CMPA fees
CMAJ 1997;156:1378
Patrick Sullivan's recent article ("Dubin calls on CMPA to eliminate fee differentials, adopt flat fee for all physicians," CMAJ 1997;156:685-7 [full text / en bref]) made me recall the "old days," when the Ontario Medical Association tariff and economics committees distributed the allocated percentage of fee increases to the different specialties. A portion of these increases was reserved to compensate specialties facing higher Canadian Medical Protective Association (CMPA) fees.
This meant that Ontario physicians were subsidizing the increased CMPA fees of certain specialties by having a smaller percentage allocated to their own specialty. This is equivalent to having a flat CMPA fee for Ontario specialists, whether they realize it or not.
I am not aware of the situation in the other provinces, but if the uniform flat fee were adopted in Ontario it would only be fair to go back to square one -- to calculate and remove the extra percentages that were allocated to specific specialties in the past and redistribute the "extra" evenly to all physicians in the province. Failure to make the necessary fee-schedule corrections would punish family physicians twice, first when the schedule was tilted to give a greater percentage to specialties facing high CMPA fees, and then again if uniform CMPA fees were adopted.
Maybe we should take Justice Charles Dubin's theory one step further -- "in the spirit of collegiality and in the interests of ensuring the continued provision of high-quality health care both for the sake of the profession and for the sake of all Canadians" we should have a uniform-fee structure not only for the expense side of the equation, but also for the income side.
Chris Stefanovich, MD
Queen Elizabeth Hospital
Toronto, Ont.
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