Posted on September 29, 2017

OAC Recognizes World Heart Day: 29 September 2017

Today, 29 September 2017, the Ontario Association of Cardiologists recognizes World Heart Day (#WorldHeartDay).

In the words of the World Heart Federation,

“Heart health is at the heart of all health. When you look after your heart it means eating and drinking well, exercising, stopping smoking… all the things that make you not only healthier, but also feel good and able to enjoy your life to the fullest.

Cardiovascular disease (CVD) is the leading cause of death and disability in the world, killing 17.5 million people a year. That’s a third of all deaths on the planet and half of all non-communicable-disease-related deaths. Around 80% of these deaths are in low- and middle-income countries where human and financial resources are least able to address the CVD burden.

World Heart Day plays a crucial role in changing all of this. It is a vital global platform that we, as well as our members and supporters, can use to raise awareness and encourage individuals, families, communities and governments to take action now. Together we have the power to reduce the burden of, and premature deaths from, CVD, helping people everywhere to live longer, better, heart-healthy lives.”

For more information click here:

Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, Ontario
M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239

Posted on September 25, 2017

Posted on August 29, 2017

2nd Annual Education Day in Adult Congenital Heart Disease (ACHD) – September 25, 2017

The Toronto Congenital Cardiac Centre for Adults (TCCCA) is holding its second annual Education Day in Adult Congenital Heart Disease (ACHD) on September 25, 2017 at the MaRS Discovery District, Conference Room CR-3.

To learn more visit:


Posted on July 20, 2017

New Standards for the Provision of Electrocardiography (ECG)-Based Testing in Ontario Now Available

In May 2017, the Cardiac Care Network of Ontario (now CorHealth Ontario) released long-awaited standards for the provision of ECG-Based Diagnostic Testing in Ontario (2017).  The OAC congratulates all involved, including those OAC members serving on the primary and secondary review panels, for their hard work in developing these important standards.

To read the standards, click here:


James Swan, M.D. F.R.C.P.(C) F.A.C.C.
President, Ontario Association of Cardiologists
34 Eglinton Ave. West
Suite 410
Toronto, ON M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239

Posted on July 4, 2017

OMA vote breakdown shows which types of doctors rejected framework deal – Toronto Star (July 3, 2017)

By Theresa Boyle, Health Reporter
Mon., July 3, 2017

The OMA has released a breakdown of how 48 physician specialty groups voted on new rules of engagement for contract negotiations with the province — and to the surprise of no one who follows Ontario medical politics closely, radiologists and cardiologists were among the minority who opposed the deal.

The agreement, which sets out a framework for how the two sides will reach a new fee contract, was endorsed by 65 per cent of the 10,261 physicians, residents, students and retirees who cast ballots in a ratification vote last month. (Only 24 per cent of the almost 43,000 eligible to vote did so.)

The deal includes a provision for binding arbitration, something the government had long resisted because it didn’t want to turn over to a third party control of an $11-billion-plus physician services budget.

But with an election on the horizon, the government capitulated on this point earlier in the year. It did so after Premier Kathleen Wynne personally reached out to the Ontario Medical Association’s leadership, the Star’s Queen’s Park columnist Martin Regg Cohn recently reported.

Of eight specialty groups that rejected the deal, radiologists were the most strongly opposed. A voting breakdown report, released last week by the OMA, shows 84 per cent of diagnostic imaging specialists and 80 per cent of neuroradiologists voted against it.

Next came the cardiologists, 71 per cent of whom were opposed. More than 50 per cent of physicians in the following specialty groups also gave it the thumbs down: plastic surgeons, geneticists, nuclear medicine specialists, gastroenterologists and chronic pain doctors.

The 41 specialty groups that supported the deal included ophthalmologists, a surprise to many. They voted 63 per cent in favour. Also endorsing it was the largest specialty group — general and family practice doctors. Of 2,274 who voted, 66 per cent gave it the nod.

Negotiations are expected to start in September. If the two sides fail to make headway on their own — which is highly possible — the dispute would be referred to mediation and arbitration.

“This is something doctors have asked for, for years,” Dr. Shawn Whatley, the OMA’s new president, said of binding arbitration.

In an interview, Whatley said that 65-per-cent voter approval for the framework agreement is strong enough to give the OMA’s negotiating team “clear direction” on how to proceed.

“But we also have to acknowledge that 35 per cent . . . voted against it. So that shows us that we have work to do and we have to engage all of our members to support whatever work happens this fall,” he said.

“We cant be presumptuous here. We have a lot of members who spent many hours informing themselves about this framework and we can’t discount their opinion as we go into negotiations,” he added.

Ontario Health Minister Dr. Eric Hoskins declined to comment for this article.

The ratification of the framework agreement is the latest chapter in the stormy relationship between the province and doctors, and within the medical profession itself.

Doctors have been without a contract for more than three years. During that time, contract negotiations fell apart, the government unilaterally imposed payment cuts on doctors, a tentative contract failed to pass a ratification vote and the OMA board was essentially overthrown in a coup.

The Ontario Association of Radiologists and Ontario Association of Cardiologists both actively campaigned against the framework agreement. Among concerns they and other opponents cited was that it singles out “relativity” as an issue that an arbitrator could have the final say on.

Relativity refers to the large variations in payments to different medical specialties. Radiologists and cardiologists are among the highest paid.

(From their OHIP payments, physicians cover the cost of overhead expenses, for example, staff salaries and rent. Specialists who work outside hospitals and purchase equipment can have particularly high overhead costs.)

Addressing relativity would involve recalibrating the OHIP fee schedule, lowering fees considered overvalued and increasing those considered undervalued.

“Giving prominence to relativity is unfair and will pit groups of doctors against each other,” warns the Ontario Association of Cardiologists on their website.

Dr. James Swan, president of the association and chair of the OMA section on cardiology, said in an interview that his group disagrees with the OMA’s approach to tackling relativity.

Even though cardiologists were disappointed with the outcome of the June vote, they still hope to exert influence by being actively involved in negotiations and in ongoing reforms of the OMA, Swan said.

On a recent blog post, Whatley wrote that “relativity has plagued medicine for a long as doctors have had fees.”

Changing fee codes for work done by different specialists will involve looking at issues of merit, effort, value, equality and democracy, he said.

“Heady concepts, but we must wrestle with them all,” Whatley said.

The Ontario Association of Radiologists did not respond to requests for an interview.

But a concern with the framework agreement cited on the association’s website is “the perpetual entrenchment of the OMA as the exclusive bargaining agent for all Ontario physicians with no alternative mechanism if this (binding arbitration) model does not work.”

The radiologists haven’t always been happy with how the OMA has represented them. In 1998, they tried unsuccessfully to sue the OMA because they were unhappy with a new fee contract, which limited how much they could bill OHIP for technical fees.

Opponents of the new framework agreement are also concerned that it directs an arbitrator, in making decisions of physician compensation, to take into account:

  • The economic situation in Ontario.
  • The achievement of a high quality, patient-centred sustainable publicly funded health care system.

The vote breakdown report also shows that 70 per cent of women voters supported the deal, compared to 63 per cent of men.

The age breakdown shows that voters ages 25 and younger were most supportive, with 76 per cent voting in favour. Least supportive were those ages 46 to 50, with 39 per cent rejecting it.

Of 11 geographical areas, district 10, which includes northwestern Ontario, was most supportive with 75 per cent voting in favour.

Most opposed was district 5 which includes parts of Peel Region, Simcoe County and Dufferin County, and where 39 per cent voted the deal down.

How physician specialty groups voted

Six specialty groups most supportive of new negotiations framework (percentage of voters in favour)

  • Infectious Diseases (87%)
  • Palliative Medicine (86%)
  • Geriatric Medicine (86%)
  • Public Health (85%)
  • Laboratory Medicine (84%)
  • Rheumatology (84%)

Six specialty groups least supportive of new negotiations framework (percentage of voters opposed)

  • Diagnostic Imaging (84%)
  • Neuroradiology (80%)
  • Cardiology (71%)
  • Plastic Surgery (69%)
  • Genetics (65%)
  • Nuclear Medicine (61%)

Posted on June 23, 2017

OAC Statement on the Formation of CorHealth Ontario

On June 21, 2017, CorHealth Ontario was announced.  CorHealth Ontario ( is  a new organization formed by the merger of the Cardiac Care Network of Ontario and the Ontario Stroke Network, with an expanded mandate spanning cardiac, stroke and vascular services through the entire course of care.

OAC President Dr. Jim Swan attended the unveiling event and stated, “OAC looks forward to working with CorHealth Ontario, formerly Cardiac Care Network of Ontario, to deliver high quality cardiac patient care in Ontario.”

Posted on June 9, 2017

OAC Recommends Voting “No” to the Tentative BA Framework Agreement

June 9, 2017

Dear OAC member,

Last night, at a meeting of the OAC Board of Directors followed by the Association’s annual meeting of members, the OAC reviewed the 2017 OMA-MOH tentative binding arbitration (BA) framework agreement.  While the OAC strongly supports BA in principle, it was the unanimous decision of the Board of Directors and all in attendance at the Annual Meeting to reject this tentative agreement for the following reasons:

  • The agreement entrenches the OMA in perpetuity as the bargaining agent for all Ontario physicians.
  • The agreement specifies income relativity for arbitration without citing other key issues.  Giving prominence to relativity is unfair and will pit groups of doctors against each other.
  • The agreement exposes the OMA to conflicts within the profession (i.e. picking “winners” and “losers”) arising from its co-management role (with MOH) of the Physician Services Budgets and expenditures.  This will be further amplified by the income relativity clause (see above) and the OMA’s current internal position on the CANDI methodology.
  • The agreement entrenches Mediation/Arbitration with the same Chairperson versus having the roles divided to ensure greater transparency.  This weakens the OMA’s position within the BA process.
  • The agreement exposes compensation of CMPA coverage to arbitration in the future.  This coverage will most likely disappear through arbitration in 2023.

The OAC believes that this BA framework agreement contains the vestiges of the OMA’s “old guard”, a group whose approach to government negotiations was resoundingly rejected in August 2016.  The agreement places a higher value on OMA organizational self-preservation than on representing the fundamental interests of all grassroots members fairly.  It serves to divide and separate, not unify, us.  In short, we believe it can be done better.

We must not be hoodwinked into supporting a BA framework agreement now for reasons of expediency. Moreover, we must not feel pressured or bullied to support this agreement to satisfy the political schedule of the Ontario Liberals.  Let’s take the time needed to get this right.

Securing a fair BA framework agreement is crucial to the future of our profession in Ontario.  We cannot afford to get this wrong.  Our collective future, and that of our patients, depend on it.

The OAC is recommending that you vote “No” to this agreement now.  Give the new OMA Board of Directors the chance to develop and pursue its own mandate, as an instrument of comprehensive reform, including developing a better BA framework agreement that ensures all doctors are treated fairly in our organization.


James Swan, MD, FRCP(C), F.A.C.C.
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, ON M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239

Posted on June 6, 2017

An Important Message for Ontario Cardiologists

Our profession has endured a lot. Since 2012, Cardiology has been subjected to attack by misinformation and arbitrary government cutbacks. At every juncture, your association has been there to fight for what is right for cardiologists and their Ontario patients and we have made huge strides. Now, we need to understand the details and consequences of this newly proposed Binding Arbitration agreement before voting on June 17, 2017.

Last year the OAC played a key role in ensuring the temporary Physician Services Agreement (tPSA), which was orchestrated in secret by the Ministry of Health and the past executive of the OMA, was soundly rejected. As part of the Coalition of Ontario Doctors (Coalition) we won the right to Binding Arbitration that we had fought so hard for and now, we need to follow through on very important next steps.

On June 17, 2017, as a member of the OMA you will be asked to vote on a tentative binding arbitration agreement (BA) with the Ontario government. A general meeting has been called for that day to vote on the tentative “framework appendix for negotiations, meditation and arbitration”. The result of that vote will have major implications for cardiology (indeed all healthcare) for decades to come. Let’s make sure we get it right and vote based on a clear understanding of what this vote is all about.

Recently, the Coalition shared the opinion of Mr. Andrew Lokan, a leading constitutional law expert. He assessed the proposed BA in the context of “how this compares with other BA agreements and how well this proposal would work for Ontario doctors”. Mr. Lokan raised 5 key issues that need clarification before OMA members should cast their votes. These issues are:

5 Key Issues that Need to be Answered Before Voting

  1. This BA entrenches the OMA as the permanent bargaining agent for doctors. Usually there is a mechanism to remove and change an agent if warranted, but this is not provided in this BA.

  2. This BA has the OMA taking on a significant role in the healthcare budgeting baseline. Ask yourself first “Could this generate internal conflicts if cutbacks are forced on a particular group “and second, “what current structure exists within the OMA to deal with this?”

  3. This BA envisions mediation and arbitration as a singularity. During the mediation phase, hints may be intentionally (or unintentionally) dropped that later affect arbitration. It’s best to clearly separate the roles of mediator and arbitrator.

  4. This BA talks about the inclusion of specific criteria for arbitration, including the permanent inclusion of income relativity. Giving prominence to income relativity over other issues has the potential to pit one group of doctors against another, which is divisive and unfair.

  5. This BA says “this is good until 2023” which implies the CMPA supplement will most likely be gone after 2023.



Recent OAC Initiatives and Successes

The OAC exists to stand up for our members and to advocate on behalf of Ontario’s cardiac patients. The OAC is you … and it’s your voice and financial support that have allowed us these recent successes.

Protecting Cardiologists While Ensuring High Quality Care for Patients

The Cardiac Care Network’s Echocardiography Quality Improvement (EQI) program underwent significant changes in 2016-17 to its processes, personnel, and documentation.

The CCN required that a “Facility Agreement” be signed by all facility owners as part of the EQI program. The OAC discovered that it contained an indemnity clause that could expose facility owners to significant cost and legal liabilities, should legal proceedings be initiated against the CCN and/or Ministry in connection with the program.

The OAC worked long and hard to improve the Facility Agreement, to protect cardiologists. In March 2017, we were successful in our efforts to have the clause removed.  Some further issues still remain that require our ongoing attention and work.  OAC is committed to resolving these quickly with the CCN so that OAC members can feel comfortable signing the document and proceeding through the accreditation process.

OAC Members: A Source of Clinical Expertise

New health care technologies can help improve patient care and reduce costs. Awareness of evolving developments and the ability to measure their actual effectiveness against established parameters is critical.

In April 2017, Health Quality Ontario (HQO), an agency of the Ontario Ministry of Health and Long-Term Care, reached out for OAC’s help in conducting a health technology assessment or (HTA). “Remote cardiac monitoring” is a new and potentially useful tool for health care that will be assessed with OAC input that will culminate in a report to the Minister in May 2018.  HQO asked if the OAC could provide clinical experts to assist with its review and recommendations concerning the prospect of extending public funding to technologies that remotely monitor pacemakers, ICDs, and cardiac resynchronization device therapies. The OAC welcomes this government outreach and looks forward to having more opportunities to contribute to public policy development and government funding decision-making in cardiac care in the future.



View our newsletter, The Pulse, to learn more about what OAC has done recently to protect health care of Ontarians. Please remember that June 17, 2017 is a pivotal moment for Ontario cardiologists and their patients. Decisions will be made that day that impact the next decade of cardiac care. Please, let’s all add our voices, pay attention to the FINE PRINT and make the right decisions.



Jim-signature copy

James Swan, MD, F.R.C.P.(C) F.A.C.C.
President, Ontario Association of Cardiologists

Posted on June 5, 2017

Coalition Outlines Concerns

Last week, the Coalition of Ontario Doctors (Coalition) outlined its concerns regarding the tentative binding arbitration (BA) agreement the OMA recently signed with the Ontario government.

Over the weekend, more physician groups went on record opposing the tentative BA agreement. As an OMA member, you will have your chance to support or reject the BA agreement at a vote that will be held during a general meeting of members on June 17, 2017.

Several components of the BA agreement are worrisome and remain not clarified by the OMA as of today. These include:

Important Questions on the tentative BA Agreement That Must Be Answered

  • Why does the BA agreement perpetually entrench the OMA as the bargaining agent for all Ontario physicians with no alternative representation mechanism if this BA model does not work out?
  • How does the OMA plan to manage conflicts within the profession that will arise from it playing a co-management role with MOH of (withthe Physician Services Budget?
  • Why are the Mediation/Arbitration roles combined in the same Chairperson, versus having the roles divided to ensure greater transparency?
  • Why have you given prominence to income relativity for arbitration while being silent on other issues of key interest to such as the projected PSA budget for the next 4 years?

OAC believes the OMA must resolve these concerns before we can recommend to our members supporting the BA agreement. The OAC encourages all members to get informed by going to the OAC website in the lead up to the June 17th vote.  Here you will find the latest developments on the tentative BA agreement. 

Stay informed. Keep in touch.

Posted on January 22, 2017

OAC’s 2017 Pre-Budget Submission: Making Heart Disease a Priority in 2017 and Beyond

Making Heart Disease a Priority in the 2017 Ontario Budget and Beyond

2017 Pre-Budget Submission to the Standing Committee on Finance and Economic Affairs
January 20, 2017



Heart disease is a leading cause of death and illness in Ontario.

Across the country, heart disease kills more women each year than all forms of cancer combined.

Congestive heart failure is the single commonest reason patients go to emergency rooms and are admitted to hospital in Ontario, where their care is very expensive and can be difficult to carry out in an efficient and timely manner due to recent funding cuts to hospital beds and health care resources.

It is estimated that up to 80% of heart disease is preventable by quitting smoking, eating a healthy diet, getting active and maintaining a healthy body weight.

Despite these statistics, the Ontario government has no co-ordinated, province-wide strategy to address heart disease and its ravaging effects on Ontario patients & their families, provincial health care expenditures, and economic productivity.

The Ontario Association of Cardiologists (OAC) believes this must change. We are calling on the Ontario government in the 2017 Budget to work with our organization to formulate the Ontario Heart Disease Prevention and Treatment Strategy. Key elements must include:

  • Restoring the cuts to hospitals that have recently (i.e. since 2012) decreased the number of cardiac care beds and cardiac resources in Ontario;
  • Strengthened investments in Ontario’s outpatient cardiac care infrastructure to support patient access to care close to home whether it be in the hospital or cardiologist office;
  • Support for the Auditor General of Ontario’s 2016 Annual Report, which recommended collaboration with Ontario’s cardiac care specialists (OAC) to ensure that the province’s limited health care resources are spent appropriately and maintain high standards of cardiac care;
  • Improved e-health integration initiatives to optimize the delivery of high quality cardiac care services in the community and hospital environments; and,
  • A co-ordinated multi-stakeholder plan that includes disease prevention, patient education, and cardiac care service delivery aimed at reducing overall incidence and expenses related to heart disease in Ontario.

As physicians who specialize in diagnosing and treating heart disease, Ontario’s cardiologists provide cost-effective care every day that is crucial to saving lives and improving the quality of life of thousands of patients with heart disease.  Recent cuts to health care funding and cardiac services are making this more difficult to deliver each day and if not reversed increased cardiac death and illness will occur.

The OAC would welcome the privilege to partner with the provincial government to develop and implement the Ontario Heart Disease Prevention and Treatment Strategy.

About the OAC

The OAC is a voluntary professional organization that represents the majority of academic (i.e. hospital-based) and community (i.e. clinic and/or office-based) cardiologists in Ontario. Founded in 1995, the OAC’s mission is to protect, maintain and improve the current high standard of cardiac care for Ontario patients across the province and ensure the cardiologists who deliver the care are fairly remunerated for these services.

The OAC is an advocacy leader for Ontario’s cardiologists and their patients. It exists independently of the Ontario Medical Association (OMA) to ensure the voice of cardiology is heard regarding issues that affect the care of cardiac patients in Ontario. While all cardiologists in Ontario are required to be members of the OMA, the OMA does not provide its Section on Cardiology with the support or infrastructure to allow it to act as an effective advocate for cardiac patients. The OAC fills this gap. Without its ongoing advocacy program, the continued high standard of cardiac care in Ontario is at risk.

Current Cardiac Care Landscape

Ontario’s once strong and co-ordinated system of hospital-based and outpatient cardiac care has come under significant strain in recent years due to arbitrary unilateral government cuts to cardiac care services. Table 1 outlines the drastic reductions that have been made since 2012 in the absence of consultation with Ontario’s cardiologists.

 Table 1: Ontario Government Budget Cuts Affecting Cardiac Care (2012-17)

Service Description Effective % Cut
 Various (incl. ECG; pre-op echo; cardiac catheterization & others)  Reduction in fees & harmonization of codes  FY 2012/13  10%
Congestive Heart Failure Patient Care Chronic Disease Assessment Code (E078) eliminated for cardiologists treating patients with congestive heart failure April 2015 100%
Echocardiography and Nuclear Cardiology Procedures Two professional fees combined and reduced for various types of echocardiography and nuclear cardiology procedures October 2015 20% of previous P1 fee
Service Description Effective % Cut
All cardiology procedures and services “Across the Board” discount applied to all OHIP physician billings (incl. professional and technical fees) April 2013 (0.5%)February 2015 (2.65%)

October 2015 (1.3%)

Global Billing Cap The government will claw back any OHIP physician services budget spending that exceeds a 1.25% increase over previous year April 2016 Unknown amount

The cuts to cardiology services within the Ministry of Health and Long-Term Care’s physician services budget have forced cardiologists to make hard choices regarding when and where they can provide cardiac care services. Patient access to care is threatened because cardiologists increasingly cannot afford to provide the services that have been promised by the Ontario government and patients have come to expect. Some clinics and offices have closed and patient access to cardiac care is significantly delayed as a result. This is not good for cardiac care. Time is muscle when it comes to delivering cardiac care and this concept needs to be recognized by government.

The OAC recognizes the Ontario government’s desire to meet its balanced budget commitment by the year 2017-18. We agree that the Ontario government should live within its means. What we object to, however, is the elimination of the government’s deficit on the backs of Ontario’s cardiac care specialists and their very sick patients.

In December 2016, Ontario Premier Kathleen Wynne and Finance Minister Charles Sousa called on the federal government to provide annual health care funding growth at 5.2%, a figure that they said was “fair and evidence-based and has been validated by a number of third-parties, such as the Conference Board of Canada, the Parliamentary Budget Officer and the Fraser Institute.”

Yet, what did Minister of Health and Long-Term Care, Hon. Dr. Eric Hoskins, offer in the latest physician services agreement “proposal” to the Ontario Medical Association last month? Annual budget increases of less than half of this amount. Does the government expect physicians to cover budget overages related to immigration and demographic change, costs which are rising sharply and out of their control, themselves?

The government’s attitude and approach to cardiac care has been disappointing. It is leading young doctors to avoid setting up in this province, forcing others who are currently here to leave and inspiring older doctors to retire early. Cardiac care service delivery is at the brink of chaos. Cardiac care must be delivered by the experts, highly trained physicians, who have the knowledge necessary to correctly diagnose and manage the cardiac patient.

Auditor General of Ontario’s 2016 Annual Report

The OAC understands that health care resources are limited and that what is available must be spent appropriately. This is why we brought forward concerns to the Auditor General of Ontario in June 2016 after trying for many months to resolve with the government what we considered to be misspending of public resources in cardiac care.

In the 2016 Annual Report of the Auditor General of Ontario, Ms. Bonnie Lysyk stated: “Concerns of the Ontario Association of Cardiologists (Cardiologists Association) about cardiac-care spending in an open letter to the Auditor General were reasonable.” Specifically, she found that the government overpaid at least $3.2 million between April 2012 and May 2015 for two cardiac rhythm monitoring tests (Holters & loop recorders) that were inappropriately claimed and paid. Moreover, the Auditor General supported the OAC’s concerns over the vast expansion of commercial echocardiography (cardiac ultrasound) labs in Ontario that have been fuelled by an arbitrary change to the physician services budget in October 2015.

Her recommendations were clear. She stated, “To strengthen the oversight of the use of cardiac ultrasound services, the Ministry of Health and Long-Term Care should work with the Ontario Association of Cardiologists and the Cardiac Care Network of Ontario to:

  1. Assess the effectiveness of the Cardiac Care Network of Ontario’s Echocardiography Quality Improvement program intended to deter inappropriate use of cardiac ultrasound services;
  2. Monitor the use of cardiac ultrasound services claimed by facilities, such as those owned by non-physicians, and take corrective actions when anomalies are identified; and
  3. Recover the $3.2 million of over payments to physicians related to cardiac rhythm monitoring tests that were inappropriately claimed.

It is time to stop the arbitrary and unilateral funding cuts focused on achieving a political objective.

Instead, we urge you to think more broadly. It is time to recognize the serious economic and human consequences that heart disease is having in Ontario and develop a new comprehensive and integrated approach to dealing with one of Ontario leading causes of death and illness. It’s time to work with the OAC to develop the Ontario Heart Disease Prevention and Treatment Strategy.

Why Work With The OAC?

Ontario cardiologists are doctors who save lives and improve the quality of life for thousands of patients facing heart disease. In an emergency, they step into a patient’s life suddenly and are trusted implicitly to help. Throughout all patient encounters they listen; ask questions; perform tests; and interpret results. Patients count on their years of training and experience to help them in ways that no one else can.

While cardiologists work in a multitude of settings including hospitals, the majority of cardiologists provide services as independent small businesses through clinics and/or community offices. They do not receive salaries, do not have a guaranteed pension or even a drug or dental plan provided for them. Instead, cardiologists make their income from government payments earned through billing for services they provide, minus the costs of running their clinic or office, which can easily represent 3%.

These costs include, but are not limited to:

  • Staff & Benefits (These costs have doubled in the past seven years)
  • Computers
  • Medical Supplies
  • Medical Equipment (e.g ECG, echocardiography machines, etc.)
  • Rent – Office
  • Insurance
  • Financial Management
  • Continuing Medical Education

In short, government payments to cardiologists are not exclusively income.

Furthermore, unlike other independent small businesses in a community, cardiologists cannot charge for services based on what they cost. Even though they face a growing population from immigration, an aging community and the costs of new equipment, community cardiologists are locked into an inflexible system that expects them to absorb the cost of change and poorly thought out government strategies to reduce the costs of delivering cardiac services. There are stringent rules about what a cardiologist can charge the health care system per patient regardless of the amount of time required to help a particular patient with heart health issues. If a patient requires additional visits to their cardiologist or more time per visit due to complications than the system’s rules prescribe, then the cardiologist is expected to absorb the additional costs. The cardiologist has reached the stage that there is no further room to absorb any additional costs; some services are being cut resulting in restricted patient access to cardiac care in the province of Ontario because of the lack of government funding.

Ultimately, cardiologists provide tremendous value to the health care system by saving lives and improving the quality of life of thousands of patients through their cost-effective services. The time demands can be enormous (late nights, on-call, weekends, emergencies) and the emotional costs of dealing with individual lives and their loved ones is unique.

As the Ontario government develops the 2017 Budget, we ask it to re-examine its treatment of the cardiology profession in the past four years and recognize the crucial role and tremendous value it is delivering to patients and the health care system.

OAC’s 2017 Budget Priorities

Heart disease is a leading cause of death and illness in Ontario. It has an enormous impact on the lives of Ontarians of all ages, living in all areas of the province and comprises a major component of province-wide health care expenditures. Yet, there is no recognition of this from the Ontario government. There is no comprehensive, co-ordinated approach to tackling this disease and the enormous human and economic impacts it is having in Ontario today.

We believe that this must change.

The Ontario government must show leadership on this issue. The future of patients currently living with heart disease and of our cardiac care services in Ontario depend on it. That is why we are calling on the Ontario government to heed our call by working with Ontario’s cardiologists to develop a province-wide Ontario Heart Disease Prevention and Treatment Strategy. Key elements of such a strategy would include:

  1. Restoration of funding to hospitals providing cardiac services to Ontario patients to increase the number of cardiac beds and resources and enable cardiologists to deliver care that meets current international standards.
  2. Strengthened investments in Ontario’s outpatient cardiac care infrastructure to support patient access to care close to home. For example, restoring the chronic care code for cardiologists and internal medicine specialists who treat congestive heart failure patients. This small annual investment of approx. $3 million/year will be revenue neutral if not improve your government’s bottom line as it will help keep many of these very sick patients from having to go to the hospital where the care is much more expensive.
  3. Consistent with Auditor General of Ontario’s 2016 Annual Report, collaboration with Ontario’s cardiac care specialists to ensure that the province’s limited health care resources are spent appropriately and maintain high standards of cardiac care. The Ministry should commit to recovering the $3.2 million misspent between April 2012 and May 2015 and reinvest this in areas of cardiac care that need it.
  4. Improved e-health integration initiatives to optimize the delivery of high quality cardiac care services in the community and hospital environments; and,
  5.  A co-ordinated multi-stakeholder plan that includes disease prevention, patient education, and cardiac care service delivery aimed at reducing overall incidence and expenses related to heart disease in Ontario.


The time has come for the Ontario government to make combatting heart disease in the province a top priority. To do so effectively, it needs to stop viewing cardiologists and cardiac care services as a cost centre within the provincial treasury. No more unilateral cuts. No more demonizing or bullying cardiac care specialists.   Instead, reach out, as per the Auditor General of Ontario’s advice, and work with us to ensure that high quality cardiac care services are provided to patients appropriately all across the province.

In the past, there has been a strong track record of collaboration between Ontario’s cardiologists and the provincial government, which led to the formation of Cardiac Care Network of Ontario and served as a model for Cancer Care Ontario. We believe that the conditions exist for this to collaboration to work again in an effort to ensure that patients with heart disease get the kind of care we all believe they are entitled to and that doctors who deliver the care are appropriately remunerated.

A comprehensive Ontario Heart Disease Prevention and Treatment Strategy is needed. Let’s work together to ensure finite health care resources are spent appropriately in cardiac care so that the best results for patients can be delivered wherever they may live in the province.

For more information, contact:

James Swan, M.D. F.R.C.P. (C) F.A.C.C.
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, ON M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239