Last night I spoke to the physicians of the Montfort Hospital in Ottawa about the unilateral cuts that the Government of Ontario has made to physician services in Ontario. Resolute, solemn, confused: these were the expressions on their faces as I described the cuts to the Physician Services Budget, the budget for doctors’ fees that pays for all physicians’ services in Ontario.
At the end of the presentation, there were one or two questions – not more – and a few people spoke about the impact primary care reform has had for patients in the Ottawa region. To these doctors, it was incomprehensible that the government is dismantling the team-based care that both patients and doctors prefer.
I was shown the letters the government had sent to the hospital, notifying the physicians of reduced contracts with a “Take it or leave” message. These are terse letters in bureaucratese without even the common courtesy of thanks or a greeting.
One of the programs being cut is payments for on call coverage. If you have ever required care at night or on a weekend, the physician caring for you was “on call”, often working at the end of a full day in the office. At the very least, they are working at a time when others are usually at leisure, a sacrifice for them but also for their families. The amount of money a physician receives for being on call in Ontario is not excessive and to receive any funding for being on call is relatively new. I was first paid for being on call about eight years ago, having worked for almost 20 years not being paid. When I am on-call, I must be within one half hour of the hospital, available for phone calls, patient assessments and consultation at all hours. I was on call last Friday from 4 p.m. until 8 a.m. Saturday morning for which I will receive $100. I can also bill fee-for-service whenever I see a patient. For me, and for most physicians, that small stipend was recognition of the sacrifice that I and my family make because I provide the service of being on call. The lack of regard demonstrated in cutting back this funding is insulting, as are all of these cuts. The government is saying to physicians, “You do not deserve to earn what you do.”
This was the first time I have given this presentation and I was worried about facing angry questions and blame for what is happening. This was not the case. As I said at the outset, my colleagues were resolute, solemn and confused – sad and disappointed. They nodded when I asked that they do their best to continue to provide the best care possible, despite these cuts, and vigorously agreed that we must continue to be engaged in the improvement of patient care and the health care system. Their applause at the end of the presentation was heartfelt and several people shook my hand or hugged me and thanked me for everything the Ontario Medical Association is doing.
This is what the compassion and devotion of the medical profession looks like in the collective. These men and women know that taking care of patients in the best way possible is their job and they will do it, as best as they can, with whatever resources are available. Their response to the OMA Board’s rejection of the Government’s proposed contract, to my presentation – applause and thanks – is compelling. These doctors deserve the Government of Ontario to be as engaged with the health care system as they are.
Doctors have a tradition of working hard through the day and night. We can be repaid with a patient’s smile and a family’s appreciation. One of my young patients thanking me can make my day. My colleagues’ thanks and appreciative if solemn applause when I am bringing bad news is enough to make me work harder for the partnership with the government that they deserve – it’s not about money. The sooner the Government of Ontario understands this, the better.