Frank Klees

Frankly Speaking


"Sadly, I believe we are witnessing the darkest days for healthcare in Ontario. Thousands of patients in Newmarket and Aurora need your help now."

This quote is from a letter received in my office on May 8, 2012 from Dr. Asif Salyani. I read many emails and letters every day, but this one was particularly disturbing. Here's why.....

The letter was written by a highly respected medical professional in our community. Dr. Salyani is a retinal specialist who treats patients who are at high risk of blindness from diseases such as macular degeneration and diabetes. He described how the diagnostic and treatment advances in ophthalmology have made early diagnosis and management of sight and life threatening conditions possible. But according to Dr. Salyani, those treatments are now at risk, and among those who will be most seriously impacted are seniors.

The McGuinty Government's budget plans for your Doctor and you........

So what's the issue, and how did we end up here ? In an attempt to make up for years of reckless spending, the McGuinty government is now desperate to find a way to work its way out of a fiscal mess. The $48 billion health budget is in its sights, and the $11 billion it pays to doctors as part of that, is in the cross hairs.

There are more than 25,000 doctors in Ontario. About 95 percent of doctors bill OHIP for each service performed on what is known as a fee-for-service billing system. This represents about

$8 billion out of the $11 billion paid to doctors. $1.9 billion is paid to doctors through what is known as "primary care group payments" which now includes more than two-thirds of family doctors who practice in one of 14 different primary care models and an additional $1billion is paid through "alternative payment programs". These consist of about 250 agreements with 6,500 physicians who receive payments through a number of arrangements depending on their specialty of practice.

The "schedule of benefits" for fee for service payments, contains more than 8,000 different fee codes that range from office visits to trauma care. Any changes to this fee schedule have always been negotiated between the province and the Ontario Medical Association. This time however, Health Minister Deb Mathews short-circuited the negotiations and unilaterally announced cuts of $338 million to the fee schedule. In the wake of that arbitrary move by the government, doctors are just coming to grips with what the impact will be on their patients and on their practices.

Unintended consequences or arrogant mismanagement ?

According to Dr. Salyani, those arbitrary reductions in fees to ophthalmology alone, will mean that he won't be able to cover even the most basic costs of the equipment that now allows for early diagnosis and appropriate treatment of patients. He points out that the fee for the Optical Coherence Tomography test is being reduced by 60 percent. Apart from the substantial investment in the equipment itself, Dr. Salyani points out, "As one of the few providers of such care in the region, I am gravely concerned about the inevitable; that patient access to care will suffer, wait lists will increase and many patients will permanently lose their sight as a result ".

While Dr. Salyani addresses the impact of the government's decision on ophthalmology, this is not the only area of medicine that will be affected by the government's unilateral decision to cut fees. All of medicine, including cardiac care, radiology, anesthesia services and family medicine will be impacted.

We all know that our province is in dire financial straits and that we have to reign in spending. We also know that health care is the largest and fastest growing area of the provincial budget. All the more reason to ensure that our investments in healthcare are both prudent and strategic. At the very least, the minister should be engaging the medical profession in discussions about how efficiencies can be achieved without compromising patient care.


I don't pretend to have the answers to this complex issue, but I have always found that the most direct way to a solution, is to listen to the people who will be most directly affected by the outcome and who have the experience and expertise to find a solution. That's why I will be hosting a Public Information Meeting for the purpose of hearing from medical practitioners in our community about how the McGuinty government's plans will affect them and their patients. I will be inviting doctors from the various specialty groups, including family practices to share their specific concerns and also to present their views on how this issue can be resolved. The public will also have an opportunity to ask questions about how they will be affected.

The Public Information Meeting will take place on May 31st at 7 p.m. at the Roxborough Retirement Residence, 1 Roxborough Rd., in Newmarket. As seating will be limited, I ask that anyone planning to attend confirm attendance with my office in advance.