February 18, 2000 The Toronto Sun

Militant MDs resist controls

By CHRISTINA BLIZZARD
Queen's Park Bureau

It's become a mantra when it comes to solving our health care woes. An ambulance is redirected? We need primary care reform. A hostage-taking in the ER? We need primary care reform. Health care costs are spiralling out of control? Send in Superman - and primary care reform.

Both the Ontario Medical Association (OMA) and the government tell us it is the panacea, a cure-all, for what ails the health care system. And it sounds very seductive. After all, the plan put forward by the OMA, and warmly received by the government, will eventually require doctors to form group practices providing round-the-clock health services to patients who sign on with one family doctor. (Right now, this is at the pilot project stage.)

There is, however, one big problem which the government appears to have overlooked: thousands of family doctors aren't about to go along with it.

Dr. Sharla Lichtman is a spokesman for the Coalition of Family Physicians, a group that represents more than 3,000 doctors - about a third of all the general practitioners in the province. She says the government is unfairly "downloading" responsibility for the crisis in health care onto doctors.

ERs aren't overcrowded because doctors' offices are closed, she says. It's a result of hospitals and ERs that have been closed or merged plus a shortage of nurses.

"The emergency room crisis exists because the government has closed hospitals and reduced the number of hospital beds for very sick patients. These patients remain trapped in emergency beds. In addition, there are insufficient nurses to care for patients, because many have left our province due to government cutbacks," says the Thornhill doctor.

She points out it was the government that removed financial incentives for family physicians to provide after-hours office care and house calls. As well, the government removed a premium for family physicians who chose to have their offices open on weekends, and limited the percentage of house calls family physicians could do before receiving a discounted fee.

NO EXTRA PAY FOR EXTRA WORK

After all, if doctors are expected to be on call 24 hours a day, seven days a week, will the government pay them extra for after-hours work? What incentive do doctors have to work those hours?

Even some specialists are alarmed at the deterioration of the health care system and feel doctors are being scape-goated for cost overruns in the system.

"A lot of docs feel they're in a straitjacket," says Dr. Patrick Hewlett, a gynaecologist, and a spokesman for another splinter group, the Ontario Physicians Alliance.

"The system is in chaos and now they want to take over the family doctor," Hewlett says, pointing out that the government is moving to put even greater controls on how doctors practise.

"We think this is pre-Gorbachev thinking which is going to cause even more chaos in the system," he says. "Doctors should have the right to choose whether they are independent, solo practitioners or in big government partnerships."

Under the proposed system of rostering, Hewlett points out that if patient goes to see another doctor, the first doctor is penalized financially. He fears the government/OMA plan will "create vastly more problems than it solves."

The OPA, which represents 620 doctors, is committed to creating a parallel "non-government health care system, as exists in every other western democracy," according to a recently released statement.

"Without a parallel, private health care system, no government monopoly system is able to deliver a full range of top quality health care services.

"The OPA believes that no agreement with the Ontario government is possible unless the government commits itself to the establishment of a private, parallel system with a publicly funded health care system which must be accessible to all." One of the biggest flaws in the OMA-government negotiations, Hewlett says, is that the province's 24,000 doctors have no choice in who represents them at the bargaining table. By law, they must pay annual dues to the OMA and by law they must be represented by that organization in bargaining.

There's no doubt that in some rural areas, where services are scarce, group practices may work very well. But it's clear that if the government and the OMA are serious about foisting primary care reform on unwilling hosts - i.e., the doctors of this province - they will find themselves facing some serious consequences in short order.