Currently, the biggest challenge we’re facing is booking patients in Ontario to receive eye care. With limited time slots and significant demand, we are trying to figure out how to care for patients, especially those who have an acute or urgent concern.  

When patients call in, the problem we face is utilizing our limited appointment slots. I was having to subsidize OHIP care prior to COVID-19. Now we have increased overhead expenses, we are scheduling longer appointments to meet regulations and therefore have less appointment availabilities which means I am further subsidizing OHIP care. OHIP, especially OHIP partial exams don’t sustain the practice, period. I’m stuck in a place where I want to help my patients but don’t have the space – and if I have the space, I don’t know how I can possibly carry the cost. We’re extremely underfunded by OHIP remuneration. I have bills to pay, staff to employ and significant overhead, making it extremely difficult to care for OHIP covered patients.  

It’s even harder to provide urgent care. Once we see a patient with an urgent need, we need access to ophthalmology care which is extremely difficult, especially in northern Ontario, where they’re also seeing fewer patients and having to redesign their practice. We’re trying to control intake of patients while sustaining a practice which results in patients being triaged and told to go to the hospital. 

We just can’t afford to do emergency eye care right now. 

I care for my patients, I want to take care of their eyes, but I also need to make sure that my business will survive. If my practice is not sustainable, those are jobs lost. How will that help save eye care?  

The impacts of COVID-19 alone will be devastating to my practice. As an older doctor seeing mostly OHIP patients, the new restrictions in the workplace means I can barely pay my share of the overhead. I can’t carry on without dramatically increasing my hours, which I’m not prepared to do. It’s pretty disastrous. 

The way OHIP renumeration is set up was already dire. In my 35 years, I have gone through every negotiation with the Government and been an active voice for reform. I’ve had meetings, written letters and done everything I could possibly do only to find ourselves back to square one. All this work and absolutely nothing has changed.  

Optometrists have never been properly compensated for the work we do. I find myself asking why am I doing this – there’s no way to earn an income of any kind. I, myself, will be left with no choice but to retire. For 35 years, I have always put my patients first. I care for my patients and their health. But it’s no longer a time to play nice. We can’t afford to continuously roll over and just do what’s best for patients – as much as we want to. It’s gone on for so long, it might be putting us out of business.  

This will not help save eye care in Ontario.  

I’m reaching a turning point. The stresses of reduced patient intake, high overhead and inadequate reform for optometrists is such that I can’t enjoy my job anymore. It’s become challenging for me moving forward to justify working. It’s just not feasible.  

When will the government start to listen? 

Access to eye care in Ontario is in trouble. With the current state of the world, so much is unknown. Since re-opening, I’ve had to cut down my practice to 40% capacity. I’m realizing more every day that things are changing, and we simply will not be able to see the same number of patients in the given time frame.  

How am I expected to pay my staff, pay rent, when we’re paying out of pocket to save eye care? I am one of the few in Ontario who has said that I’m done seeing OHIP patients – I cannot personally afford to any longer. I could barely do it before COVID and now there is just no way to do so and hope to run a business.  

What many fail to understand is the financial situation the government has put us in. Even more jarring is how long it’s been since the government has done anything about it. I graduated in 1992 –I have been waiting 30 years for the government to make effective change.  

I am fed up – it’s become too much.  

Unfortunately, patients will soon feel the impact on access to eye care in Ontario if we don’t make changes now. Patients in Ontario will have nowhere to turn to, and some will have to go to emergency in a time where we cannot afford to so. 

We simply cannot continue to see patients under the current OHIP guidelines and expect to make money. The time to save eye care in Ontario is now. We cannot afford to wait any longer.

In our practice, we primarily deal with pediatrics and vision rehabilitation, which means we see many patients with special needs and in an immunocompromised state.  

We expect everything to change once we reopen. With our population of immunocompromised patients, there is no room for error. We need to ensure we have all the proper supplies and that the proper systems and protocols are in place to protect our patients and our staff. The current return-to-work plan will mean a drastically reduced patient load with increased expenses to ensure we are properly equipped. 

We also worry about increased fear in the community. With extended waitlists and delays in seeing patients, we risk missing vital symptoms. The last thing we want is for people to wait until the last minute to see a doctor and for it to be too late. We need early intervention because when we don’t get to patients on time, we risk vision and we risk lives.  

This will change the whole nature of our practice and those qualifying for our services. It is impossible to continue operating the way OHIP fees are set up. With the decreased number of pediatric patients we are able to see, and the impossibly low renumeration, we will be operating at a significant loss for each OHIP patient. This could force us to prioritize our private pay patients just to keep our doors open.   

We care deeply for all of our patients. This is not what we want to implement, but it is what it will come to without immediate action and change.   

I am proud to have a large office that has continually met the needs of all our patients. Prior to COVID, when patients called, they were typically seen within 24 hours of calling and triaged to further care if necessary. With fewer patients and staff, this is going to change.

My concern goes far beyond the significant decrease we will see in the number of patients. We have seen our operating expenses continue to climb – from rent, electricity and increased supplier costs. Over the years, as a result of the lack of increase in our fees from OHIP, we have struggled to keep our prices competitive and give our staff yearly raises. Since starting my practice 10 years ago, I have yet to see any type of wage increase.

COVID has made the cracks in the system more visible. For years, we have had to increase the number of patients we see daily just to offset the cost of operating expenses and to continue to provide patient care and take care of our staff. This is now not an option.

When we re-open, we will have fewer doctors, less staff, and have to see fewer patients to keep everyone safe. We were already seeing a loss of income per exam due to stagnant OHIP fees. It was a loss before, it is an even greater loss now.

We need action. We need to be seen.

We have concerns about our ability to function post-COVID in light of reduced patient numbers, increased costs of providing care, and above all, the inflexibility of the Ontario Ministry of Health and Long-Term Care to reimburse us appropriately. 

I have a serious concern for patients. We are doing our best to deliver care to our patients under these circumstances. While telemedicine has been helpful in these times, it is not a replacement for the full patient care we provide in-office. The inability to follow-up properly – let alone triaging patients by the severity of their symptoms – will present issues which can lead to poor outcomes for many should unapparent symptoms exist.  

We are expecting months of backlog upon return and a severe drop in revenue which will cause issues with retaining and hiring new staff. It is already difficult to properly staff our practice and this will create more difficulties compounded by the fact we will have reduced income for training needs.  

I believe the return to work represents a pivotal moment for Ontario Optometry, as it will provide a favourable environment to produce change in our current OHIP reimbursement. It is imperative that our upcoming return-to-work be accompanied with decisive action, strong public education, and political lobbying from ODs across the province – by showing unity in effecting long-overdue change.