PSA Arbitration Award: What It Means for Family Medicine & What Comes Next

Dear SGFP members,

There have been several significant developments since my last Chair’s Letter. The arbitration board is awarding a 9.95% increase to the physician services budget for Year 1 of the 2024-2028 Physician Services Agreement (PSA). While the award is more than the minimal 3% increase proposed by the government, we know this is not enough to save family medicine in Ontario. We acknowledge the OMA's (NTF, CEO, and OMA Board) efforts in making it clear to the arbitration board that the doctors of Ontario deserve more, and we are grateful the arbitration framework no longer allows unilateral government decisions.

While we thank the OMA for the case they brought forward to the arbitration board on behalf of family doctors, this award will not resolve the crisis facing family medicine in Ontario. The arbitration board acknowledged the serious recruitment and retention issues we face, particularly in family medicine, and the growing complexity of patient needs.  

Throughout their briefs, the Ministry attempted to downplay many critical issues facing SGFP members. While the Ministry contested the idea of a physician shortage, the arbitration board sided with the OMA’s evidence, recognizing we still face substantial challenges, including a severe shortage of family doctors and inadequate funding to support our current service levels. With 2.5 million Ontarians lacking access to a family doctor, ERs are overcrowded, and without preventative care, patients are dying from preventable cancers, all while the Ministry delays PSA settlements. It is clear, that urgent solutions are needed.

Here's what we know so far:

1. A year 1 9.95% increase. The 9.95% is split 70/30.

- 70% of the 9.95% increase (about 6.95%) will be distributed as follows:

i. the 6.95% will be adjusted based on the relativity formula (which attempts to provide more equitable distribution to lower-paid specialists).  

ii. as part of that adjustment, some will be allocated equally across the board.

iii. the impact on fee-for-service codes in the schedule of benefits and non-fee-for-service payments in the capitation model is yet to be determined.  

- 30% is for targeted funding

- The award is retroactive to April 1, 2024. Based on this increase, you will receive lump sum payments for work you have done since April 2024.

What’s yet to be determined:

2. What portion of the 70% will be paid to each physician across the board, by specialty, and what portion will be based on relativity?  

3. How will the remaining 30% (about 3%) be used for targeted investments?

- The arbitration board has recognized the compelling case for immediately applying targeted funding to family medicine. FM is our priority for targeted investments in the negotiations for Years 2-4.

The specifics on distribution of these final two items are not yet known, and the details will be determined during the next stage of negotiations or arbitration.

We understand that there is considerable confusion and uncertainty about how this award will roll out, especially regarding its impact across all practice models. We know you want to know how much money you will receive and when it will happen. The SGFP is committed to providing clear and timely updates as we work through these details. We recognize that more must be achieved, and we will continue to fight for family doctors in this province.

The SGFP continues to work on several key priorities:

1. Relativity remains a key issue for the SGFP:

Advocating for modernization of the relativity framework to ensure family physicians' work is recognized for its immense value when funds are distributed to various sections.

2. Exploring the development of new funding models and solutions for saving family medicine, similar to recent successful collaborations in other provinces.

3. Working with the OMA and the MOH to ensure that the targeted funding addresses the immediate crisis in family medicine, including the administrative burdens we face.

4. Continuing to champion other critical issues affecting our members, such as:

- Rural and Northern recruitment and retention

- Gender pay equity

- Attachment and access to care

The SGFP is pleased that the arbitration board acknowledged the issues we highlighted, including the crisis in family medicine, administrative burdens, and recruitment challenges in rural and northern areas. The Ministry of Health's initial position was offensive and insulting to family physicians, and we were satisfied to see Arbitrator Kaplan’s recognition of these concerns align with our submission and reinforce the need for continued action.

Thank you for being so dedicated to your patients and communities. Your commitment is essential for improving Ontario's healthcare system. We will keep you informed and advocate for the best outcomes for our members, ensuring you feel valued and supported.

Warm regards,

Dr. David Barber

Chair, Section on General and Family Practice

The Ontario Medical Association (OMA) facilitates the distribution of communications for its various Constituency Groups, and therefore the views and the opinions expressed in this communication may not reflect the views, policies, and opinions of the OMA. The OMA does not warrant the accuracy, timeliness, or completeness of the information contained in this communication, nor does it accept any responsibility for its contents.