Hearing a familiar tune in the Great White North
Complaints about wait times to see family physicians, anger over government pay cuts for specialists, and specialists threatening to leave town made the news this past weekend—in Ontario.
I was sitting in Toronto Pearson International Airport reading the Toronto Globe & Mail trying to find information on the Chicago White Sox. Instead I found an article, editorial and editorial cartoon all focusing on disputes between the Ontario Medical Association and the provincial government, which is targeting healthcare expenses as it addresses a $15 billion (Canadian) deficit. Hmmm, sounds familiar.
In the U.S., the 50 states act as our problem-solving laboratories, trying out individual approaches to shared dilemmas. But, as the situation in Ontario shows, it can't hurt to also try to learn from what the Canadian provinces are doing.
As in the U.S., the Ontario government was trying to improve primary-care services with a bump in pay. But the Globe & Mail cites a provincial auditor's report (PDF) questioning the value of this investment.
The report noted that 60% of patients surveyed had to wait a week or longer to see their family physician after becoming ill. It also noted that, of the 8.6 million people enrolled in alternative funding arrangements called Family Health Groups and Family Health Organizations, 1.9 million (22%) did not visit their doctors in fiscal 2009/2010, but their physicians still collected $123 million for their "care" just the same.
While the Globe article noted that government is suggesting that "virtual visits" might help solve the access problem, it doesn't mention cutting back on fees for family doctors. The physicians targeted for pay cuts are chiefly cardiologists, ophthalmologists and diagnostic radiologists.
According to the article, the logic behind many of these cuts is that technology has made several common tests and procedures easier to perform. The article also notes how some routine tests, such as an echocardiogram before routine non-cardiac surgery, hasn't shown to improve outcomes, so fewer will be done.
The editorial, which proclaims "fee cuts are good medicine," also notes that a cataract operation that used to take two hours now takes 15 minutes.
Doctors are fighting back.
Specialists are threatening to leave the province for greener pastures, and the paper's editorial cartoon pictures a bird-watcher identifying some migrating creatures as "fee-cut cardiologists."
"Doctors remain available to work with the province to achieve savings in healthcare, but we won't do it without an assurance that there will be a fair process that considers our input," Dr. Scott Wooder, president-elect of the Ontario Medical Association, said in a news release.
The paper, however, notes that four other provinces are considering overhauling their systems of doctor payment and that, like others whose income comes from taxes others pay, physicians "must face the realities of a bad economy." The editorial concludes by saying how the province needs to shore up its budget, and noting to doctors that "It's not personal."
I doubt they take comfort in that.
Follow Andis Robeznieks on Twitter: @MHARobeznieks.