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Ontario seeks to cut pay for family doctors, but MDs dispute claim they make too much for too little work

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The provincial government wants to claw back how much it pays thousands of Ontario family doctors and force them to put in longer hours, arguing they are averaging $400,000-plus annually for what amounts to part-time work.

Doctors are up in arms over the proposals and charge that the government has got it wrong when it comes to their workload. They warn if they are hit with another pay cut — on top of one imposed four years ago as well as an ongoing compensation freeze — patients will pay the price because family physicians will be driven from the field.

Dr. Tara Kiran, vice chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto, said she worries deep cuts being proposed by the province will make if difficult for patients to find family doctors.
Dr. Tara Kiran, vice chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto, said she worries deep cuts being proposed by the province will make if difficult for patients to find family doctors.  (Rene Johnston / Toronto Star)

“I’m worried that the deep cuts being proposed will make it near impossible for people to find a family doctor, and that will have repercussions for the whole health system,” family doctor Tara Kiran, vice chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto, wrote in an email.

The two sides have been arguing their cases before a board of arbitration, which completed seven months of hearings Sunday. The Ontario Medical Association contends the government has built its case upon faulty findings by the provincial auditor.

The arbitration board is tasked with resolving an almost-five-year-old contract dispute between the government and the OMA, which represents the province’s 31,000 practising physicians.

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The government’s proposed changes to family medicine (also known as primary care) are among the most controversial issues the board has been asked to weigh in on as part of its deliberations over the size of the physician services budget. Ontario now spends more than $12 billion — or 10 per cent of the entire provincial budget — on doctors.

The three-member board is expected to come down with binding decisions this spring, ending phase 1 of the arbitration process.

Phase 2, expected to be even more contentious, will address how to divvy up the pot of money among some 35 specialty groups.

All of this is happening at the same time the province is undertaking a massive restructuring of the entire health system. Next week, the government is expected to announce the creation of a new “super health agency” to replace more than 20 smaller agencies. Sources say the super agency will oversee primary care.

The 5,300-plus family doctors facing the prospect of pay cuts comprise about half of Ontario’s roughly 11,000 practising primary care doctors. They work in more than 800 group practices across the province, known as “family health organizations,” or FHOs.

FHOs were developed in 2007 to improve primary care — for example, by increasing access through after-hours availability — largely through changing financial incentives for doctors.

Twelve years later, the government argues it has paid for improvements in care, which have not materialized and that the price is too high to expand this model further.

In the past, family doctors were paid mostly through fee-for-service, which saw them reimbursed for every service rendered. There is an inherent incentive in the fee-for-service model to have high-volume practices; the more services provided, the more money made.

But under FHOs, doctors derive the bulk of their income through “capitation,” a form of compensation that reimburses them a set amount for each patient signed up with them — no matter how many times a patient is seen or even if a patient is not seen. The amount varies according to a patient’s age and health.

Three-person board of arbitration tasked with resolving OMA contract dispute: Ron Pink, OMA nominee, left, Bill Kaplan, board chair, centre, and Kevin Smith, health ministry nominee.
Three-person board of arbitration tasked with resolving OMA contract dispute: Ron Pink, OMA nominee, left, Bill Kaplan, board chair, centre, and Kevin Smith, health ministry nominee.  (Rene Johnston/Toronto Star)

In 2016/17, the average FHO doctor (with 1,300 patients) made $406,390, according to the government’s written submission to the arbitration panel. That compares to $214,015 for a family doctor paid fee-for-service.

(Physician compensation is not the same as income. From their compensation, FHO doctors have to pay for overhead costs such as staff salaries and rent. Arrangements vary from practice to practice, with the health ministry, hospitals and local communities also pitching in for non-physician expenses.)

Some fee-for-service family doctors and specialists have even taken to social media to argue that their FHO peers are paid too much.

The government’s submission states that FHOs have become so popular, the number of doctors working in them has surged by 154 per cent since 2008/09. To contain costs, the ministry says it was forced to limit their growth starting in 2012.

The government is now seeking to cut the pay of FHO doctors by an average of 9 per cent each, or about $33,600. That would be on top of a cut of 2.65 per cent the province imposed in 2015, as well as a compensation freeze in place since 2012.

In making its case, the government relies heavily on the 2016 provincial auditor’s report, which states that FHOs have not proven their worth. FHO doctors were paid $522 million more in 2014/15 than they would have received if they were paid fee-for-service, according to the report.

That was, in part, because they were paid for 1.8 million patients rostered with them, even though they did not actually see those patients, the auditor wrote.

“The $522 million is significant, as it indicates that the physicians were not providing core primary care services as often as they should be (or expected to be) and/or that base capitation payments are excessive,” the report reads.

The auditor found that an average FHO doctor works only 3.4 days per week.

The province made significant investments in FHOs, but “most objectives (were) not met,” wrote the auditor, charging that they failed to increase access to care, quality and continuity of care and cost effectiveness.

FHOs have not delivered on commitments to provide after-hours care, the auditor said, adding they have also not done much to shorten wait times for primary care.

Many patients get their primary care elsewhere, including walk-in clinics, other family doctors and hospital emergency departments, meaning the province is paying twice for these patients to be treated, according to the report.

The auditor concluded by urging the province to review how much it pays these doctors to ensure taxpayers are getting good value for money.

In addition to seeking pay cuts, the province wants more work and accountability from FHO doctors. The government wants the average physician to put in a 36-hour work week.

“It’s a very expensive model to deliver primary care physician services and it is not performing optimally,” government negotiating team member Bob Bass told the arbitration board on a recent hearing day. “From the government’s perspective, significant change is required to both moderate the costs and improve the quality.”

But the OMA says the government has built its case on bad information from the auditor who failed to understand how they work.

OMA lawyer Howard Goldblatt said the government is more intent on prescribing or dictating a solution without really diagnosing the problem.
OMA lawyer Howard Goldblatt said the government is more intent on prescribing or dictating a solution without really diagnosing the problem.  (Supplied photo)

“It was done by accountants, not by doctors,” OMA lawyer Howard Goldblatt told the arbitration panel, referring to the auditor’s report.

“The government is more intent on prescribing or dictating a solution without really diagnosing the problem,” he continued.

The OMA wants the government to join it in studying FHOs so that any decisions taken are based on what it contends is accurate information.

The auditor erred by calculating the workload of FHO doctors based on the number of patient visits, the OMA charges.

It stands to reason many patients would have fewer appointments, given one reason for creating FHOs was to move doctors away from high-volume, fee-for-service practices, the OMA argues. Financial incentives were changed to encourage doctors to deal with multiple conditions in a single visit rather than call patients back for multiple visits.

(Depending on the doctor, those working in fee-for-service family practices may also deal with multiple conditions in a single visit.)

The auditor also failed to take into account the fact FHO doctors are more likely to communicate with patients via email and phone since their pay is no longer based on face-to-face visits, the OMA adds.

Then there is all the paperwork that comes with working in a FHO, noted Kiran who practices out of one in downtown Toronto. Because FHOs provide full-service family medicine, there is much administrative work associated with appointments, tests and referrals, she explained, adding that FHO doctors also spend time communicating with other providers in a patient’s circle of care.

“This work is what can lead to burnout and frustration, and is not accounted for in the government’s proposals,” she wrote in her email.

Kiran and the OMA warn the proposed changes to family medicine will drive doctors back to practising high-volume, fee-for-service medicine.

“Family doctors would be forced to see a ludicrously high volume of patients in-person each day,” she said. “For patients, this would likely mean shorter appointments, less flexibility to bring up multiple problems in a single visit, and less flexibility to call or email your doctor about an issue.”

The OMA points out another reason for introducing FHOs was to address past shortages of family doctors by making family medicine more attractive. The proposed changes threaten to turn back the clock on those gains, doctors argue.

In a written brief submitted to the arbitration panel, the OMA used strong language to warn of dire consequences if the arbitrators and government get it wrong:

The ministry’s proposals have “the potential to cause huge destabilization in primary care … The very real risk to patient quality of care and provider well-being cannot be ignored.”

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle

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Anglais

12 strategies to manage credit card payments and debt

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Today, almost everyone carries a credit card in their wallets. It is used to pay for almost everything from groceries to flight tickets to gas.

If managed properly, credit cards can be an essential financial tool that allows users to build credible credit, earn money back and gain great perks, like purchase protection and insurance. However, carrying a poor credit balance can plunge you into massive debt.

“Credit card debt is very high-interest debt, typically in the neighbourhood of 20% or more,” said Scott Hannah, president and CEO of Credit Counselling Society in a report.

If you have a balance payment on your credit card, clearing it off can be a difficult task if you’re a low-income earner—or you’ve already incurred too much debt that after using a credit card payment calculator you know you’ll be unable to pay back.

However, no matter how terrible you think your current situation is, there’s always a way out that works best for you. With interest on loans compounding everyday, there’s little wonder why clearing a credit card debt is so difficult. In fact, according to MNP, an accounting firm, nearly half of all Canadians are less than $200 per month away from becoming financially insolvent.

Tackling credit card debt can seem quite tedious, especially with many people choosing to ignore the problem and just keep making the minimum payment. Here are some practical strategies you can take advantage of to effectively tackle credit card debt.

1. Gain a complete understanding of your debt problem

This starting point for anyone trying to get out of debt is to understand why you’re in debt, in the first place.

Critically examine all areas of your finances to determine if your expenses don’t match your finances or if it was due to an unforeseen circumstance such as a medical emergency. Whatever the case may be, it is very important to know the reason why you are in so much debt so you can effectively tackle the root cause.

2. Look into your spending habits

Typically, one quick way to stop yourself from running into credit card debt is to examine your spending habits. What are the things you spend your credit card on? Are they essentials or things that can be easily done away with?

According to Hannah, most people can only account for about 75 to 80 per cent of their monthly expenditures and the remaining gets blurry. It is important to track your expenditure—whether it’s an extra shot of drinks at the bar or a box of cereal from the supermarket. Knowing what you spend money on allows you to build a better financial strategy against debt.

3. Build a budget

Once you have a clear picture of what your monthly expenses are, building a budget becomes the most important step towards managing your income better. Having one central location for tracking both your income and expenses is great in curtailing unnecessary spending and getting you out of debt.

Your budget needs to contain all of your expenses incorporated from essentials like groceries, mortgage, medical care and insurance to others such as utilities. While most people struggle to stick to their budget, you can create some margin for flexibility to make it easier for you.

4. Increase your minimum payment

For most credit cards, the minimum payment is approximately 2 per cent of the last month’s balance. But therein lies the problem because if you consistently pay only the minimum, then the lump of that money goes straight to your interest and not the principal.

Paying some extra money every month would go a long way in helping you clear your credit card debt faster and reduce the compounding interest.

5. Ask for a lower rate

It is very possible to negotiate for a lower rate with your bank; only thing is, most people tend not to do so. If you find yourself struggling with paying back your credit card debt, you can reach out to your lender and ask them to offer you a lower rate.

Long-time customers who have a history of making timely payments have more advantage with getting their request approved.

6. Take advantage of a balance transfer promotion

In a bid to entice new customers, lenders run promotions periodically on balance transfers for their credit cards. Basically, these offers involve having a low-interest rate between 0 to 2 per cent for a limited period—usually between 6 to 10 months.

Always be on the lookout for a lender that offers the lowest rates and longest promotional period, which would give you enough time to clear your debt.

7. Switch to a low-interest credit card

Once you have critically examined your spending habit and created a budget, yet it is obvious that you will always carry over a credit card balance, then it is time to switch to a low-interest credit card.

While these types of credit cards usually have little perks, they are quite useful in wiping a couple of percentage points off your interest. Typically, rates on low-interest credit cards vary but they could be as low as half the interest on a regular card.

8. Begin an avalanche

The avalanche method is great for those who have a lot of debt with several creditors. This method means you’d make the minimum payments on all your existing debts and then add any extra income to the debt that has the highest interest rate.

Using the avalanche method allows you to reduce the interest paid while clearing multiple debts.

9. Use the debt snowball approach

Another debt repayment strategy that you should consider is the debt snowball method. In this strategy, you would focus on paying off your small debt first before moving to the larger ones—all whilst still paying the minimum on all other debt—regardless of interest rate.

10. Get an extra income source

Creating additional streams of income goes a long way in helping you clear your credit card debt. By finding a better paying job or choosing a good side hustle, you can easily put down more money towards your debt repayment.

There’s a lot of gigs you can offer today to raise extra money such as writing, graphic design, proofreading, teaching and programming.

11. Use a personal loan

If your credit card balance is quite high, paying it off using a personal loan may be very advantageous. While the interest rates on credit cards can be as high as 29 per cent, with a good credit score you can qualify for a personal loan at a lower rate.

The main advantage of using this strategy is being able to pay off multiple credit card debts and focus on making single but fixed monthly payments on the remaining loan. Also, you spend lesser money on interest costs and repaying the loan in instalment would boost your credit score.

12. Spend more cash

Despite being very valuable items, credit cards can quickly run you into massive debt when not used properly. If you already have some debt yet to be paid, it is better to spend more cash than accumulate more debt on your credit card.

Get a low-interest credit card but only use it in emergencies once you know there isn’t enough money in your bank account to pay off the accumulated debt.

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Anglais

‘Business as usual’ for Dorel Industries after terminating go-private deal

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MONTREAL — Dorel Industries Inc. says it will continue to pursue its business strategy going forward after terminating an agreement to go private after discussions with shareholders.

« Moving ahead. Business as usual, » a spokesman for the company said in an email on Monday.

A group led by Cerberus Capital Management had previously agreed to buy outstanding shares of Dorel for $16 apiece, except for shares owned by the family that controls the company’s multiple-voting shares.

But Dorel chief executive Martin Schwartz said the Montreal-based maker of car seats, strollers, bicycles and home furniture pulled the plug on a deal on the eve of Tuesday’s special meeting after reviewing votes from shareholders.

“Independent shareholders have clearly expressed their confidence in Dorel’s future and the greater potential for Dorel as a public entity, » he said in a news release.

Dorel’s board of directors, with Martin Schwartz, Alan Schwartz, Jeffrey Schwartz and Jeff Segel recused, unanimously approved the deal’s termination upon the recommendation of a special committee.

The transaction required approval by two-thirds of the votes cast, and more than 50 per cent of the votes cast by non-family shareholders.

Schwartz said enhancing shareholder value remains a top priority while it stays focused on growing its brands, which include Schwinn and Mongoose bikes, Safety 1st-brand car seats and DHP Furniture.

Dorel said the move to end the go-private deal was mutual, despite the funds’ increased purchase price offer earlier this year.

It said there is no break fee applicable in this case.

Montreal-based investment firm Letko, Brosseau & Associates Inc. and San Diego’s Brandes Investment Partners LP, which together control more than 19 per cent of Dorel’s outstanding class B subordinate shares voiced their opposition to the amended offer, which was increased from the initial Nov. 2 offer of $14.50 per share.

« We believe that several minority shareholders shared our opinion, » said Letko vice-president Stephane Lebrun, during a phone interview.

« We are confident of the long-term potential of the company and we have confidence in the managers in place.”

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Anglais

Pandemic funds helping Montreal businesses build for a better tomorrow

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Many entrepreneurs have had to tap into government loans during the pandemic, at first just to survive, but now some are using the money to better prepare their businesses for the post-COVID future.

One of those businesses is Del Friscos, a popular family restaurant in Dollard-des-Ormeaux that, like many Montreal-area restaurants, has had to adapt from a sit-down establishment to one that takes orders online for takeout or delivery.

“It was hard going from totally in-house seating,” said Del Friscos co-owner Terry Konstas. “We didn’t have an in-house delivery system, which we quickly added. There were so many of our employees that were laid off that wanted to work so we adapted to a delivery system and added platforms like Uber and DoorDash.”

Helping them through the transition were emergency grants and low-interest loans from the federal and provincial governments, some of which are directly administered by PME MTL, a non-profit business-development organization established to assist the island’s small and medium-sized businesses.

Konstas said he had never even heard of PME MTL until a customer told him about them and when he got in touch, he discovered there were many government programs available to help his business get through the downturn and build for the future. “They’ve been very helpful right from day one,” said Konstas.

“We used some of the funds to catch up on our suppliers and our rents, the part that wasn’t covered from the federal side, and we used some of it for our new virtual concepts,” he said, referring to a virtual kitchen model which the restaurant has since adopted.

The virtual kitchen lets them create completely different menu items from the casual American Italian dishes that Del Friscos is known for and market them under different restaurant brand names. Under the Prasinó Soup & Salad banner, they sell healthy Greek options and their Stallone’s Sub Shop brand offers hearty sandwiches, yet the food from both is created in the same Del Friscos kitchen.

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