The cost of access

The Ontario Ministry of Health and Long Term Care (MOHLTC), led by the Minister of Health, Dr. Eric Hoskins, under the orders of Premier Kathleen Wynne, ceased negotiations with the Family Doctors and Specialists of Ontario over one year ago. In this time, they have imposed a serious of “discounts” (their term) that have totalled anywhere from 7% to 30% depending on who you ask. They claim that doctors in Ontario are overpaid and need to do their part in reducing the provincial debt (which we could argue is a direct result of inappropriate governing by recent mandates, but that’s another story).

The reality for those in the trenches is a significant reduction in funding, which ultimately will have effects on patient care, if not already evident.

My personal whining tales of woe include a net loss of approximately $30,000 in my first 5 months of this fiscal year. That is the cost of at least one of my staff. If I let a staff member go, access to my office will be affected. And that is the topic of today’s rant: the cost of access.

Not so long ago, the Ministry complained that access to primary care doctors was poor. It still is. They urged all parties to step up their game to speed up access to their Family Doctors, and reduce waiting times in Emergency Departments. Primacy Care workers responded. Advanced access became mainstream in Family Practices, so now patients could call and get same-day appointments with higher frequency. Emergency Departments reorganized their procedures and became more efficient in seeing the wide range of patients coming in. More people were being seen quicker, and this became the new standard. As people continue to age and also live longer, more medical issues present. But since quicker access is the new normal, they were able to be seen more often and more frequently, including after hours and weekends.

The more people seen, means more tests and investigations were ordered. This also means more doctors were seeing more patients. All this adds up to higher billings. Fast forward to 2014 and the Government of Ontario complains to the MOHLTC that doctor’s billings are too high and take up too much of the health care budget. How could this not be foreseen? The obvious result of mandating doctors to see more people more frequently is more billings to the health care system. And now the doctors are being punished for giving the MOH what it wanted: greater access.

If the Ministry of Health wants to continue trying to improve patient access to doctors in Ontario, they need to return to the negotiating table with the doctors of Ontario, otherwise access will most likely be the first casualty. Once access becomes endangered, that’s when unnecessarily morbidity and mortality follows.

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