Dear Colleagues,
The following document will give you some idea of what the OMA negotiating team was facing last time and how easily they folded. This is perhaps the best argument for why you need to join DoctorsOntario right now. The next round of negotiations will start in a little over a month.
Sincerely,
Douglas Mark, MD, Interim-President DoctorsOntario
P.S. Help us spread the word and fight the good fight on your behalf. Please visit our website at www.doctorsontario.ca and take out a DO membership or make a contribution.
Behind the scenes of OMA fee talks
WRITTEN BY COLIN LESLIE ON NOVEMBER 5, 2013 FOR THE MEDICAL POST
It was near Valentine’s Day 2012 when the two negotiating teams sat down for the first time.
On one side sat the Ontario government’s team, led by Graham Scott, a former deputy minister of health—and a conservative—who was selected by Deb Matthews, Ontario health minster—and a Liberal. On the Ontario Medical Association side sat lead negotiator and lawyer Brian Burkett, negotiations chairman Dr. Wayne Tanner and the rest of the OMA’s negotiating team.
That first meeting occurred in a board room in the OMA’s white office tower on Toronto’s Bloor St. Scott and some members of his team spoke for two hours and then passed over the white binder outlining the government’s position.
What was in that white binder shocked the OMA’s negotiations team—but then the ministry’s own team members had also been astonished when they first heard the government position.
The above (and indeed the rest of this editorial) provides backroom info not previously known. We’re
about to start a new round of master agreement negotiations in Ontario. I hope, in a periodic series of editorials this winter, to tell as much as I can of what happened in the closed-door negotiation meetings that led to the last fee deal. My goal in doing so is to give doctors a more nuanced and informed perspective as we go through the new talks.
Up first, the creation of the ministry team. . . .
Ontario health minister Deb Matthews, though a Liberal, actually comes from a powerful conservative family. Her father, Don Matthews, was an adviser to former Ontario premier—and Progressive Conservative—Bill Davis.
I don’t (yet) know if Matthews picked Scott herself or how much cabinet input there was, but some say he was a “pivotal” choice in that he made the government’s team bipartisan. After all, Scott had been chief of staff to Robert Stanfield, the moderate Progressive Conservative federal leader of the opposition in the 1970s, and he’d been a deputy minister of health in the Davis government in Ontario in the early 1980s.
In any event, it was about this time in November two years ago that rumours started going around that Scott would lead the government team—and ministry folk began asking others to join the team.
The government’s team ultimately featured outside experts from key spheres of knowledge: a CEO from a large academic medical centre (Dr. Barry McLellan of Sunnybrook), a primary-care doctor from a large group (Dr. David Price), an academic with an economics background (Will Falk) and a CEO of a local health integration network (Camille Orridge, CEO of the Toronto LHIN).
As well, of course, there was an assistant deputy minister (ADM), a rep from Matthews’ office and a professional negotiator.
So how did the government communicate its goals to the negotiating team?
In early January 2012, Susan Fitzpatrick, the ADM for negotiations and accountability management at the health ministry, briefed the team using a PowerPoint presentation on the objectives the cabinet had already approved. It was a stunner: The document said the government was looking for “four zeros.”
Now, remember this isn’t how most doctors think of a “zero” fee increase—that fees will stay the same; rather, this referred to total physician compensation in Ontario.
The reaction of the negotiations team was along the lines of: “Whoa! Have you guys really done the math on this? How much is utilization going up?”
Utilization, which refers to the rise in number of fees per doctor plus the rise in number of doctors, had been going up 3.7% annually. So even with zero fee increases, the government’s physician compensation cost would be going up 3.7% per year. So, after a lot of math was done and allowing for a small decrease in utilization, the conclusion was that the government was asking them to negotiate a deal where the fee schedule would fall by about 3% annually.
“Well, that is just a negotiating position, right?” was the general reaction of the team.
There was a lot of back-and-forth about that in early January. Perhaps Scott and Fitzpatrick knew the actual walk-away position all along but at some point during this period it became clear to the rest of the team the government really did need two years of zero. (Indeed, the province was also seeking a couple of zeros from hospitals, teachers and public servants.)
Scott, known as a straightforward guy, tells the team something like: “This is a huge shift from past negotiations. Going from plus 4% to minus 3% isn’t going to be easy to accept.” The 2008 deal had increases of 4%, 4% and 4.25% for a total of 12.25% over four years. “So how do we show them?” Scott asked, referring to how to convince the OMA team this was necessary.
So from mid-January to mid-February, the ministry team set about looking at how to get to that drop of about 3% per year and preparing the details for that white binder that was passed to the OMA near Valentine’s Day. The contents of that binder outlined how dire the province’s finances had become; it included a 15-year history of physician compensation compared with other professionals and a summary of the government’s proposals over four years, which totalled between $1- and $1.1-billion in savings. These proposals were not solely about money.
The tabs in that binder covered proposals in several specific areas, which I plan to write about later.