Millions unable to book eye exams as negotiations with Ontario government stall

TORONTO -

For the last three weeks, children, teenagers and seniors in Ontario have been unable to book eye appointments with their doctors—and with negotiations between optometrists and the province stalled, it doesn’t appear as though they will be able to do so any time soon.

Susan Hepp has called nearly 50 optometrists trying to get an appointment for her daughter, who is attending university in Toronto. The 19-year-old is taking all virtual classes, and is experiencing challenges with all the screen time.

“I don’t want her suffering for a whole term and not being able to see properly,” Hepp said. “When you have eye strain you start to get headaches and you don’t want to be on screen as long, so it’s hard because she’s in third year so the courses are pretty intensive.”

As part of the Ontario Association of Optometrists’ (OAO) job action, doctors are not providing eye exams to those covered by the Ontario Health Insurance Plan (OHIP). This includes those under the age of 20 and over the age of 65.

Dr. Wes McCann, a member of OAO, said that he understands people are frustrated, but most patients understand why it’s necessary.

“This is not something we're excited about doing. We care greatly for our patients,” he told CTV News Toronto on Thursday. “When we've spoken to those patients and explained the full situation, they completely support our position and are baffled that the government isn't reacting to this challenge. There's a lot of misinformation out there.”

According to the OAO, Ontario is the lowest publicly-funded eye care province in all of Canada. On average, the provincial government provides about $44.65 per examination covered under OHIP.

McCann says that a third-party report funded by the OAO found the actually average cost for optometrists was about closer to $75.51 in 2019.

“And that doesn’t even include any sort of compensation for the optometrist,” he said. “That's just overhead labor, like cost of staff, electricity, etc.”

In 1989, the Ontario government covered an average of $39.15 per eye test. Thirty-two years later, that fee has only increased by about $5.

The Ministry of Health will be providing optometrists with a one-time payment of $39 million as a “catch up” fee for the time they were left without an agreement and is proposing an 8.48 per cent increase for exams.

“Our government has made every effort possible to lay the foundation for a long-term relationship with the Ontario Association of Optometrists (OAO),” a spokesperson said in a statement on Thursday. “We are disappointed that the OAO recently declined the third-party mediator's conditions that would allow us to resume mediation and reach a deal that supports high-quality vision care for Ontarians. The Ministry of Health agreed to the conditions of the third-party mediator to continue discussions and we urge the OAO to do the same.”

“We put forward a fair and reasonable proposal that is designed to take immediate action to address years of neglect and represents a starting point for further discussions.”

The ministry also notes that not every province funds optometrists and that "Ontario is also the only province where patients don’t have to pay an additional amount out of their own pockets for an insured eye exam."

However, the OAO says that an eight per cent increase in fees still leaves optometrists paying out of pocket for every exam covered by OHIP. In fact, they argue that to even reach the fees in the next lowest-funded province of Manitoba, the increase would have to be about 65 per cent.

McCann says that an eight per cent increase is not a sustainable model.

“It still only moves the ball from $44 to $48, which is way far off our $80 cost of delivery,” he said.

“We're happy to come back to the negotiating table. We're ready and willing and we will stop the job action if they commit to cost of delivery or commit to not being the lowest publicly funded province in Canada. If any of those are met, we're willing to come out of job action and start having negotiations and discussions again. But right now, they're not even willing to commit to that.”

McCann says they have not heard from the government since the job action started. In fact, he says that the OAO has held a total of three meetings with the government—a one-hour call over zoom and two mediation sessions. The Ministry of Health says they last proposed a condition to resume remediation on Aug. 28—but McCann says the OAO  did not want to waste taxdollars knowing that covering the cost of an eye exam was not on the table.

A spokesperson for the ministry added that they cannot agree to an increase without first "engaging in a process of due diligence to validate the facts." To do so they have offered to set up a joint working group to "dig deeply" into the issue.

While negotiations have stalled, patients have taken to social media to express their frustration that they can’t get eye examinations. Some say their senior family members need to get their prescriptions updated and can’t, while others say their kids can’t see the chalkboard in class.

Other residents argue that if they can’t be covered by OHIP, they should be given the option to pay for the examination themselves.

Hepp says that at this point, she would be willing to pay for an appointment rather than wait until her daughter turns 20 and is no longer covered by the provincial program. However, she also realizes that once the job action concludes, it may take a while for optometrists to catch up.

“Now, people who have missed appointments for three weeks or however long ago it goes, it’ll get so backed up that trying to get an appointment with anyone will be impossible," she said, adding that she has not received a referral by anyone she has reached out too.

McCann acknowledges that the job action does put a burden on the health-care system, but also said that once patients understand what they are fighting for, most understand.

“Every patient feels that our cost of delivery should be covered. They all think it's ludicrous that that we pay out of pocket to see a patient and do it at no cost, and we don't get paid for it,” he said. “They think it's just absolutely crazy. And they don't understand why the ministry of health isn't willing to commit to covering that cost.”

A spokesperson for the Ministry of Health said that if individual optometrists decide to withhold care from patients, they are “expected to take steps to ensure patients can continue to receive appropriate care, such as referrals.”