Update: This blog has been corrected to include new information about thyroid testing that became available.
Recently, a lot of media have been reporting on the dispute between Ontario's doctors and the Liberal government headed by Kathleen Wynne, and her Health Minister, Dr. Eric Hoskins. Most of the reporting focuses on the unilaterally imposed 1.65 per cent across the board decrease in fees applied on October 1st (which is on top of the 2.65 per cent decrease as of April 1st that is conveniently never mentioned by Dr. Hoskins and Premier Wynne). However, as the old saying goes, the devil is in the details, and what is lost in the shuffle is that in addition to the across the board fee reductions, there are a number of targeted cuts to patient services. The consequences of these cuts range from inconvenient, to dangerous to simply unknowable at this time.
For example, for women undergoing fertility testing and treatment, testing your thyroid hormone in the doctors office (a so called point of are test) will only be allowed once a year. Clearly the government bureaucrats feel the test is ordered too often, and so, they've decided one test a year is enough. Now here's where it gets tricky. Pregnant women are about five times more likely to develop hypothyroidism than non pregnant women of the same age. It is acknowledged that hypothyroidism in pregnancy is associated with an increased risk of abortion, habitual abortion, premature delivery, intrauterine fetal death, fetal retardation and fetal congenital anomalies, congenital hypothyroidism, postpartum bleeding, anemia, post-partum depression and cardiac dysfunction, which leads to increased maternal morbidity, perinatal morbidity and mortality.
If you get diagnosed with hypothyroidism during your pregnancy, or if you were hypothyroid but well treated before getting pregnant, your doctor will have to monitor your levels up to every four weeks, as hormones fluctuate significantly during pregnancy. If you are part of a obstetrics/fertility clinic, this would have been done right at the time of your visit, and results would be available to you in a timely manner. Now however, you will have to go to the lab, wait in yet another line up, and wait for however long it takes your doctor to get the result to hear back. Granted, this is not likely to be threatening to you or your baby, but it does add to the incovenience factor, and for most women of child bearing age, means even more time off work, for yet another appointment.
On a more dangerous level, there have been targeted reductions in fee codes for addiction medicine specialists. Now I have a great deal of empathy for physicians who deal with addictions. They deal on an ongoing basis with some of the most challenging patients you can imagine. We're talking about some of the poorest and most disenfranchised members of society here, and since so many addicts are victims of abuse of one form or another, the stories these physicians hear on a regular basis will give the average person nightmares for years. There are only a handful of doctors who deal in addictions, and importantly, only a handful that have a licence to prescribe methadone (it requires special training to get that licence).
In order to appropriately treat addicts with methadone, physicians screen these patients for drugs abuse using an expensive urine assay that they pay for as part of their overhead. This is strictly a patient safety issue as unfortunately, there is a high rate of relapse in these patients, and it is dangerous to mix methadone with other street drugs. This is particularly important when first initiating treatment, as many addicts may have residual amounts of their illicit drug in their system. However, on October 1st the government unilaterally cut the code for screening (G040) from $29 per test to $15. While math wasn't my best subject in school, it still sure seems like more than 1.65 per cent to me. Understandably, these addiction clinics are re-evaluating whether they should continue providing services and I know of two that are planning on closing, and another that is reducing it's hours. As for their patients on methadone, they will be left without support, and will likely fall back into the vicious cycle of addiction and poverty. But hey, people who are marginalized by society don't vote, do they?
Reading through the full list of "targeted cuts" imposed unilaterally by Dr. Hoskins and his Ministry, shows a rather extensive list of areas where patients will suffer, including those with chronic diseases, heart disease, diabetes and so on. At this point in time it is unclear how the after effects of these cuts will play out, but the reality is these cuts are targeted at some of the sickest, and in many cases, elderly members of our society. Yet when asked about patient care, Dr. Hoskins simply repeats the mantra that a "modest discount" is all he's asked for and that there will be no cuts to patient services.
Say, can you repeat the joke at the top of the column?
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