Save Eye Care Campaign: September Update

September 17, 2021 Dear MPP:

On behalf of all members of the Ontario Association of Optometrists (OAO) I would like to provide you with an update on our discussions with the Ford Government, including the Minister of Health, Christine Elliott, as they relate to Ontario’s unsustainable eye care system. Unfortunately, it has been 17 days since millions of Ontarians have had access to primary eye care services. We need your help to ensure the health and safety of children, seniors, and the most vulnerable in your riding.

In November of 2020, Minister Elliott stated, “It’s not your (optometrists) responsibility to be paying out of your pocket for these services”. We agree with the Health Minister. Here is what has happened since:

• In December of 2020, the OAO offered to work collaboratively with the Ministry of Health on a study to review the operating costs of optometry offices in Ontario. They did NOT accept that invitation.
• Given the unwillingness on the Ministry’s part to participate in such a study, the OAO was left with no choice but to commission its own by an independent third party national accounting firm (BDO). They determined that the average operating cost to provide an eye exam in Ontario (without doctor compensation) was $75.51 in 2019.
• The Minister refuses to commit to anything more than studying and reviewing overhead costs to “inform” future negotiations. What is overtly missing in the Minister’s offer is any commitment to covering those basic costs. Making an unequivocal commitment to do so would ensure that the OAO would enter into negotiations immediately and suspend job action. To date, the Minister continues to refuse to agree to this basic term of reference leaving us to wonder if she has any serious intention of ever covering costs.

In her public August 23, 2021 tweet, the Health Minister states, “the government recently entered into rigorous bilateral negotiations, later with the support of a third-party mediator, with the OAO”. Here is what occurred that the Minister defined as“rigorous”:

• Radio silence from the Ministry from December 4, 2020 until August 5, 2021.
• A 60 minute virtual face to face meeting on August 5, 2021 followed by the Ministry triggering mediation on August 6, 2021 giving OAO one hour’s notice (on a Friday afternoon) before issuing a statement to the media.
• Day 1 of Mediation on August 12, 2021.
• Day 2 of Mediation on August 16, 2021 where after two days of mediation, the Ministry remained fixated on its proposal and unwilling to budge in any meaningful way. Subsequently, mediation was adjourned.
• Hours later, the Minister makes a public offer to OAO and its members via the press.
• This behaviour lacks both vigor and good faith. It has left the OAO and its members questioning if the Minister has any genuine intentions of committing to both a renewed working relationship and a collaborative sustainable solution.

In her September public editorial, the Health Minister states that a proposed 8.48% increase “represents a significant and sustainable increase”:

• Such an increase would move the average reimbursement for an eye exam from $44.65 to $48.43 requiring the average Ontario optometrist today to still pay more than $30 out of pocket to examine an OHIP-insured patient. This may be sustainable for the Ontario government but it is not for Ontario optometrists. It ensures that patient access to quality eye care will become increasingly more compromised.

In her public August 23, 2021 tweet, the Health Minister offers,“A one-time payment of$39million this payment would cover a retroactive period over the past decade and was calculated to reflect similar increases applied to physicians during this time”:

• While Ontario physicians receive the second-highest compensation in all of Canada, Ontario optometrists receive the lowest compensation rates for services in all of Canada. Comparing increases is irrelevant when the starting base rates are so different because of decades of neglect to eye care in Ontario.
• The one-time $39 million payment averages to just over $1 per exam for every optometry service performed over the last decade. It is focused on the past and does nothing to address Ontario’s broken and unsustainable eye care system. It is a waste of taxpayers’ dollars.

In her September public editorial, the Health Minister states that “The offer on the table is an extremely fair and reasonable one”:

• Such an offer continues to ensure that Ontario optometrists will remain the lowest remunerated for an eye exam in all of Canada.
• To reach the funding levels of the next lowest-funded province (Manitoba) in the country, a 65% increase in funding is needed. Our equipment, staffing and rent costs are not lower than those in Manitoba.

• To this day, the Minister refuses to agree to enter into negotiations whereby they will ensure Ontario optometrists will no longer receive the lowest remuneration for an eye exam in the country, a commitment which would ensure optometrists no longer subsidize public eye care. Making an unequivocal commitment to do so would ensure that the OAO would enter into negotiations immediately and suspend job action.

In her September public editorial, Minister Elliot stated, “We recognize that their business model for optometry services may have changed given a shifting global marketplace”:

• It is unfortunate but very telling that the Minister chooses to characterize the access issue to quality eye care as a shift in “business model”.
• The only two things that have changed for Ontario optometrists is the growing demand for underfunded public eye care and an increase in liability brought on by an expanded scope of practice.
• As baby boomers enter into their senior years of life, they have an increased risk of developing cataracts, glaucoma, and macular degeneration. A surge in seniors with more complex eye care needs is inundating optometry offices.

• In 2011, the Ministry expanded the scope of practice for Ontario optometrists to allow them to diagnose eye diseases and to manage them therapeutically. This gave optometrists an increase in liability with no change in compensation. This scope expansion continues to save the province a substantial amount of money. Patients can access their optometrist for many conditions, rather than having to seek care via the more costly route of their family doctor, an ophthalmologist, or the emergency room. Ontarians need continued access to quality eye care and optometrists should not have to pay out of pocket to provide that care.

In her September public editorial, Minister Elliot stated, “Since day one, our government has been hard at work ensuring that patients have access to the care they need”:

• Well before anyone in the world had heard of COVID-19, Ontario optometrists were urging the Ontario government to address an impending crisis in primary eye care. The Health Ministry procrastinated and created delay tactics just as successive governments have for over 30 years. This month, patients in the northern community of Kenora are having their cataract surgeries cancelled because optometrists are not available to provide supportive post-operative care.
• Ophthalmologists across Ontario work collaboratively with optometrists to provide seamless patient-centric care. Attached are several letters of support urging the Ontario government to address the underfunding situation. Ophthalmologist Dr. Bruce Nichols (Ivey Institute of London), states:

“I believe that many in government do not fully understand the impact of the Optometric role and may minimize its standing in the delivery of health care to all Ontarians. The net effect of this misunderstanding, in my opinion, is exactly why Ontario Optometrists are underpaid and undervalued.”

Recently, Minister Elliot publicly stated, “For years, Ontario’s optometrists have been ignored by previous governments That is unacceptable”:

• We agree with the Health Minister and so do our patients and your constituents.
• The math is simple and Ontarians understand how this government is continuing to follow in the footsteps of previous governments by neglecting eye care and exploiting the valuable services that optometrists provide.
• To date, Ontarians have sent and signed over 300,000 letters and petitions to the Health Minister voicing their concerns and standing strong with Ontario optometrists. As every day passes, we will continue to educate tens of thousands of Ontarians that this government does not prioritize their eye care.

Our team will continue to fight for our patients’ access to care. A real commitment to either cost recovery or ensuring Ontario optometrists are no longer the lowest funded in the country is all that is required to resume talks.

We would like the opportunity to further discuss with you how these delays negatively impact the people in your riding. If you are interested in standing up for the health care rights of the most vulnerable in your community, we urge you to contact the Health Minister and the Premier to demand a new mandate to solve the crisis.

Eye health has a direct impact on an individual’s quality of life, and we will continue to advocate for our patients whose lives are negatively impacted by the Ford government’s lack of interest in this aspect of essential healthcare.

Sincerely,

Dr. Sheldon Salaba President