As I write this, yet another round of Arbitration has begun between the Ministry of Health (MOH) and the Ontario Medical Association (OMA). This time, the goal is to provide a contract for years 2-4 for the Physicians Services Agreement (PSA). As was pointed out to me on social media (thanks Jane and Lisa), year 2 of this current PSA cycle began on April 1, 2025. Yet again, physicians are going to be due retroactive pay for whatever the Arbitrator decides.
Lawyers from both sides have prepared rather thick legal documents called “briefs”. (Proof number 4,638 that lawyers have a rather weird sense of humour). These briefs are public.
I’d be lying if I said that I had thoroughly understood the briefs from both sides. The excruciating agony in trying to parse the language in these things would make having a kidney stone preferable. But these are my humble thoughts from trying to do so….
- The MOH team appears to have learned their lesson from last time.
To be abundantly clear right off the bat, the MOH offer for physicians is too low. They are clearly undervaluing doctors in their stance and if the Arbitrator was to accept their position, it would spell further disaster for health care in Ontario.
But….
As I mentioned in my last blog, offering low is what you expect from the other side. It’s part of posturing for the Arbitrator and I’m genuinely not ruffled by it. What would have been unacceptable is they had refused to recognize the severity of the health care crisis like they did last time. Or if they had once again repeated the truly stupid statement that they weren’t concerned about the shortage of comprehensive care family doctors.
Additionally, the MOH has actually agreed to enhance family medicine models through the “FHO+” program, and has agreed to spend a large chunk of the funds on family physicians, an area of the health care system that is dire need. In essence, they admit that there is a problem with a shortage of comprehensive care family doctors. (NB – I will have my thoughts on the FHO+ model sometime early next week).
To re-iterate, there are still a number of problematic issues with their arbitration proposals, including the too low wage increase, the hopelessly complex method of “accountability” in the FHO+ model, a laughable statement that attachment bonuses for Complex patients will begin on July 1, 2025 when the Arbitrator won’t even rule on this until September or October of this year.
But their position is at least not stupid, and certainly not enough to make me go off like last time.
2. The OMA Disappoints With Their Brief
Once again, to be fair, there is a lot to like in the OMA Brief. There is a good analysis of the economic picture in Ontario, a great analysis of the the delays in care, the crisis in family medicine, hard hitting information about the challenges of recruiting and retaining physicians, superb advocating to relieve the admin burden and a clear explanation of why many Alternate Payment Plans are outdated.
Alas, there is once again a “but” here…..
All of the above is what one should expect from a representative organization. One should however, also expect that organization to advocate strongly to make sure their members get their increases in a reasonable time. And it’s here that the OMA falls (badly) flat.
One of (if not THE biggest) issues for physicians these past couple of years has been the constant delays in getting the increases the Arbitrator awarded them in a timely manner. Just recently the MOH unilaterally announced a delay in paying the retroactive funds owed physicians. This is amongst a series of delays all attributed to an ancient and decrepit computer system at the government. (They’ve been making this statement for well over a decade, and very tellingly, have NEVER bothered to upgrade their system).
While the last 4 pages of the OMA Arbitration Brief does a nice job of outlining the issue for the Arbitrator, including the consequences of the MOH incompetence (physicians will simply stop doing certain procedures), the remedy the OMA seeks is milquetoast at best. From the Arbitration brief (edited):
“As a result, the OMA requests, as is normal and customary, that this Board of Arbitration remain seized with respect to any issues arising from the implementation of this Award……….“
“….with the OMA reserving its right to seek appropriate remedies (e.g. interest) in the event that the Ministry fails to meet agreed upon or directed implementation dates, particularly where the Ministry is unable to provide justification for any delay, or otherwise where the delay is unreasonable and unwarranted.”
That’s it?? All this means is that WHEN (not if – we all know the MOH can’t get their act together) the next payment delays show up, all that will happen is the OMA will complain to the Arbitrator, then there will be more hearings, and those hearings will go on for months/years and then finally, the Arbitrator MAY announce penalties to the MOH. The only good that will come out of this is that a bunch of lawyers will get rich going to repeated hearings.
What’s worse is the OMA readily admits they know the Arbitrator “favours accountability measures” in their video on the new FHO+ model (around the 3:36 mark). So doctors have to be accountable to follow an agreement, but the MOH can wiggle out and delay? The OMA can’t advocate for accountability to go both ways?
EVEN worse is that in reading the MOH briefs, they actually clearly lay out what accountability measures they want from physicians. Page 92 specifically outlines what accountability they expect from family physicians in the new FHO+ model, and how the penalties will be implemented if physicians don’t meet those accountabilities. No “seizing of the Arbitration Board” or any such thing. Now I disagree wholeheartedly with the MOH stance on this – but at least they clearly outlined what remedies they are seeking without the need for further drawn out processes. The OMA couldn’t have done the same thing??
Overall, this Arbitration hearing appears less contentious than last time, and the gap in asks is smaller overall. Hopefully this means a quicker resolution. But while there is a lot of good stuff in the OMA brief, it’s hard not feel let down by the subservient, almost nonchalant attitude the OMA is taking on payment delays. Sure looks like a golden opportunity to address this was missed.
justanoldcountrydoctor 