What my patients need to know about the government imposed clawbacks

Over the next few months, Ontario doctors are going to be subject to severe clawbacks from the Ontario government, and I want my patients to know exactly what will be happening, and why we’ve gotten to this point.

As most of you know, the Ontario government and Ontario doctors failed to come to a funding agreement in January 2015. Rather than opt for a fair binding arbitration process, the government proceeded to unilaterally impose a 3.15% cut to all doctor services (on top of the 2.5% cut from 2012), and most concerning, to set an arbitrary global cap on total compensation to doctors.

For those who don’t understand how physicians are compensated, here’s a Coles Notes version. Some doctors 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 doctors 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 doctors once a month the owed amount. Simple again.

But here is what the government has decided to impose on doctors. They have decided to cut all of the individual visit fees by a set percentage, as well as setting a cap on total billings by all doctors. If total billings by doctors province-wide go above this arbitrary upper limit, the province will clawback that money from all doctors. Remember those monthly payments? For a few months this winter, each doctor may literally be paid ZERO dollars. Staff and expenses will still need to be paid, and I’ll show up to work every day to care for you for free, and I will pay for all of this out of pocket.

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. Physicians will continue to see patients, and not be paid for it.

There is no maximum clawback. 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.

This letter isn’t meant to earn your sympathy, because I know many of you are struggling financially, and doctors are still well paid. But we are asking the government for a fair process. They refuse to let an independent 3rd party decide on fair compensation through arbitration, choosing to instead impose their own cuts. Any other profession would go on strike, but doctors realize how much our patients need us, and we would never go on strike (nor are we allowed to by our regulatory college).

If the government continues to make these severe cuts, the only recourse doctors will have will be to retire, or to leave the province. Specialists will leave for other provinces or retire. Many already have since the negotiations fell apart in January. Family doctors will leave the province, since other provinces need family doctors just as much as Ontario does, and seem to value them more. Alberta’s doctors agreed to a seven-year deal in 2013. Manitoba’s doctors agreed to a four-year deal in 2015. Saskatchewan agreed to a four-year deal just last month worth a two-per-cent increase per year over four years. Even Quebec has come to an agreement with its general practitioners. In the past few months, doctors across the country have seen the negotiations playing out in Ontario, and Ontario has developed a reputation as a province that has a poor relationship with doctors. No other province has unilaterally imposed cuts and changes on its doctors. Very few doctors will come here for the foreseeable future. Waiting lists will continue to grow, and fewer patients will have family doctors.

We aren’t asking for raises. We only want the government to agree to a binding arbitration process, and let a 3rd party decide on a fair outcome. Please contact your MPP to let them know your feelings on this issue. We can’t afford to lose more Ontario doctors because of the stubbornness of one government.

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2 thoughts on “What my patients need to know about the government imposed clawbacks

  1. Paul Conte

    Some will simply adjust their practices and clinics to try not to go over the Ontario government hard billing cap for the whole profession. I have cut services offered by 10-20% since government imposition. I have done that by cutting back the hours that I work (on average by 1-1.5 hours for a 5-11 hour day) and decreasing the number of patients I see per hour. For the record, I am a straight fee for service doctor doing my part to help the government meet their hard cap. Sorry for all the patients who have to wait longer or go without but it is their health care system and their government. Their fault if they refuse to hold it accountable and they let the government bully the medical doctors.

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