A letter to residents…

Dear fellow residents,

I know that we’ve been bombarded with emails about the Tentative Physician Services Agreement (TPSA). Many of us are likely well informed, as information and discussion has been all over social media. Others wonder why they should care as the TPSA covers a term when many won’t be in practice yet. Many wonder why they should even seek more information when the OMA fully endorses the TPSA.

However, there are three things to know about the deal that the I feel are critical to making an informed vote.

Promise of stability? All I see are Cuts!

The deal legitimizes all of the unilateral cuts the government made to our profession in 2015 and then doubles down on this with a hard cap on the physician services budget (PSB). This hard cap will start with slashing $200 million worth of fee codes from the current budget – to be decided later in an unspecified way which is impossible to predict. The deal does some handwaving with its figures, but overall over the next 4 years, the allowable increase in the PSB is 3.1% per year – less than the increases in 2 of the last 4 years according to OMA Economics. Last year alone, despite 7% across-the-board cuts, physician services grew by 3.3%. Any cost overruns will trigger additional cuts. We will be responsible for funding the increased health care use that coming our way with an aging population! This places us in a direct conflict of interest: caring for our patients or keeping to the government’s budget. This in my opinion is a serious issue and sets a dangerous precedent.

8 years of straight cuts will leave many of our colleagues unable to purchase new equipment and forced to cut costs by laying off staff – including nurses and support staff who themselves work hard on our patient’s behalf.

This agreement also sets the baseline for future negotiations – for contracts that we will depend on when we become staff physicians!

Worrying lack of detail

This deal is only 6 pages long. It sacrifices detail and relies upon future good-faith negotiations between the OMA and the MOH. The same MOH that is being sued by the OMA for violating the Charter of Rights and Freedoms. The same OMA that was successfully litigated by the Ontario Association of Radiologists over the faulty proxy vote form that, in the judge’s opinion, “is all of unhelpful, unclear, unbalanced, and unfair. It is a catalyst for a governance meltdown at the upcoming general meeting“. Current actions by these two parties appear self-serving. This gives me pause about their ability to co-manage the budget to find solutions to improve the healthcare system.

The final and arguably the most critical point for us as residents lies in the answer to this question:

How is this going to affect my job prospects?

I am wary about the long-term impacts of this contract will have. At a health policy level, public statements by individuals with insider knowledge have revealed OMA discussions on reducing new physician influx from 950 to 750 per year. These statements have been substantiated by firsthand accounts of OMA roadshow meetings relating to the “unsustainable growth” of the net 950 new physicians per year. A letter obtained by PARO from the MOH states that no discrimination will occur towards new physicians. However, it is deeply concerning that PARO had to seek these assurances in the first place. Additionally, we will be only one member at a table with multiple other stakeholders. If the political climate changes, it is unclear how much protection that letter will offer residents.

I am a surgical resident. I have seen firsthand the decrease in surgical volumes due to cuts to OR times. Between the eroding OR times at an institutional level, and the anticipated and promised cuts in the TPSA, there is no reason for current surgeon practice groups to hire new graduates. This will compromise our job prospects, and is a secondary fallout from the underfunding created by the TPSA.

For my Family Medicine resident colleagues, the TPSA restores managed entry positions. However, this promise rings hollow. Patient rostering fees and income stabilization are not reinstated, meaning that new FHO practices will likely lose money in their first 1-2 years. This will have dramatic economic implications for new family doctors. Worse, it is a huge barrier for those who do not have additional financial support from a spouse or family. Finally, the New Graduate Entry Program remains; this fatally flawed program should be fought tooth and nail by the OMA.

Regardless of how you vote, learn both sides of the debate. As for me, I will vote No.


Victor McPherson, MD, MSc
PGY5 Urology, Western University

About Vote No

Coalition of Ontario Doctors
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