CMPA, OMA try to heal rift over regional rating

CMAJ 2000;163(2):201

The possible move toward an OMPA is being driven by the CMPA's decision to pursue regional rating, which will see Ontario physicians pay malpractice protection charges that are by far the highest in the country. The rift between the CMPA and Ontario Medical Association is one of the most serious in the history of the CMPA, which turns 100 next year.

It was also the first issue to greet Dr. John Gray, the Ontario FP who stepped into the CMPA's top job — secretary treasurer — in May. Gray has been on the road since then, trying to explain the rationale behind regional rating.

Gray says the issue is relatively simple. The CMPA now pays about $46 million more to provide malpractice protection for Ontario doctors every year than it earns in fees ($130 million vs. $84 million, see chart). In Quebec, revenue from Quebec doctors totals almost $60 million annually, while CMPA costs come to only $20 million. "As the facts become known," says Gray, "there is less opposition."

Under regional rating, Ontario physicians would see an aggregate fee increase of 45%, with increases varying by specialty. (By one estimate, fees for Ontario obstetricians may rise to $65 000 from $30 000.) Quebec doctors would enjoy an aggregate reduction of 63%, while doctors in the rest of Canada would probably see small decreases.

The Ontario government is one of the parties demanding change. It is already paying about $60 million annually to reimburse doctors for their CMPA coverage and would likely have to pay about $40 million more under regional rating. The province currently covers about 72% of physicians' CMPA costs; although doctors are responsible only for the amount they were paying in 1986, they report that reimbursement takes up to 15 months. Dr. John Jeffery, the head of obstetrics at Ontario's Kingston General Hospital, says that with a 45% fee increase, the province's obstetricians would have to perform 12 deliveries a month simply to pay monthly carrying charges on the CMPA premium.

Gray says regional rating points to the need for tort reform. Why, for instance, is the average medicolegal settlement in Ontario 156% higher than in Quebec ($172 000 vs. $67 000)? "Perhaps it's a cultural difference," says Gray, with Quebecers "looking to the courts less than they do in Ontario."

OMA President Albert Schumacher says the association would prefer to have Ontario doctors remain with the CMPA, but "we have to explore all our options." He says frustration has been growing over certain aspects of CMPA policy. For instance, the CMPA "hasn't gone that extra step" of covering Ontario doctors who see American patients. Schumacher says that's a major issue in border areas like Windsor, where he practises, because American patients are a major source of income for doctors in certain specialties. "Basically, we've been told not to see these patients. There's a market of 5 million people here [Americans living near the border] but the CMPA is not too interested. It only wants to insure [under] medicare."

The OMA also wants the CMPA to do a better job promoting risk management. "This is a bone of contention," says Schumacher. Gray, a past president of the OMA, admits that the CMPA must "become more aggressive" in this area.

The OMA also thinks the CMPA should be actively pursuing tort reform. "Basically," says Schumacher, "they've just sat back and said, 'We don't care who pays [the CMPA fees].' " However, tort reform involves political lobbying, and this may prove difficult for a tradition-bound organization like the CMPA. "We have always had a single focus [of representing members] and a reputation of integrity," says Gray. "We do not get political."

Gray and Schumacher have both received many letters from doctors telling them to "work things out." Will they? "I'm cautiously optimistic," says Schumacher, who adds that Gray's arrival at the CMPA will help. "I think liaison with the CMPA will be better because he's there."

Gray, whose annual CMPA fee was $50 when he joined in 1972, acknowledges that Ontario doctors account for about 40% of CMPA membership, but says the organization "could survive without Ontario, absolutely."

However, he too is confident that an agreement can be reached. "The members need to hear firsthand about regional rating," he says. "If they do, I think an understanding will develop that this was the way we had to go."

Ontario doctors appeared to make their feelings clear during the OMA annual meeting in May, when they passed a motion stating that a referendum of the membership must be held if the OMA recommends an alternative to CMPA coverage for Ontario's doctors. — Patrick Sullivan, CMAJ

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