Outdated funding model for doctors at CHEO is affecting its ability to deliver care: Alex Munter

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Some young patients are being transported out of the region, even out of the province, for care as CHEO struggles with worsening physician shortages.

Hospital president and CEO Alex Munter said there is an urgent need to address the “outdated” funding model for physicians at the hospital, which is making it difficult to retain doctors or to hire new ones and affecting patient care.

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“Fewer physicians to serve a growing population of children, means kids being forced to wait longer than is safe or being sent out of region and out of province for medically necessary care,” said Munter in a statement Monday.

Doctors at the hospital, part of a group known as the Children’s Hospital Academic Medical Organization (CHAMO), are funded directly by the ministry of health through what is known as an alternative funding plan. That funding plan is part of the ongoing negotiations between the Ontario Medical Association (OMA) and Ontario’s ministry of health over physician pay.

In a document that is part of the arbitration process between the OMA and the ministry of health, the doctor’s group CHAMO says that funding agreement is so far out of date that the hospital is in crisis trying to keep the physicians it has and to hire doctors to replace those that have left.

The document paints a picture of a hospital unable to keep up with demand, in part because the funding model has not kept up with competitive pay at a time when demand for pediatric health care is surging.

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Some departments at CHEO have physician vacancy rates of 40 per cent and struggle to keep the doctors they have, let alone recruiting new ones, according to the document.

The surge in demand for pediatric care, coupled with the “worsening physician resource challenges … has resulted in a pediatric capacity crisis that means babies, children and youth are not receiving expected levels of care.”

The situation is leaving CHEO “unable to provide children with sufficiently early intervention and proactive care,” according to the document.

“All of this has real and adverse impacts on children. At present, less than 40 per cent of children at CHEO are receiving care within clinically-safe timelines. These unacceptable care delays are, in no small part, due to a physician funding arrangement that is insufficient to meet patient needs.”

CHEO serves Eastern and Northern Ontario, as well as the Outaouais and parts of Nunavut as a tertiary trauma centre. It is one of only two Level 1 pediatric trauma units in Ontario.

The doctors group says some departments have been severely impacted and are “struggling to maintain their current complement, let alone recruit doctors.”

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The hospital’s department of medical imaging has lost more than 42 per cent of its physicians since 2018 and currently has a 40 per cent vacancy rate, the document says. Wait times for MRIs and ultrasounds for non-urgent cases are now the longest in the province.

The department of pediatrics lost 41 physicians since 2018, compared to 10 in the five preceding years. Other departments are losing physicians as well as seeing physicians cut back on their hours to take on “more lucrative opportunities in the community.”

In addition, the document says there is an “urgent need” to hire psychiatrists to staff CHEO’s new mental health transition unit, which takes high acuity crisis patients out of the emergency department to provide short stay, stabilization and community contact services. The unit was recently opened.

The hospital is dealing with a surge in demand that is exacerbated by the physician recruitment crisis, says the doctors’ group.

CHEO has been part of a campaign to “right-size” pediatric health care in Ontario. That campaign became urgent during the 2022-2023 viral season when a surge of patients with respiratory illnesses left the hospital with too few beds and historic waits in the emergency department, along with other delays.

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The hospital has since received substantial funding to add new beds and expand in other areas in an attempt to better meet demands. Last year, the province announced a $330-million investment to expand children’s health services across the province, including at CHEO. The funding represented the single biggest expansion of CHEO’s capacity, Munter said at the time.

Still, doctors say their funding has not been right-sized.

The Ontario Medical Association and the ministry of health have gone into arbitration at a time when more than two million Ontario residents are without a family doctor.

In its argument as part of arbitration with the OMA, the ministry of health said there is no concern about a diminished supply of doctors in the province. It also said recruitment and retention of doctors in Ontario is not a major concern.

Those comments were widely criticized and led one doctors’ group, the Ontario Union of Family Physicians, to call for Health Minister Sylvia Jones’ resignation.

Jones clarified that the ministry was not saying retention was not a big issue or that there was no doctor shortage.

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She said Ontario physicians are a “really important part of our health-care system and we’ll continue to work with them to grow the workforce.”

She added that the province had done that by committing to open two new medical schools and expanding residency positions.

Munter said the hospital is optimistic that the issue is on the ministry’s radar.

“CHEO will continue to work with our physicians, the ministry and the OMA to modernize our alternate funding plan.”

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