Chronic underfunding of Optometry in Ontario – A crisis 30 years in the making

Patrick Monaghan
5 min readJun 6, 2021
A poster you’re likely to see up in every optometrist office in Ontario right now

The Ontario Association of Optometrists has recently launched a campaign to help push the provincial government to fix a big issue that’s been brewing for decades.

For some context, if you go to the government website discussing OHIP coverage for optometry, look at the first sentence:

They’re claiming that what is paid to an optometrist office for an OHIP-insured eye exam “covers the cost” of that service.

Here’s the thing - It doesn’t.

Not even close.

Source: Ontario Association of Optometrists

Look at those dollar amounts:

1989 – $39.15

2021 – $44.65

The average amount the provincial government pays out to “cover the cost” of an eye exam has only gone up by about 5 dollars in 32 YEARS.

Just from inflation alone, that $39 should have nearly doubled to keep pace with rising operating costs.

From a recent article discussing the situation:

“When we provide an eye exam, we spend about half an hour doing that for the patient, and our operating costs to deliver those exams are over $80 now between staff salaries, utilities, leases on equipment, those types of things.” – Dr. Sheldon Salaba (President of the Ontario Association of Optometrists)

Also note that those costs don’t even include paying the doctor.

Imagine a restaurant serving a meal that costs over $80 to prepare (before the chef is even paid), but are only reimbursed $45 for it. Now, make it illegal for that restaurant to charge the customer anything higher than the $45 for the meal, preventing the restaurant from covering their own costs.

Doesn’t sound sustainable, does it?

There’s no way that dish will stay on the menu if the restaurant wants to stay in business, especially if that’s what the majority of their customers are coming in for.

This is the situation with optometry in Ontario.

Consider an example now in the profession:

A senior couple both have eye exams booked back-to-back, likely occupying an hour of the doctor’s schedule. The chair-time cost for the office to provide them both exams may be about $180 or so (again, before the doctor is even paid). OHIP will reimburse less than $100 total, leaving the office to take a massive loss just to ensure those patients have access to care.

Now imagine that’s your whole day.

Does that sound fair to you?

Does it seem likely that this office will be able to stay afloat if their patient base is mostly falling into OHIP-insured categories?

Some offices already have to limit how many OHIP patients they see in a day, otherwise they can’t afford to stay open.

If there is high demand for exams for OHIP “covered” patients, but an optometry office needs to limit OHIP patients, they’ll be forced to book these patients weeks or even months down the line.

It shouldn’t have to be this way, but becomes necessary in certain areas depending on what their operating costs are.

So what is the solution?

The Ontario Association of Optometrists (OAO) has been trying to work with the Ontario government to fix this broken system for many years, but there’s a huge limiting factor that has prevented any meaningful progress:

Optometry does not have a formal negotiation process with the provincial government to negotiate fees. Any conversations happening between the groups are informal and non-binding.

Many regulated health professions DO have a formal negotiation process enshrined in the legislation, ensuring that there are regular scheduled discussions to renegotiate fees for OHIP-insured services.

Optometry has been denied this critically important process, and so fees have remained largely stagnant for decades.

It has reached the breaking point.

The ask

To prevent any job action come September, the OAO has set out two simple, and very reasonable requests:

“All we’re asking for to avoid this is that they enter a formal negotiation process with us and we’re asking for them to figure out a funding solution that, at a minimum, covers the operating cost of delivering the service.” – Dr. Salaba

  1. A formal negotiation process
  2. An agreement to find a funding solution that (at minimum) covers the cost to provide care

The OAO has already provided the current Ontario government with multiple possible solutions to make this work, but the government has yet to make any meaningful headway in the process.

Optometrists want to be able to provide high level care to every single person in Ontario, no matter how old they are, but they shouldn’t have to take a financial loss to provide that service.

How you can help

If you think what Ontario optometrists are asking for here is reasonable, there are a few easy ways you can help tell the government.

  • If you have an eye exam coming up, please consider signing the petition they’ll likely have sitting at the reception desk. These signed petitions will be collected, sent to the local MPP, and then brought to legislature. Many MPPs have tabled the petition already, and the collection of petitions is still ongoing.

On that page you’ll find a pre-written digital letter you can send to your MPP, showing your support for the optometry profession in Ontario.

Here’s what the letter looks like:

You don’t even have to know who your MPP is, all you have to do is enter your postal code (along with your name and email), and it will be sent directly to the appropriate member.

It’s quick. It’s easy. It helps.

If you want to make it more personal:

  • Call your MPP’s office directly, or arrange a meeting, and let them know that you think this is an issue that needs to be addressed

The more the government hears from patients like you, the more likely they are to give this issue the attention it needs, preserving access to eye care for all Ontarians.

If the Ontario government values the service that optometrists provide, it’s time for them to step up and commit to making this right.