The domino effect of Ontario’s unilateral moves on primary care

The Province of Ontario is in debt and healthcare spending is a major cause for being in the red. Ontario needs to save money. A few years ago, Ontario attempted to negotiate a revamping of the Schedule of Fees for its doctors, but was not successful in accomplishing all the changes they desired. The agreement lasted 2 years, and Ontario’s doctors ended up agreeing to an imposed 0.5% pay cut on all of their billings during this period. This pay cut continues beyond that term of 2 years. Doctors wanted to help “do their part”.

Now with the negotiations once again being unsuccessful between the Ministry of Health and the Ontario Medical Association (OMA), we are exactly back at square one. The o.5% pay cut continues, and the Province is threatening further unilateral imposed cuts, notably increasing the 0.5% “discount” by an additional 2.65%. Family doctors are also being targeted with more of these discounts, which would total 5.65% on their overall billings. This does not include the elimination of possible billable procedures or “bonuses”.

The government wants to make this changes in order to save money by reducing the amount each doctor can bill for services. My belief is that this will unfortunately backfire and cause and overall increase in healthcare expenditure.

If these imposed deduction discounts are implemented, my practice will most likely lose in the range of $30,000-$40,000 of billings in a year. That is roughly the cost of one of my staff. Realistically, I will not end up letting go one of my staff, but adjustments would need to be made in order to continue being able to operate my practice.

Reducing our hours is an option, but this would limit access, and drive more people to the more expensive Emergency Department.

A more realistic approach to recovering the lost billings would be to cease providing “free” services to the patients. The prime example would be prescription renewals. Right now, patients can have their medications refilled without needing an appointment either by calling in or having their pharmacy fax over a request. Some practices charge a nominal $10 or $15 for this service (our’s does not). I personally receive 15-20 requests per day for refills, which would amount to about 45 minutes to 1 hour of my time each day. If we required every patient to come in to see the doctor to get their prescriptions renewed, at a minor visit billing (A001) which is currently listed at $21.70 per visit, I have been saving OHIP $434.00 per day. This amounts to just under $80,000 per year if I work 46 weeks per year. (I usually work more). And that’s just me! Think about the increase in billings if every family doctor followed suit.

Further to this example, if patients were now required to come into the office for prescription refills rather than calling in or having their pharmacy fax in a request, the demand for the family doctor’s time increases, meaning access for actual medical issues would be compromised. This translates to denials of appointment requests, and/or increased wait times to gain access to their family doctor. Ultimately, both result in more patients resorting to going back to the more expensive Emergency Department.

This will not save money, but will increase billings and healthcare spending!

As a reminder, a lot of the misconception that the Ministry of Health and Long Term Care fails to clarify to the public, is that the high costs attributed to doctor’s are the billings. Billings do not mean salaries. Family doctors in particular use the earnings from billings to pay rents and overhead for their offices, pay the salaries of their employees, and pay their expensive annual licenses (I pay north of $12,000 per year for the multitude that I’m required to have). Once business taxes are deducted from the original amount, what’s left over can be used for my own salary (which goes through further reductions via personal taxes), and savings for my eventual retirement. Don’t forget that even though doctors get paid by the Government, they are not civil servants, so that means no EI, no sick days, and no pension plan.

Perhaps it’s no wonder that many doctors choose (or may be forced) to work well past the average retirement age.

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