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

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: