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Dermatologist threatens to leave the province over 'restriction' on his services.

Northeastern Ontario was on the brink of losing its only full-time dermatologist late last month, and the Sudbury-area medical community is blaming the Ministry of Health.

Dr. Jean-Pierre Donahue had threatened to close up his practice on Nov. 29 and leave Sudbury for the U.S. after failing to resolve a six-month battle with the ministry over a threshold billing provision which is part of the present agreement between the province and the Ontario Medical Association (OMA).

Donahue's departure would leave the Sudbury Region with only one part-time dermatologist. The balance of northeastern Ontario is also serviced by fly-in dermatologists.

His frustration with the billing system is shared by many specialists in Northern Ontario, according to Dr. Killion de Blacam, president of the Sudbury and District Medical Society.

"There's going to be chaos after Christmas," de Blacam stated, predicting that more doctors will follow Donahue's lead as fiscal year-end (April) approaches.

"We're going to lose some key specialists," he said.

de Blacam issued this warning earlier in the year in a letter addressed to the Ministry of Health.

Donahue, meanwhile, claimed that he will have no trouble moving his practice to the States.

"I have a lot of places to select from," he said as he flipped through a listing of job openings at U.S. hospitals. "I get calls at least twice a month from recruiters in the U.S. asking me if I'd be interested in going there. I don't have to go looking; they come to me."

Donahue admitted, however, that job prospects would not be as promising for his 14 staff members in Sudbury.

"With the amount of working capital reduced and the atmosphere of restraint right now, no hospital or medical office is going to hire them," he predicted. "And if they are hired, it's going to be either at the bottom of the ladder or part-time jobs."

SERVICE RESTRICTION

One day prior to making the announcement of his departure, Donahue charged that threshold billing is a restriction of service.

"They (the government) are telling the doctor that you can only see a certain number of patients, but they just don't come out and say it," he said. "It's a rationing of health care. They're just not telling anyone."

However, a spokesman for provincial Health Minister Frances Lankin, disputed Donahue's claim.

"The sky is the limit," said Paul Howard, the minister's communication's adviser, pointing to the incremental nature of the agreement.

Under the terms of the agreement between the OMA and province, OHIP will reimburse doctors for their full cost of operation up to $400,000. It will pay two-thirds of any costs up to $450,000 and only one-third for costs exceeding that amount.

Donahue clarified that capping support for a doctor's billing means more than capping the doctor's income because billing fees are also used to pay for the salaries of support staff, as well as for office rent, supplies and capital equipment.

He claimed his own operating costs top the threshold set down in the agreement forcing him to obtain bank loans for approximately $150,000 to keep his practice going.

Donahue claimed that doctors who continue to conduct business after reaching the $450,000 level do so at a loss.

"When doctors take a two-month vacation, it's not because they can afford to, it's because they have reached the cap and can't afford to see any more patients for the year," Donahue charged.

Howard disagreed, and added that doctors only have themselves to blame for the current situation.

"This (situation) is the result of an agreement which was backed by a majority of the province's doctors," he said.

FINAL MEETING

Donahue had originally planned to close his office on Nov. 15, but agreed to put the move on hold after meeting with provincial Treasurer Floyd Laughren and Northern Development and Mines Minister Shelley Martel. The two Sudbury MPPs promised Donahue a meeting with a senior official from the health ministry.

Even though he agreed to the meeting, Donahue was pessimistic concerning its outcome.

"They're going to get me an appointment with a faceless someone in the OHIP bureaucracy who's going to study my case and give me my day in court," he commented. "This way they can say they did what they could, but the ministry turned me down."

The health minister can grant exemptions of the billing threshold to physicians working a particular geographic or specialty area or who are working under the province's Underserviced Areas Program.

However, Donahue claimed the minister previously informed the OMA executive that financial constraints make it impossible to grant exemptions during the current fiscal year.

Ironically, Donahue's case followed on the heals of a provincial announcement that it would provide a $2-million grant to Laurentian and Lakehead universities for a human resources study to determine why it is difficult for Northern Ontario to attract and retain health-care professionals.

While the five-year-program is just being established, Dr. Paul Cappon, vice-president of academics at Laurentian University, said that he has some ideas regarding the Donahue case, but would only share them with the ministry if asked.

"I'd welcome a request for advice," Cappon said, adding that the ministry must "address the problems specific to Northern Ontario."
COPYRIGHT 1991 Laurentian Business Publishing, Inc.
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Copyright 1991, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:Jean-Pierre Donahue
Author:Krejlgaard, Chris
Publication:Northern Ontario Business
Date:Dec 1, 1991
Words:870
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