OMA’s Recent Messages to Family Physicians are Disappointing and Misleading

Last week, Alberta, the province that once had a health Minister who went to a physicians house to berate him in person, created a new pay model for their family physicians. Even Alberta, the province whose premier told the health service to not talk about vaccines, realized the obvious. Family physicians need to be paid commensurate to the foundational work they do, and the role they play, in a high functioning health system.

I’ve taken a look at the new Alberta model. Some of the specifics are gated but the rough overall numbers are public. My back of napkin math suggests there is about a 24% increase in gross income for family physicians with a practice size of 1200. This includes payments for indirect work (checking labs, reviewing reports, supervising staff – all the admin work that Ontario refuses to recognize) and increased payments for more complex patients. I congratulate my colleagues in Alberta on this accomplishment. It WILL stabilize not only family medicine, but their whole health care system.

In response OMA CEO Kimberly Moran sent out an email on Friday Dec 20th. (A complete guess on my part is that she saw some of the responses to this deal on Social Media). I personally was offended (but not surprised) by the manipulation of figures and data in her email. While it’s true that every thing she wrote in the email was technically correct, the manner in which it was presented created an impression of successes that just aren’t there when it comes to advocating for family physicians.

I hate to talk numbers, this stuff gets confusing. But here’s a short set of data you need to know (numbers rounded for simplicity).

• 2022/23 is the BASE YEAR for all future increases negotiated/arbitrated going forward
• The 2022/23 physicians budget was $16 billion
• For 2023/24 (the last year of the previous agreement) the OMA negotiated a 2.8% ($448 million) increase
• for 2024/25 the Arbitrator awarded us 9.95% compounded to the 2.8% from 2023/24 – which winds up being 13.03% more than the BASE YEAR ($2.08 Billion more than 2022/23)

So what’s the problem? Well for starters Ms. Moran states that the OMA “successfully” advocated for a 9.95% increase without mentioning that the OMA asked for 22.9%. Getting less than half of what you ask for is successful? But more importantly she went on to tell family physicians that they will receive a higher increase than the arbitration award of 9.95%. (11.75 – 13.54% depending on the practice model). But here’s the thing, the arbitration award was the increase for one year only (2024/25). The increase that family doctors are getting is an increase from the BASE YEAR (2022/23) – so it reflects your increase for two years not one like the arbitration award. The two year increase to the physicians budget is, as mentioned above 13.02%.

Now I completely respect the fact that the numbers that I’m quoting do not reflect the fact that the the award is meant to be split 70/30 between fee increases and targeted funds (but neither did Ms. Moran’s email!!). A very brief summary of how targeted funds are supposed to work:

• 70% of the $2.08 billion are supposed to go to fee increases ($1.456 billion)
• the other 30% is supposed to be targeted ( $624 million)
• of the $1.456 billion, 25% ($364 million) is supposed to go to across the board (ATB) increases for everybody. Crunching the numbers means everyone gets a 2.27% increase to their 2022/23 (BASE YEAR) income. The rest of the increase is based on relativity. Ophthalmologists for example get an additional 0.18% for relativity, and family doctors get between 9.48 – 11.27% additional for relativity. But again – that’s the increase for TWO YEARS, whereas the 9.95% was just for the one year.

This type of sophistry in messaging from the OMA regarding family medicine is sadly all too common. For example, the OMA has said that Ontario Family doctors have the highest capitation rates in Canada. Is that statement true? Of course it is. BUT – what’s also true is that no other province has deductions for outside use. Also, at a bare minimum family physicians in British Columbia, Saskatchewan, Alberta and Manitoba (with Manitoba being on top) pay family physicians more. Maybe Nova Scotia as well. Ignoring that while trumpeting higher overall capitation payments is unsettling.

While I sadly did expect such sleight of hand over numbers from OMA central, I must admit I was very disappointed in the SGFP email that came shortly thereafter. The SGFP has recently really gotten quite a bit stronger at advocating for family doctors and done some good work. But even they sadly fell into the trap when SGFP Chair Dave Barber told members in his letter:

“…Family doctors will receive increases greater than the 9.95% arbitration award announced earlier this year”.

Again, technically a true statement, but very inappropriate. I don’t know what he was thinking signing off on that.

The really sad thing is that it didn’t have to be this way. The OMA (and SGFP) could have been completely forthright and honest and simply laid out the facts as I did above. This still shows family doctors getting a relativity bump more than a lot of other specialties. And they could have said that they want a good chunk of the targeted funds to go to Family Medicine but the government continues to fight them. Finally, they could have blamed the government for not recognizing the seriousness of the crisis. All of that still would have talked about the positive work being done, without creating the impression that they were trying to hoodwink the members. But alas……

What can we done? Well, I’ve said it many times before. Only the members can change the OMA if they want to. This year in particular, four physician members are up for election for Board Director – which represents half of all the physician positions. There are also multiple candidates running for SGFP executive positions. This really represents the best opportunity in a long time to continue to change the culture at the OMA so that we don’t get disingenuous messaging like this.

I’ll have my thoughts on the election in an upcoming blog.