OMA President Dr. Mike Toth provided an update on the state of health care in Northern Ontario, and the impacts of the Wynne government's cut to medical services, during a keynote address at the recent Association of Municipalities of Ontario Conference in Niagara Falls.
Along with Dr. Virginia Walley, the OMA met with 23 municipalities to discuss the state of medical care in their communities and to address local concerns.
Remarks by OMA President Dr. Mike Toth , AMO Northern Districts, Monday, August 17, 2015
Thank you for your introduction. I am delighted to be here. As you can see from the video, doctors like Doris Mitchell are providing exceptional care in our northern communities.
I want to talk about health care in this province, and specifically the state of health care in the North. I know this is a subject that is important to all of us in this room, and also to your communities and your constituents. But unfortunately, I am not here to bring good news—I am actually here to tell you about what I believe the future has in store.
Specifically, I want to talk about cuts to medical care, and the effect this will have on everyone in this province—you as leaders in the community, physicians and most importantly Ontarians.
Before I do that, I want to take a moment to tell you something about myself and the people I represent.
I have the honour of being the 134th President of the Ontario Medical Association, or OMA.
The OMA represents more than 34,000 doctors, doctors in training and medical students across the province.
We are the people your constituents turn to when they need medical care.
Every day in Ontario, our doctors diagnose, treat and care for about 320,000 patients.
Every year in Ontario, there are 59 million patient visits to family physicians.
There are 57 million patient visits to specialists.
And there are 5.9 million visits to emergency rooms.
My point? Ontario doctors deliver a great deal of care to a great many people. And we love what we do.
I am a family doctor myself. I practice in Aylmer, in the County of Elgin. That's a couple of hours west of here.
I have been a doctor for some 29 years.
I have looked after generations of families in my community—everything from treating infections to delivering very difficult news.
So I am here today as a doctor and a citizen of a rural community.
I know firsthand about the relationship between doctors and small communities including the challenges communities have in attracting and retaining physicians. I suspect that's something many of you know about as well.
I think we all know that despite some very significant improvements that have been made to health care in Ontario this past decade, there are still too many places in Ontario where it is much, much too hard to find a doctor – particularly in the north, where a trip to the doctor’s office is not always just a short drive down the street.
Here’s the reality:
There are still some 800,000 people in Ontario without a family doctor.
72,000 of them live in the North. That means roughly one person out of every eight in Northern Ontario does not have a family physician.
That's a big concern. For you. For me. And we would all hope for Premier Wynne and for Minister Hoskins.
But the truth is, however concerned they may be, their recent actions are making the situation worse, much worse, not better.
I suspect you all know about the government's strategy with respect to primary care teams in Ontario, and the restrictions on these teams when it comes to recruiting new doctors.
For those of you who don't know, the government has produced a list, by postal code, of areas that they consider "high needs" in terms of access to physicians. If you are not considered high need, you don't get to recruit new family doctors into Family Health Organizations and Family Health Networks.
Now, I am speaking to a room full of people from Northern Ontario, which is pretty much all classified as high need. So why would you care? Why wouldn't you say, "Great! More doctors for our high need communities"?
Because the government has now also decided that the total number of physicians allowed to enter into FHOs and FHNs should now be reduced to 20 per month down from 40, for the entire province.
Total. Across the province. 20 new doctors allowed. There are over 200 communities on the government’s list of areas of high physician need.
Which means that a place like Kenora is competing with parts of Ottawa – for what is now a dramatically reduced number of eligible doctors. Timmins will compete with parts of Toronto. Kapuskasing will compete with Sudbury.
It’s worth mentioning, that there are approximately 500 newly qualified family practitioners graduating from training programs this year who will be competing for those 20 spots per month.
In effect, the chances of high need northern districts being able to recruit new physicians have just been cut in half. The North has a hard enough time recruiting family doctors – these cuts will only make it harder. And that is the last thing your part of the province needs.
It isn't practical. It’s counterintuitive and turns the clock back. It is effectively a betrayal of 10 years of hard work by health care professionals and the government, building and developing this acclaimed team model of care in order to improve access for patients.
10 years building it – and now they're moving backwards.
Reducing entries to group-based models of practice is just one of the actions this government is unilaterally taking.
Another action is cutting Continuing Medical Education funding or CME. CME is a requirement for physicians and many other health professionals. The issue here is that it is much easier for a doctor in, say, Toronto to do their CME given that most courses take place in urban areas. Northern doctors must travel to take these courses at their own expense.
This cut has a significant impact on Northern Ontario physicians as CME was used as a significant recruitment and retention tool for northern and rural physicians. That is no longer the case.
Removing these incentives to work in rural and remote areas makes physician recruitment harder for every community represented in this room today.
Another government action is the limit placed on medical care they will pay for annually. Once that limit is reached, physicians will have to pay. That’s despite the fact the province grows by 140,000 people each year—that’s the size of Prince Edward Island and more than Thunder Bay. So when the growth in medical care reaches that cap, physicians take over the cost.
Think about that. The government is telling Ontarians that if they use too many health care services, doctors have to pay for it.
Not only does this run completely contrary to the spirit of universal health care, it is also set up to be as impractical and unworkable as possible.
The message will come sometime during the year to doctors: "Guess what? You treated too many people, so now you owe us this much money!"
Look. Doctors see the patients who come to their offices. We provide care based on our patients' needs. We aren’t going to say no to delivering care. The population is aging and growing and new OHIP services are added to the budget. But shouldn’t the government be paying for this?
Can you imagine running your communities that way? Maybe telling folks in your town that they have done too much work so they have to give back some of their pay.
You'd never do that, because, pardon the pun, that's no way to operate.
These are just some of the things the government is doing that effectively put financial issues ahead of patient care. And at what cost?
Health care in Ontario doesn't need cuts. It needs investment.
The math isn’t complicated.
The Ministry of Health's own numbers suggest that demand for medical care will grow by at least 2.7 percent per year due to a growing and aging population.
The government's response? Fund only 1.25 percent.
It won't work.
It's all very well for Finance Minister Sousa to boast publicly about the fact that Ontario has the lowest program spending per capita for health among all provinces.
What he doesn't boast about is the fact that Ontario also has the lowest number of family doctors per 100,000 people in Canada, and fewer hospital beds per 1,000 people than any other province.
Not to mention the second lowest number of registered nurses per 100,000 people in Canada.
You may have heard just last week, that the government has begun to undertake plans to cut 50 Ontario residency positions over the next two years. Training fewer physicians will only make the situation worse.
This, if I might put it bluntly, is what you get when you put the budget before care.
It's what you get when you are so focused on the road you're driving on that you fail to realize that you're going the wrong way.
And that is what has happened to the government.
They are so focused on cutting costs that they haven't noticed – or are afraid to admit – that they have made an ill-fated 180 degree turn, and are taking us back to the bad old days when millions of people couldn't find a doctor, had wait times longer than we have now, Emergency Departments were being closed and nurses and physicians were talking with their feet and leaving the province in droves. In fact, BC has asked to advertise in an OMA Journal saying if you are sick of the way things are in Ontario come our way.
Let me be clear. I know that the Premier and the Minister Hoskins, and this entire government, have a hard job right now.
They have a responsibility to oversee, and try to balance, the provincial budget. And it's a tough slog.
I know this.
Ontario doctors know this. And we want to help.
But we can’t ignore the healthcare of Ontarians to balance this government’s fiscal mess.
And it really does seem as if health care is being ignored, or at least badly short-changed, in order to reduce the deficit.
Make no mistake; Ontario doctors want to be part of the solution. In fact, the 2012 physician agreement saw physicians cut their fees and bring $850 million in savings to the system.
This round Ontario doctors understood that the government is facing serious economic challenges and that is why we offered to freeze fees but asked the government to take responsibility for paying for natural growth of this province.
They said NO.
The offer to freeze fees, combined with the five percent cut three years ago is a pretty good demonstration of our willingness to share the pain.
That's more than 8 percent in cuts in the last 8 years. At a certain point you have to ask, how fair is it to try to balance your budget on the backs of health care providers?
The freeze on fees has to be accompanied by a commitment to fund growth. Because if the government doesn't do that, it is patients who are going to be left behind.
Patients in North Bay. In French River. In Peterborough. Here in Niagara Falls.
North, south, east and west, if the government doesn't acknowledge that our population is growing, is getting older, and is going to need more medical care...
... then Ontarians aren't going to get the care they need.
In a country that prides itself on its publicly-funded universal health care system, that is unacceptable.
In a province where the government's own plan for health care is called "Patients First", that is ridiculous.
So today, I am asking for your help.
We want to get back to the negotiating table with the government and get a reasonable deal, so we can help them continue with a positive transformation of health care in communities like yours.
We want to work with the government to help them continue to transform our health care system, to continue the work we have done together over the past decade. In order to do this, we need to have the government as a partner. We need to be able to work together. We need an agreement with this government that works for patients, as well as physicians.
But in order for that to happen, we need them to really put patients first. Ahead of budgets. Ahead of politics.
This is an important message we need to deliver to your provincial and federal counterparts. Putting patients first is a message that needs to be part of the conversation in the upcoming by-election in Simcoe North. It needs to be part of the conversation in the federal election on October 19.
So I'm asking your municipalities to do what other communities such as Hamilton and the County of Hastings have done – what the Eastern Ontario Wardens' Caucus did last month – which was to come out publicly in supporting health care, and against government cuts to patient care.
Ask your municipalities to pass a motion to this effect – tell your communities that these cuts will affect them.
I can't guarantee it will work, but I can guarantee you'll be heard. And the government will know that its high need areas in the north don't feel as if their high needs are being met.
And patients will know that the people who represent them, and the doctors who care for them, are putting patients first.
I would like to leave you today with another story similar to that of Dr. Doris Mitchell who is putting patients first in her community in Chapleau. This particular story highlights mental health, an issue that is particularly across the province.
Thank you and I look forward to chatting with you over lunch.