Chair's Message – MOHLTC Arbitration

The release of the arbitration position for primary care as outlined by the Ministry of Health and Long Term Care (MOHLTC) has created a lot of angst among family physicians in Ontario.

For those of you that have not seen this document, some of the more contentious points are as follows:

  • Requirements to provide 90 per cent of time in clinic for a roster size of 1,300 patients and to see a minimum number of patients per half day of clinic time.
  • Maintain a minimum number of physicians in a FHO and to comply with rigorous after-hours service requirements, even if the group was engaged in other work like ER duty, intrapartum obstetrics and/or hospital work.
  • Reductions in pay through reduction in base capitation rate, elimination of preventive care bonuses and movement of some common fee codes into the basket of services.
  • Requirements to provide same day or next day access to patients with certain conditions.
  • Changes to recover outside access for rostered patients dollar for dollar, including ER visits.


I should acknowledge that this is an arbitration position only, but it is frightening to think that this may represent the Ministry’s attitude towards primary care, and in particular patient- enrollment models. If even some of these proposals are accepted by the arbitrator it could have a devastating effect on family doctor morale, teaching and academic work, the existence of patient enrollment models and the choice of family medicine as a career by medical students.

I understand that the Ministry wants to improve access to primary care, but there could be a lot of collateral damage if this proposal goes forward.

As always, I welcome your feedback at or via Twitter @DOCSJW.