TORONTO | Ontario’s 200 neurologists have joined the 800 pediatricians of the province in voicing their opposition to what could be Ontario’s future method for determining fee relativity.

Both clinical sections of the Ontario Medical Association (OMA) aren’t sweet on the Comparison of Average Net Daily Income (CANDI), an income relativity tool the OMA governing general council will be meeting Nov. 21 and 22 here to discuss and consider adopting. CANDI, if adopted, would replace a relative value implementation committee (RVIC).

According to Dr. Mike Nicolle, past tariff chairman of the section on neurology, CANDI “appears to be nothing more than a way of providing the best mathematical formula to perpetuate previous inequities (and) avoiding fallout from tough decisions.”

Writing in the July/August issue of the Ontario Medical Review, the OMA’s member magazine, the London-based Dr. Nicolle described himself as a member of an “undervalued” section who has “seen several previous plans to redress (the issue of fee disparities) come and go with no meaningful action to close the gaps.”

He went on, “a survey of physicians in Ontario would quickly identify fee codes widely acknowledged to be grossly out of relativity with modern medicine, and yet there is no political will for this.”

For sections like neurology, “this worsens the manpower situation as practising neurologists age and trainees move toward much better remunerated specialties,” he added.

During an interview with the Medical Post, neurology section chair Dr. Bob Yufe supported Dr. Nicolle. His section voted for the OMA’s 2000 contract almost unanimously based on the premise that the RVIC fee-for-income process would go forward, he said, though he admitted there was no guarantee that would happen.

CANDI, said Dr. Yufe, “looks different” from that proposal because, as he understands it, “significant chunks of money will be taken from the specialties and given to general practitioners.”

To him, “relativity corrects disparities not only between the specialties and GPs, but also among the specialties.”

‘Nothing’ happens

According to Dr. Yufe, “for high-earning specialties, nothing usually happens, while money is taken from low-earning specialties. The OMA is catering to the largest voting sections. We support the section on pediatrics’ view that the CANDI process is flawed.”

CANDI is divisive to OMA members, he said. “A number of low-paying specialties are angry about what’s been done. This isn’t the way to do things. Division is the least thing the OMA needs right now.”

Toronto-based Dr. Yufe said there are as many as 15 sections comprising OMA council’s medical assembly, which also include psychiatry and geriatrics, and all of them probably have problems with CANDI. Members of his section thought the way the last two OMA contracts were drawn up would provide them with some relativity relief.

The current one, while specifying money to be used to increase fees across-the-board, also contains an envelope to address relativity gaps.

“We really thought the OMA was going to implement relativity,” Dr. Yufe said. “Then, they decided to change. Millions will be going to higher-earning specialties, while the little ones are being left aside to wither and die. The economics just aren’t there for a young neurologist to come out and practise. Community neurology is dying.”

Dr. Yufe said the November meeting will be “very divisive.”

OMA president Dr. Suzanne Strasberg was out of the country and unavailable for comment as was RVIC working group chairman and OMA president-elect Dr. Mark MacLeod, who was attending health professions regulatory advisory council meetings at press time.

But in an earlier letter to the editor, published by the Medical Post in the wake of a July 21 Medical Post story on the pediatricians’ campaign, Dr. Strasberg noted that OMA council decided at its annual meeting last May to “reopen RVIC, and ultimately it will be OMA council that will have the final say on whether the revised methodology is adopted in November.”