1. Presentation to New York State Academy of Family Physicians Scott Wooder, MD Chair OMA Negotiations Committee January 31, 2009

2. Overview Ontario Medical Association Scope of Negotiations Negotiations Process 2008 Negotiations Factors necessary for successful negotiation

3. Health Expenditures in Ontario Total 2007/08 Ontario Provincial Budget: $95.96 billion Total 2007/08 Provincial Expenditure on Health: $42.32 billion (44.1%) Total 2007/08 Provincial Expenditure on Physicians: $9.52 billion (9.92%) 2007/08 Ontario GDP: $582.02 billion

4. Ontario Medical Association Established at an inaugural meeting on June 1, 1881. 34,000 members: Practicing physicians, residents, and students Governed by an elected Council composed of 250 delegates who represent geographical and specialty divisions Between meetings of Council, the Board of Directors represents the OMA’s governing body and members in all business affairs, and exercises the rights and powers of the Association. Contractually established right and duty to negotiate physician compensation for all direct and indirect payments from government Membership is voluntary Dues are mandatory ($1730)  Enshrined in legislation

5. Ontario Medical Association The OMA negotiates  The Schedule of Benefits  All Alternate Payment Programs  Academic Health Science Contracts  Hospital on Call Stipend  All Sessional payments  Primary Care Models including capitation rates and bonuses  IT grants  Workman Compensation Rates*  Payments from other Ministries  Payment for forms*  Salaries for clinical work

6. Negotiations 2008

7. Negotiations Cycle Negotiations is a continuous cycle 1.Internal consultation 2.Mandate development 3.Bilateral negotiations 4.Ratification 5.Implementation Repeat

8. Consultation Process Council Workshops  Spring 2006: Introduction to the negotiations process  Winter 2006: Priority Setting  April 2007: Plan B Physician Leader Consultations October 2007: Master List of Broad Negotiating Issues Negotiations Survey – Fall 2007 (3800 responses) Negotiations Committee members at various meetings Negotiations Committee met with over 35 Sections

9. Negotiations OMA Negotiations Committee elected July 2007  5 physicians, all in full time practice  Chair, 2 GPs, 2 Specialists and outside Negotiations Advisor OMA Board approved Negotiations Mandate December 2007 Bilateral Negotiations began February 14, 2008 Monthly meetings and updates for the OMA Board and Executive 45 bilateral meetings February 2008 to July 2008; 5 meetings held in September 2008 Each committee member spent over 100 days on this set of negotiations

10. Negotiations September 11, 2008 Board meeting - unanimous endorsement September 27-28, 2008 Physician Leader Meeting President and Negotiations Chair went on the road to explain agreement Visited over 20 communities in a 3 week period October 8-15 2008 Member Referendum: 34% turnout with 79% support October 18, 2008 Special Council meeting: Voted to accept

11. Agreement Highlights

12. Highlights Total Contract Value $1.1 billion Programs $240 million Fees 12.25% 3% October 2008 2% October 2009 3% October 2010 4.25% September 2011 April 1, 2008 to March 31, 2012

13. Highlights: Programs Primary Care Programs Interprofessional Shared Care: Nurses Chronic Disease Management: Diabetes Unattached Patients: Bonus and Registry Bonuses: In Office Services; Out of Office Services; After Hours Care; Out of Office Care Other Hospital Care Programs Most Responsible Physician (MRP) Hospital On Call Programs Other Programs LHIN Physician Collaboration Incentive Fund Northern and Rural Programs

14. Relativity Our Focus in 2008 was to address wide disparity in income between specialties Our policy is to move specialists to a common net hourly rate Family doctors target is to earn 80% of specialist’s net hourly rate In 2003 Family doctors earned about 58% of specialist average In 2008 Family doctors earn about 76% of specialist average Many Family doctors involved in a comprehensive care model of care do much better than 80% of specialist average

15. Negotiations-Essential Factors Internal Political harmony  Discipline Respectful relationship with Payor  Work to achieve a set of common goals  Leverage  BATNA Commit to Deliver on Agreement  Letter of agreement  Spirit of agreement  New issues Trust