Doctors Divided: The Battle Over Relative Physician Compensation in Ontario

After a major setback in the fall of 2018, Dr. David Jacobs, a radiologist and physician leader in Toronto, Ontario, Canada, was frustrated in his attempts to reform the Ontario Medical Association (OMA), the professional association which represented all physicians in the province. He must decide whether to keep trying to reform the OMA or to launch a new association, the Ontario Specialists Association (OSA), which would be devoted to addressing the minority interests of the province's high-billing specialists. After years of trying to make progress on the key issues for specialist physicians within the OMA, the minority specialist group felt poorly represented by the OMA and unfairly treated in contract negotiations for physician services with the province's Ministry of Health, the sole payer of insured physician services in Ontario. Jacobs must decide whether it was in the best interests of the high-billing specialists to continue being represented by the OMA - whose membership was dominated by primary care physicians with divergent interests from those of the specialists - or to establish the OSA to represent the unique interests of specialists in contract negotiations with the Ministry. The central issue dividing the minority specialists and the majority primary care physicians was a fair resolution to the issue of "relativity" - or relative physician compensation between areas of clinical practice. The minority high-billing specialists were facing another round of fee cuts in order to redirect money to the lower billing majority including primary care. Consequently, the high-billing specialists were contemplating leaving from the OMA - their representative that had sanctioned the proposed deal that benefited the majority at their expense.

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