Recruitment and retention of doctors in Ontario is “not a major concern,” the Ministry of Health suggests in arguments it is making in arbitration with the Ontario Medical Association over physician compensation.
The argument from the province comes as the OMA, which represents Ontario’s doctors, has repeatedly warned that more than two million residents don’t have a family doctor and thousands of physician jobs are going unfilled.
The province is in the midst of negotiations with the OMA for the next Physician Services Agreement, which determines how doctors are compensated, covering the next four years.
But the talks are going so poorly that an arbitrator is now being asked to determine compensation levels for the first year while the two sides work on the 2025-2028 period, one of the doctors involved said.
“Things are in such dire shape that that’s the fastest way to get money out the door to stabilize family doctors’ practices,” said Dr. David Barber, the chair of the OMA’s Section on General and Family Practice.
The government’s arguments in its arbitration brief are unlikely to improve relations, he said.
“It’s really quite insulting,” Barber said.
“The numbers are one thing, right, but … the government’s approach here is their briefing essentially says there’s nothing wrong. I get there’s posturing, but this is actually quite dangerous posturing on the side of the government.”
Substantial difference in proposals
The OMA is proposing a five per cent general price increase for the year, a 10.2 per cent “catch up” to account for inflation and “low price increases” since 2012, as well as 7.7 per cent to be directed to various health system programs.
In comparison to the 15.2 per cent in direct increases the OMA is proposing, the Ministry of Health is proposing three per cent. There is no need for any “catch up,” it argues.
“The average physician income adjustments compared favourably with other settlements where retention and recruitment is not a major concern,” the ministry wrote.
“We will illustrate that there is no concern of a diminished supply of physicians. Across Canada, Ontario has the best record in attracting medical graduates to train in Ontario. Further, Ontario has enjoyed a growth in physicians that far outstrips population growth.”
The ministry cited various data points to back up its arguments. The supply of doctors has grown 8.9 per cent from 2019-20 to 2023-24, while the population grew 7.1 per cent, it said.
In that same time period, the average income of a physician increased by about 10 per cent, while the average patient encounters per physician dropped 3.7 per cent, the ministry said.
“It is concerning that while physician incomes have been rising, and the number of physicians outpaces population growth, patient access appears to have worsened,” the ministry wrote.
“Why are the number of physicians increasing, yet physician services decreasing? It could be the desire by physicians for greater work-life balance.”
Ontario short more than 2,000 doctors, OMA says
The ministry argues that an agreement for doctors should be approached differently than for nurses, where a recent deal put shortages “front and centre.”
The government also says many initiatives are underway to increase patient care and access to family doctors.
“These considerations are particularly relevant when the (arbitrator) considers issues such as retention and recruitment of physicians,” it wrote. “There is an entirely different consideration for this hearing than there was in the recent health-care decisions in hospitals.”
The OMA’s arguments also contain a multitude of numbers. There are 2.3 million Ontario residents without a family doctor, they argued. Using a calculation involving census data the province is short more than 2,000 doctors, they said. Data from government agency Health Force Ontario shows more than 3,000 physician job vacancies, they said. As well, Ontario has 234 doctors per 100,000 population, one of the lowest rates in the country.
“Ontario is facing a physician human resources crisis,” the OMA wrote.
“The evidence of this is everywhere. It can be seen, for example, in the unprecedented number of patients unattached to a family physician, the closures and crowding of emergency departments, the long wait lists to see a specialist, and the backlog of surgical procedures and diagnostic imaging in the post-pandemic era.”
Health Minister Sylvia Jones said she disagreed with Barber’s assertion that the province’s position is insulting.
“I think that we have shown through many different initiatives that we are very focused on ensuring that we have a health-care system that continues to serve the patients,” she said, citing more powers that have been given to pharmacists in the past couple of years.
“When we increased scope of practice for (pharmacists) we saw a decrease in the numbers of patients who are going to the emergency department.”
NDP health critic France Gelinas said the government needs to work with doctors to address the issues that are driving physicians out of family medicine.
“Over two million people in Ontario don’t have a doctor,” she wrote in a statement. “Instead of trying to solve this problem, the government wants to ignore it.”