why I am recommending a Yes vote.
I am sure you have heard from a variety of sources a variety of opinions. I would urge you to go to the OMA website and read the many documents outlining details in the agreement and address questions about the agreement.
My brief answer as to why I recommend the Yes vote is that for many physicians, especially psychiatrists and other low-paid specialists, the 2016 tentative PSA will mean that you are likely not going to face significant cuts for the next 4 years. Although it will be a challenge, I am optimistic that growth will stay within the 3.1% covered by the agreement. As relativity is a principle in guiding the additional cuts, it would be reasonable to assume that low-paid specialties will not see significant cuts.
The tPSA allows for growth at 2.5% with one time funding in each year which can be used to offset additional growth up to about 3.1%. If growth is less than 3.1% then the one time funding will be available for physicians. Included in the 2.5% growth figure are non-fee-for-service programs, like capitation, AFPs, Hospital-on-Call, Psychiatric Stipends, Sessional Fees and ACT & Hospital Salaries etc. The first round of cuts announced in early 2015 affected the non-fee-for-service programs but the October 2015 cuts did not. If the tPSA is rejected and the growth rate is set at 1.25%, we do not know what specific cuts the Ministry will make but it is reasonable to assume that given the magnitude of the cuts necessary over the next 4 years that the non-fee-for-service programs will be affected.
Those who are advocating against the tentative PSA will tell you that if the physician services budget grows by more than 3.1% there will be additional cuts. That is true, there is no guarantee there will not be additional cuts and keeping growth below 3.1% will be a challenge. However, the alternative would be to live with certain unilateral cuts to keep within the 1.25% budget. To do that for the current fiscal year they would need to cut another $460 million or 4%.
As OMA President Virginia Walley has said, “While the tentative PSA isn’t perfect, with it our profession now has the opportunity to move forward with much-needed stability and predictability. That’s in stark contrast to the potential outcome of voting no – with continued unilateral action [and] with possible and permanent cuts of more than $1 billion to funding for physician services.”
We do not know how the government would cut more than $1 billion to funding for physician services.
Realistically some portion would be across the board. Given the government’s interest in doctors who bill over $1 million, we can assume bigger cuts on billings over $1 million. Finally, there would probably be some new targeted cuts. Physicians would have no input into those cuts. If growth is more than 3.1%, you can expect more than $1 billion in additional cuts to continue to keep within the 1.25% budget.
Those who are advocating against the tentative PSA will tell you that if we reject this PSA we can return to the negotiations with government and get a better deal. Do not believe that. That was not what happened in early 2015. When I talk to negotiators, and not just the OMA outside advisors, but professional negotiators not involved in this agreement, they tell me that is not what happens. It is much more likely they will quickly implement cuts and not be interested in returning to negotiations anytime soon.
If the OMA membership rejects this tentative PSA, the OMA would continue with efforts to get binding arbitration through our Charter challenge. We would most likely also try once again to convince the government to agree to binding arbitration without having to go to court and to negotiate another agreement. However, this government and governments across Canada are resolute in their resolve to control health care spending and they get widespread support from health care commentators and the media to do so. I believe if the OMA membership rejects this tentative PSA, the message politicians, the media and the public will take away will be that doctors are self-serving and not willing to participate in the very real challenge of reigning in health care costs.
Rejecting this tentative PSA will keep us on the sidelines. One of the positive aspects of this agreement is the commitment of the government to “acknowledge that physician participation is essential to health system transformation. The Parties are committed to ongoing engagement between the OMA and the MOHLTC regarding health system reform and design.” (Section 7 of the TPSA) In addition, this agreement commits the government to “form a bilateral group to make recommendations about physician supply and distribution. This group will consult widely within the health, regulatory and education sectors and will bring forward a set of recommendations to the Parties no later than March 1, 2017 for a sustainable supply of physician human resources for Ontario.” (Section 5c of the TPSA)
I strongly believe that the profession wants a voice in these discussions and it is hard to imagine improving our health care system or dealing with physician human resources without the OMA at the table. I have been involved in the OMA and negotiations with government for more than two decades. We all know what happened in the ‘90s, when the OMA was not working with government. Our interests are better served if the OMA is involved. With the OMA at the table, physicians have the opportunity to counter any proposals that make no sense and are not good for patients or the profession.
This tentative PSA has many disappointments. It does not do away with the current cuts; there will be additional cuts of $200 million; and it does not guarantee there will not be additional cuts if utilization is above 3.1%. However, like the OMA Board, I believe the OMA has secured important safeguards for members that will protect physicians against additional unilateral cuts and other actions by government, and provide much-needed stability and predictability for our practices, our patients, and the health care system overall.
While this tentative Agreement does not contain binding arbitration, our Charter challenge against the government will continue for a legal declaration that we are entitled to binding arbitration, as we firmly believe this is our right. The Liberal Government has been unwavering in refusing to agree to binding arbitration. I would also point out that other provinces have been reluctant to agree to binding arbitration and the Ontario Conservative Party is even more opposed to binding arbitration than the Liberal Party. Further, the Ontario Conservative Party supported a freeze on the physician service budget and for all the PC support for our issues, I have not heard that the PC Party has altered that position.
It is clear the only way we will get binding arbitration will be through the courts. It will take years for our Charter challenge to work its way through the courts. It will most likely not be resolved until 2020. With a successful outcome, we can then enter negotiations with the binding dispute mechanism all of us are looking for.
If this tentative PSA is accepted by the membership, we will send a powerful message to the public and the government that we want to deal with the challenges facing our health care system while protecting our Charter challenge. At the same time we can stop future cuts.
I hope you will vote and I hope you will vote YES.
Follow me on Twitter @weirdoug