Are you feeling uncertain and uneasy about your professional future

Lately, a number of troubling events have taken place that should be of serious concern to Ontario's physicians:

• The Harmonized Sales Tax (HST) in Ontario, which will have to be absorbed by physicians without any tax credit, thus further eroding our incomes with no offsetting benefits. The government, after all, must somehow pay for its irresponsible eHealth spending, and is therefore unilaterally postponing our fee increase while increasing our practice costs.

• The desperate selling off by government of family practice - piece by piece - to far less qualified non-medical practitioners in the upcoming Bill 179;

• The eHealth fiasco, which evaporated one billion dollars - or nearly one-third of the total family physician payment budget - from the healthcare coffers, giving us no prospect for a universal EMR system in the foreseeable future.

This is just a short list of recent developments, which threaten our futures. Others could be added as well. It is no wonder that many Ontario physicians are becoming increasingly concerned. We, the Coalition of Family Physicians of Ontario (COFP), are also concerned. We are frankly puzzled by the lack of effective representation of our interests by the Ontario Medical Association (OMA) that has allowed the above to take place, to the detriment of both physicians and our patients. We believe that effective and fair representation of all physicians is the key to achieving real solutions that are required in our healthcare system now and in the future.

The government agendas imposed on the OMA have resulted in pitting some groups of physicians against others. This has created deep divisions among physicians practicing in different payment models in Family Medicine, as well as in other specialities divided along the lines of academic versus community practice, such as Pediatrics, Psychiatry, Neurology, and Rheumatology, to mention just a few.

The Ontario Medical Association has attempted for many years to address such divisive inter- and intra-sectional disparities, and this process continues today without any equitable resolution. Whether this can ever be achieved under the current representative structure is doubtful. It is as if the OMA is playing into the government's agenda of divide-and-conquer, while the interests of many dues-paying members are being ignored or sacrificed.

The most recent delay in the scheduled fee increase of 3% is a good example. The government claims that the delay is due to administrative problems, but this is hard to believe. After all, they have had over a year to prepare to administer the increase. Surely the $24.7 billion deficit in Ontario is the more likely culprit here, as is the $1 billion eHealth fiasco, the results of government mismanagement, poor economic conditions and the governement's insistence that it must remain the sole payer for most medical services. This latter policy appears to be increasingly abandoned under the radar in most other provinces, because it is simply unrealistic and unsustainable. Yet in Ontario it it zealously enforced, with physicians bearing much of the burden. The Harmonized Sales Tax will only add to this burden for all physicians, and may well prove disastrous for some.

The expansion of scopes of practice of other health providers through Bill 179 is moving forward at full speed. Government is eager to provide additional freedoms and rights to other providers, while it continues to limit the rights and freedoms of physicians. Many of these non-medical providers do not depend on government funding for their livelihoods. For most physicians, this is not an option. It's therefore no surprise that the government is eager to enable such providers, since it does not need to pay for their services directly. So the government benefits, while non-medical providers benefit as well. But does the patient benefit? The COFP believes that this approach is a shortsighted and dangerous solution that is ultimately in nobody's interests. Unfortunately, this initiative has met only token opposition and little well organized public dissent on the part of the OMA, which surely has the resources to do more.

The Harmonized Sales Tax (HST) is perhaps the most important and unfortunately overlooked problem. It will hit many physicians hard while others may not be affected as severely. The HST is presented as an innovation in taxation by government that will be good for small business. However, it will only hurt physicians, since we cannot reclaim or pass on the increased costs to anyone, while at the same time we are prevented by government law from innovating in ways that are 'outside the box'. Attempts by physicians to offset this looming cash grab will be severely limited by current legislation in Bill 8 – Commitment to the Future of Medicare Act, 2004, as well as the OMA Dues Act, which keeps doctors under tight government control and stymies innovation. These pieces of legislation also prevent any effective dissent on the part of the Ontario Medical Association. Remember that the OMA is appointed by the government to represent us, and is also assured by the government of its fiscal viability by collection of our obligatory dues. This hardly amounts to effective representation of our interests and cannot serve us well. The imposition of the HST on physician practices effectively wipes out any gains in our fees that we may have recently achieved through earnest negotiation, and will likely set us back much further. Yet we have heard surprisingly little from the OMA on this insidious development. The HST, as it applies to physicians, must be reversed before it makes many of our practices economically non-viable.

Government may indeed be limited in its ability to pay physicians in a fair and timely way due to new financial constraints, some of which are of their own making. But simply generating new and punitive taxation masures such as the HST is not the solution. Neither is allowing non-medical practitioners to provide complex medical care, the welfare of patients be damned. Neither is the single-minded pursuit of legislated one-tier medicine in Ontario, a system that no province in Canada can fully afford, and which most of the others have de facto abandoned. There are indeed many good reasons why we, Ontario's physicians, are increasingly uneasy and uncertain about our future, while lacking effective representation to change things. The COFP understands this and wishes to empower physicians to take control over their professional lives. This is why we ask for your support.

Douglas Mark MD, President
and the Board of the Coalition of Family Physicians of Ontario

For more than a decade, the Coalition of Family Physicians has successfully represented Ontario physicians on many fronts, such as the draconian audits conducted by the Medical Review Committee not so long ago. We are an independent organization, chosen by you rather than being imposed on doctors by government. We rely on voluntary financial support rather than obligatory dues. This means that we are not saddled by obligations to support the government agenda of health care transformation. Needless to say, only physician representation that is not tied to government funding or its vision of health care has the potential to provide meaningful solutions to healthcare delivery in the difficult economic times ahead. We hope that you will support us in this, since it ultimately affects us all, both as physicians and as Ontarians

Douglas Mark MD, President
and the Board of the Coalition of Family Physicians of Ontario

P.S. Since our financial status is assured not by government but by your voluntary support, please consider joining the COFP and supporting our efforts to ensure a brighter future for Ontario's physicians and our patients. We can't do it without you!

THE COALITION OF FAMILY PHYSICIANS OF ONTARIO

45 Sheppard Ave E, Suite 900, Toronto, Ontario, M2N 5W9

Tel.: (416) 412-1474 Toll Free Tel.: 1-866-495-4346 Fax: (416) 412-7297 Toll Free Fax:1-866-495-4349

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