OMA up in arms over impact of cuts on docs

Clarification requested by Ontario Medical Association

“Physician fees have actually been cut 2.65% (on top of the cut they took in 2012) across the board.  While the overall physician services budget will increase 1.25% each year, the 1.25% increase to the physician services budget will go mainly to pay for new doctors to meet the increasing need for care from a growing and aging population, which requires more complex care, though the need is estimated to increase 2.7% each year so the government is not funding all of the need.”

Managed entry process imposes limit on new family physicians eligible for capitated practice models

The Ontario Medical Association is up in arms over cutbacks to physician remuneration and changes to the Ministry of Health and Long-Term Care’s managed entry process, which limits the number of new physicians joining capitated health care models to 20 per month and restricts them to underserviced areas of the province.

Among the cuts is the elimination of premiums for internal medicine specialists treating patients with diabetes, COPD, inflammatory bowel disease and other chronic illnesses. The premium was negotiated in 2004 to speed access to care and seems to have worked, said OMA president Mike Toth. The problem is that physicians who tailored their practice to seeing these patients “may be looking at a 30 per cent decrease in their overall income” and may have to make some changes to their practice, jeopardizing the improved access the premiums made possible.

According to Toth, the Ministry has factored in a 1.25 per cent increase in physician compensation to account for the province’s growing population, but at the same time froze the physician services budget at $11.3 billion.

“We estimated natural growth at 2.7 per cent for this year, so the government is funding less than half of that, and to stay within its fixed budget, cuts were needed,” said Toth.

“We think it’s a bit short-sighted of the government to so focus on its fiscal problems to the detriment of the health-care system. We think the right thing for the government to do is to sit down and talk with us, so we can find some solutions like we have in the past.”

The OMA and the government differ on how the changes to the managed entry process will affect Northern
Ontario.

Toth acknowledges that most of Northern Ontario with the exception of part of Thunder Bay is included in a list of 191 underserved communities, but questioned how many of the 20 spots per month would be filled in the North given that many of the underserved communities on the list are in southern Ontario.

In an emailed response to the Northern Ontario Medical Journal, the Ministry pointed out that “under the previous model, 20 new physicians per month were eligible for entry into the Family Health Organization and Family Health Network compensation models in areas that were underserved by family physicians, while 20 more were eligible in areas that were already well served.

“Although the Ministry saw significant interest in well-served communities, few physicians were choosing to practise in these models in the areas that could most benefit from them. That is why as part of our plan, we focused all new entrants into underserviced areas, which include many communities in the North that have traditionally struggled to recruit and attract physicians.”

Graduates of family medicine residency programs unable to qualify for one of the 20 openings can open a new practice under the “fee-for-service model or under the Comprehensive Care model, where they receive premiums and bonuses for providing chronic disease management and preventive care for their patients…

“With the approval of the Ministry and the LHIN and/or subject to available FTE positions within the model,” they can also replace a retiring physician in a Family Health Organization or Family Health Network…or join one of the many specialized models, including Community Health Centres, Aboriginal Health Access Centres, or practise under the Rural and Northern Physician Group Agreement.

Focusing growth in these models into area of high physician need will benefit patients in Northern Ontario, where we know that we need to recruit more physicians,” claims the
Ministry.

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