The Ontario government is preparing to unilaterally cut doctors' fees on a range of services as its woes on the labour front escalate.
The government's talks with the province's doctors stalled on Tuesday after it rejected the Ontario Medical Association's offer to continue negotiating with the help of a conciliator. On Monday, the province's high-school teachers followed their elementary counterparts and abandoned collective bargaining talks with the province.
The standoff with the province's doctors and teachers leaves the McGuinty government facing its first showdown with labour. Both the OMA and teachers' unions accuse the government of a hardball approach to collective bargaining. OMA president Stewart Kennedy said at a hastily arranged news conference on Tuesday that his group is exploring its legal options. The OMA is not a union, so it cannot follow labour leaders representing teachers, and launch a challenge before the Ontario Labour Relations Board.
Dr. Kennedy said the government plans to introduce regulations over the next few days that would eliminate the monthly, $2.50 comprehensive care management fee family doctors receive for each patient, which would produce annual savings of $300-million. The government is also planning to reduce fees for removing cataracts and reading X-rays and ultrasounds, which have not fallen in lockstep with improvements in technology that allow doctors to perform these procedures faster.
Health Minister Deb Matthews said at a separate news conference that she wants doctors to work with the government to find places where the province is spending money that do not improve patient care.
"We will try to find a negotiated settlement," Ms. Matthews said. "But if we can't reach an agreement, yes, we will have to act unilaterally."
Talks with the OMA broke off just hours after the minority Liberal government survived its first budget vote with the help of New Democratic Party Leader Andrea Horwath. The province dodged a snap election after the NDP's 17 caucus members abstained from voting on the budget motion, allowing it to pass. As a result of the 52-37 vote, the budget bill now moves through the legislature for debate.
"It is frustrating that the government will negotiate a deal to avoid an election," Dr. Kennedy said. "But they aren't willing to negotiate a reasonable agreement with Ontario's doctors about the future of our health-care system."
The budget bill freezes funding for the services doctors provide at $11-billion, the same as in last year's budget. Dr. Kennedy said the province's 25,000 doctors have agreed to the government's demand to freeze their fees for two years. But he is calling on the government to provide $700-million in new funding for another 80,000 seniors who will require care this year as well as 700 new doctors who will begin practising. The OMA contract expired on March 31.
If the government caps overall funding at $11-billion, Dr. Kennedy said, each doctor's pay will actually decrease by almost 16 per cent over four years.
Ms. Matthews countered that the government is choosing to spend its scarce health-care dollars where they are most needed – caring for patients in their own home.
"If I have to choose between home care and paying doctors more, I will choose home care every time," she said.
The province can get better value for the $11-billion it spends, she said, by no longer paying for services that do not improve patient care and by reducing other fees. The savings can be redirected to providing more services for an aging population and paying fees to new doctors.
Ms. Matthews said the government is working on the regulations – which the government can adopt without legislative approval – in the event it does not reach an agreement with the OMA.
"But my goal is to find common ground," she said.
With a report from Caroline Alphonso
Karen Howlett