There is a laundry list of things that concern Ontario doctors about the unilateral cuts made by the Ontario government. The 2.65% cut to all individual fees (on top of cuts imposed in 2012) will drive physicians out of the province, and cuts directed at new grads will detract them from even starting practice in Ontario. Physicians know that our patients will feel these cuts with increased wait times and decreased access, despite the best efforts of physicians.
But it’s the clawbacks coming in 2015-2016 that will confuse the public, and truly scares physicians.
For those who don’t understand how physicians are compensated, here’s a Coles Notes version. Some physicians are paid fee-for-service based on a fee schedule set out by the government. Do a specific service, get paid a specific amount. Simple. Some physicians get paid based on the number of patients on their roster that they are responsible for. Again, the government has agreed on a specific amount to pay them per patient. Simple. Depending on the patients seen, or the roster size, the government pays physicians once a month the owed amount. Simple again.
Except the Ontario government is in a lot of fiscal trouble, much of which is of their own doing through failed programs. So in their infinite wisdom, they have decided to cut all of the individual physician visit fees, as well as setting a cap on total billings by all physicians. If total physician billings province-wide for a fiscal year go above this capricious upper limit, the province will clawback that amount of money from all physicians. Remember those monthly payments to physicians? The clawback will mean that all physicians will literally be paid ZERO dollars for an unspecified number of months. Can you imagine being paid zero dollars for services that you provide in any profession? My patients will need to be seen in January 2016, February 2016, and March 2016, and there is a good chance I won’t be paid for months of clinics.
Let that sink in for a second. The government has set specific fees that they pay physicians for certain tasks or responsibilities. But if demand from patients over the next year (aging population, immigrants, outbreaks, etc.) exceeds the cap, then the province will not pay for that extra care. Patient demand for care is largely out of the control of physicians, yet the government is dictating that any demand above their arbitrary cap won’t be paid for.
There is no maximum claw back. 5%? 10%? With an aging population requiring more care than ever before, we can’t possibly fathom how high demand may go. If the government decides that they want to fund more surgeries, or new clinics, or new nursing homes, or any new program, total physician billings will increase, and they won’t have to pay a penny more than the cap they have set. More physicians providing more services, and far less pie to share.
How would this type of clawback play out in other areas of the public sector?
Imagine if nursing wages were agreed to at a certain fee, and the government decides to hire more nurses to meet increasing demand. But at the end of the year they realize that the overall nursing budget went over their “nursing cap”. So they claw back the overage from all nurses by not paying any of them for a few months.
Imaging if the government decides to hire extra teachers to finally curb increasing class sizes. At the end of the year, they tell teachers that they set a total cap and don’t have the extra money to pay, and that all teachers will not be paid for a few months to make up for the extra hired teachers.
Imagine your local police department requires extra officers because of a crime spree. At the end of the year, the police services board tells the officers that they went over their labour costs, and that all of the officers will have to be unpaid for a few months.
Those scenarios are just as ridiculous as what is being imposed on doctors. I say imposed, because we have no choice in the matter. The government has decided that these cuts and caps will be their policy moving forward, with no further negotiation. The public is usually quite surprised to hear that physicians and the government don’t have a true negotiation. If the government decides to impose certain payments on physicians, we have no recourse. It’s a one-way street. No other profession would stand for this type of policy, and the government is taking advantage of the fact they know that physicians cannot legally strike.
These unlimited clawbacks are questionable policy, if not illegal, and I hope that the citizens of Ontario make it clear to their MPPs that at the very least, physicians deserve to be compensated for the services they provide, at the fees agreed to by the government.