VOLUME 36, NO. 15, April 18, 2000

Ontarians 'startlingly unaware' what GPs are paid

By Matt Borsellino

Once inflated view of earnings is corrected, most recommend pay increase

TORONTO - Ontarians are startlingly unaware of how much their GPs are paid, a survey commissioned by the Coalition of Family Physicians (COFP) has concluded.

The poll by Northstar Research Partners, which cost nearly $10,000, comes at a sensitive time as negotiators for the Ontario Medical Association and provincial health ministry are said to be closing in on a deal. Primary care reform has been at the centre of much of those talks.

Ontarians have a "very inflated view" of what family doctors are paid for specific services on an hourly basis and in terms of take-home income, the COFP survey found. When that impression is corrected, however, most would recommend an average 8% pay increase for the province's 10,000 or so GPs.

COFP president Dr. Sharla Lichtman said during an interview she doesn't know whether the survey will have any impact on negotiations at such a late stage.

"But this is the first step toward dispelling some of the myths about family physicians that are out there," she noted.

Ontarians believe family doctors need to be paid fairly, Dr. Lichtman added, and the COFP was interested in finding out how they really feel about GPs.

"How can we start a useful dialogue if they aren't very well informed? It's clear we need to start making more information available to the public," she said.

According to the survey, 84% of Ontarians believe their family doctor is overpaid or fairly paid.

Patients over-estimated the rate for an intermediate assessment, one of the Ontario Health Insurance Plan's most billed codes, by 300%. They over-estimated payment for general assessments by 200%.

They thought money paid on an hourly basis was double what it really is. And 63% said GPs are paid an average of $69 to refer patients to specialists, review and copy charts and test results, and ensure everyone involved gets those documents. Family doctors are actually paid nothing for such work.

"Given the public's inflated view of what family physicians actually are remunerated, perhaps it isn't surprising that Ontarians feel their family physicians are paid fairly," survey officials concluded in their key findings.

The impression of fairness, though, changed significantly when survey participants were told that fees have increased 3.25% since 1992, while inflation ran 10.5% over that span. Participants then suggested an average raise of 7.9% would be a fair increase.

Further, there's strong agreement that unless GPs are treated fairly in any upcoming wage deal, a number will either leave the province or the profession altogether, exacerbating current shortages now reported by nearly three dozen communities in both rural and urban areas of the province.

In fact, the survey found a co-relation between those who view their GP favorably and those who view the provincial health-care system the same way.

Some of the survey's other findings:

Dr. Lichtman cautioned the last point can be interpreted a number of ways. Identifying their GP is not always the same as being able to access one, she said.

"I have patients who come to my office (in Thornhill north of Toronto) from Barrie and Windsor because they can't find a family doctor where they live," she noted.

The COFP has also begun publishing a series of letters from grassroots doctors across the province believing "it's time the government, OMA and public understand how front line providers . . . view the impending and dangerous changes being proposed."

Most GPs in Ontario aren't interested in capitation, rostering and contracts, "not even a little bit," states a letter, from Dr. Stephen Blanchard of Picton. (Surveys done by the Canada Health Monitor in 1995 and 1997, however, show that more than 80% of Canadians support the concept of patients registering with a family doctor.)

"I resent the implication that family physicians are partially responsible for the current health-care/emergency crisis," he wrote. "I also resent the idea that the 'solution' is to force us into the proposed primary care reform set-up when the real cause of the problem is poor family physician supply largely due to government cutbacks and general underfunding of the system and of primary care in particular."

The short supply of GPs gives them "significant bargaining power" in Dr. Blanchard's opinion.

"However, it appears organizations that are supposed to represent us seem not to realize this since they appear so willing to actively go along with government's vision of our future. If we, the family doctors in the trenches, don't like what the government and OMA have planned for us, we need to take time from our hectic schedules to urgently notify the OMA of our opinions."