Doctor’s Day Celebrated the Trust Patients Put in Us

“I love my Doctor and their team of colleagues. They are friendly and give me the best care I need. Thank you to Dr. Hameed and her team of Colleagues at St. Joeseph Family Medical in London Ontario.”
– Christine

“Dr. Gimbel is a super G.P. I have had issues from time to time, and Dr. Gimbel leaves no stone unturned until these issues are resolved. She has a good sense of humour, always listened to my issue and diagnoses them as speedily as possible. She is worthy of special mention on doctors day. “
– Roy

As President of the Ontario Medical Association, I am proud to lead an organization that represents so many remarkable people like Dr. Hameed and Gimbel. The public trusts us to protect their health and the health of their loved ones.

We repay that trust with a commitment to patients that often comes before everything else in our professional and personal lives. Ontario’s doctors keep the provinces 14 million people healthy, take care of them when they are sick and are vital members of our communities.

This commitment is the cornerstone of Ontario’s health care system.

For Doctors’ Day 2019, we asked Ontarians to share stories about their doctors and the difference they have made in their lives and communities.

Over the month of May, people across the province responded with moving personal stories like the two above.

Patients recounted how their doctor held their hand during their darkest hour, helping them to conquer illness or find the courage to keep fighting. They shared stories of doctors who went above and beyond and expressed admiration for the daily challenges that doctors overcome in the pursuit of excellent patient care.

This outpouring of support doesn’t surprise me. I know my colleagues well, and I’ve witnessed their daily dedication to their patients during my 27 years of rural medicine practice in Stayner.

I love practicing family medicine and value the trusting relationship between me and my patients. It is the same relationship Ontario’s 31,500 physicians have with more than 340,000 patients they see every day.

As president of the Ontario Medical Association, I will be writing a lot about issues that affect both the profession and patients in my term over the next year. I will post them on this blog, and on my twitter feed.

Ontario’s doctors are on the front line of the health care system. We see what is not working within the system and how it can be fixed. We understand that changes to the health care system must work for patients in real-life situations. As we work with government to fix our health care system, solve critical issues like hallway medicine and deliver high-quality care, the health and well being of our patients will always come first.

For more stories underscoring the strong and valued relationship we have with our patients, click here. I beam with pride in my colleagues when I read these, and I hope you do to.

Note:  The original version of this blog appeared on the OMA newsroom and the OMA facebook page.

Ontario Health Teams A Good Start For System Transformation

The Ontario health care system is in distress.  Frontline health care workers like myself know this.  Many of the rules that we are forced to abide by are archaic and make no sense.  Outdated fax technology only flourishes in health care.  Hospitals are bursting at the seams.  Home care is proving woefully inadequate.  Sadly, patients are suffering from the consequences.  This is what 15 years of neglect and lack of foresight by the previous Ontario Liberal government has caused.

To fix the situation, the new Conservative government of Premier Doug Ford is proposing what has been called the most massive transformation of health care since Medicare. The first step is to form an agency– called Ontario Health – that will merge up to 20 different agencies into one.  Long-time fans of mine (all three of them) will know this is music to my ears.  It was step three in the seven-point plan I urged then-Premier Wynne to follow to fix health care back in 2017.  I can’t help but be pleased this is finally happening – and certainly expect a significant reduction in Ontario’s bloated bureaucracy as a result.

The second step is to form a number of “Ontario Health Teams”(OHTs).  The goal of these teams is to provide Integrated Care Delivery Systems (ICDS).  There’s a lot of bureaucratic verbiage in the documents released to date, but essentially the goal is to ensure that different health care providers (doctors/home care/hospitals, etc.) work seamlessly to deliver care to patients, as they move through the health care system.  I know, it sounds incredibly basic, and should be straightforward, but unfortunately, it just doesn’t happen as well as it should right now

Can OHTs work?  As always, the devil is in the details.  The first thing that is needed is the political will to transform the health care system.  This is clearly evident.  Health Minister Christine Elliott has been widely lauded as a very capable minister and truly has the ability to provide the political will necessary.  Dr. Reuben Devlin (the Chair of the Premier’s Council on Ending Hallway Medicine) is a strong leader as well.  Thankfully, the person who will have to do a lot of the bureaucratic heavy lifting is new Deputy Minister Helen Angus.  I’ve written about her before, and she certainly appears to be a very strong deputy minister.  I think she’ll do very well.

The next step is to ensure that similar models across the world are studied, and only the successful ones copied.  You see, the OHTs appear to be the Ontario version of something called Accountable Care Organizations (ACOs – I know, you have acronym overload by now).  The goal of ACOs is to provide an amount of funding to a geographic region, and to have all of the health care delivered to patients in that area paid for by that funding.  The OHTs however, appear to be taking a more cautious, pragmatic approach, and are only going to provide funding for outpatient services, and not include physicians’ services. They may evolve in the future, and it’s a smart move on the government’s part not to move too quickly.

Now, the reality is that only some ACOs worldwide actually meet the goals of simultaneously improving health care while reducing health care costs.  So it’s incumbent upon OHTs to reflect those effective models, and not the ones that have failed.  What do the successful models have in common?

First, it is essential to have strong physician leadershipin these models.  For too long, Ontario’s physicians have been blocked from providing advice to the government.  Physicians work on the front lines of health care delivery, and see the effects of bad policy every single day.  They have many ideas on how to transform health care for the better.  The previous Liberal government only viewed front line health care workers as eye candy for photo ops and nothing more. Thankfully, this seems to be changing, and it was refreshing to have Premier Ford’s Senior Advisor Greg Harrington come to visit us at the Ontario Medical Association head office last week (I can’t recall anyone from Kathleen Wynne’s office visiting us).  Governments co-operating with physicians can only help patient care.

Secondly, the mess that is Ontario’s IT infrastructure needs to get cleaned up quickly. You see in 2019, for seamless care to be provided to patients, hospitals need to talk quickly, securely and electronically with home care providers.  Doctors need to talk to pharmacies.  Nursing homes need to get doctors quickly.  In short, the relevant data has to follow the patient.  Projects like the one I was proud to spearhead in Georgian Bay have proven that we can save money and provide better health care at the same time.

These are challenging times in health care, but there is also a great opportunity.  By properly instituting OHTs, Ontario has a chance to finally start reversing its poor record of the past 15 years.  Done properly, this reform of health care could also be a lasting legacy for Premier Ford.

Let’s get it done right.

A Personal Journey Through Public and Private Health Care

Disclaimer:  The following blog was written by Dr. Darren Cargill (pictured below).  He asked that I put it up for him.  Dr. Cargill is a palliative care physician from Windsor, Ontario.  Opinions are his and his alone, and do not necessarily reflect my opinions, or those of the Ontario Medical Association.

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Recently, a series of articles in the Toronto Star claim that Ontario Premier Doug Ford is looking at “private” options to end hallway medicine.  This was, of course, immediately denied by Health Minister Christine Elliot who stated her government’s ongoing support for public health care.

To support this narrative, the Ontario NDP brought forward a leaked piece of draft legislation called the “Health Systems Efficiency Act”. This draft suggests that all 14 Local Health Integration Networks (LHINs) and many other agencies (Health Quality Ontario, eHealth, etc.) are to be rolled into one big Agency.  NDP Leader Andrea Horwath claims that this draft legislation is a signal that private health care is the real agenda for the Ford government.  Interesting times for health care in Ontario.

In Andre Picard’s book “Matters of Life and Death,” he eloquently outlines the history of Medicare in Canada, warts and all.  I think we can all agree with his comment “Canadians want care that is appropriate, timely, accessible, safe and affordable, from birth to death.”

So here is our story. In 2007, my wife was diagnosed with cancer. She received excellent care here in Windsor as well as at Western in London as part of her journey.  I can honestly say, that she would not be here today if not for that excellent care. I am indebted to our system for saving her.

Getting cancer at 29 is frightening.  When we wanted a second opinion to confirm the diagnosis and ensure that we were receiving the best possible care, we booked an appointment at Karmanos Cancer Centre in Detroit.  A second opinion in Ontario would have taken months. We got our appointment within days across the border. They confirmed that Windsor was giving us fantastic care.

At one point during her treatment, she needed an MRI.  The wait was many months in Ontario.  At first, she was ok to wait but as the days passed, the wait took its toll.  Eventually, we decided to go to Detroit and have the MRI done, with only a few days wait and near instantaneous access to the results.

When we needed help conceiving following chemotherapy, this too was not covered by our public system and we paid out of pocket for that.  We required help from physicians in both Windsor and Detroit. Today we have a son.  And he has a mother.

Neither system alone gave us what we needed. It was both.

We already have private health care in Canada.  Doctors’ offices are privately run businesses that rely on single-payer public funding to operate. We also have private care when we pay out of pocket for drugs, physiotherapy, psychotherapy, fertility treatments, and dental care.  Canadians already spend money out of pocket for health care so the fears around a “two-tiered” system are odd, to say the least. Two-tiered refers to the argument about equity, not public/private, in my humble opinion.

Many will claim I am a physician and had “the means” to avail myself of private care.  But for the record, I was less than 2 years into my career and still had over two hundred thousand dollars in debt from tuition gathering interest every day.  We had to ask family for loans to support us.

For me, the price was worth it.  I would have preferred to have all of our care provided in Canada, but the public system simply could not give us everything we needed.  I believe it was providence that we ended up in Windsor, a short drive away from a world class cancer centre and fertility experts in Detroit.  Ontario gave us most of what we needed and prevented catastrophic financial consequences but privately delivered care in Detroit helped to fill in the gaps.

Why couldn’t I have those options in Canada?

To be clear, I am not suggesting we adopt a US style for-profit system and I am not suggesting we abandon our public system. What I am suggesting is that we have a mature conversation about our system, it’s limitations and whether there is a way to supplement or augment our “good not great” publicly funded, single payer system with private options that could enhance the care we deliver. Can we make our system better through private innovation and efficiencies while preserving all the best parts of public Medicare?

I am asking for a conversation.

As a palliative care physician, I won’t benefit from privatization.  End of life care and symptom management for patients with life-limiting illness will remain publicly funded.  But end of life care does give us a great example of what a good conversation could look like.

In 2015 the Supreme Court of Canada’s Carter decision came down and we were required, as a nation, to address the issue of Medical Assistance In Dying (MAID). Previously, MAID was taboo and “verboten.”  We could not raise it with our patients or even discuss it. But a funny thing happened. Once this prohibition was raised, it got easier to discuss death and dying. Whether or not you support MAID or not, one thing is indisputable.  The conversation has been elevated.

In his book, Picard states “we talk endlessly about sustainability of Medicare but have no idea what we want to sustain.  Our Medicare model is a relic, frozen in time. Tommy Douglas’s role in shaping publicly funded health care is celebrated, mythologized even.  But we conveniently ignore that Medicare was designed to meet the needs of 1950s Canada.”

All on the first page of his chapter on Medicare.I couldn’t agree more.  And while we are at it, let’s stop tilting at wind mills.

I do not pretend to have all the answers.  I just know we need a mature conversation about public AND private health care.  Let’s not shut down the conversation out of fear-mongering and ignorance. To paraphrase former CPSO president David Rouselle: “let’s not repeat the same sterile conservations again.”

How to “Axe the Fax” in Health Care

Recently, Globe and Mail Health Columnist Andre Picard wondered why fax machines are still the norm in health care.  Electronic communication is faster and more efficient than faxing.  In the past, it was thought that faxing was at least more secure.  However, with the emergence of “faxploit”, and reports showing how missed results are worse, it’s clear that secure electronic communication is safer.  Britain has moved to “axe the fax”in health care, acknowledging that using fax machines is farcical.

So why are faxes used so often in health care?  I can’t speak for other provinces (although the answer is likely similar) but in Ontario, it’s because the IT infrastructure for health care was so poorly thought out by the previous Liberal government that there really is no choice.  There is a mis-mash of different software for different health care providers, none of which interacts with each other.

Physicians in Ontario currently are able to purchase one of twelve Electronic Medical Record (EMR) services. NONE of these services is actually able to communicate with each other electronically.  Going from one doctor to another, means that your records are not interchangeable.

Hospitals in Ontario have the choice of even more products, though generally pick one of the three most physician unfriendly versions.  The Home Care system uses a Province wide system, but can’t interface with hospitals and physicians.  Then there’s Public Health, multiple allied health care agencies, nursing homes and so on.

The result is a byzantine system with no easy co-ordination and absolutely no interchangeability.  Hence, I fax referrals to Home Care, specialists fax me with their consult notes, and nursing homes fax me three month drug reviews.

The most commonly suggested solution for this problem is to develop something called a Provincial Electronic Health Record (EHR).  The idea is to have every health care provider get rid of whatever software they are using now, and use one Province wide system only.  The system would be cloud based, and allow you only to access the information that you have privileges for.  For example, family doctors could see the whole chart, but a pharmacist could only access the medication record (and some relevant lab work), a personal support worker would only be able to access notes they had written and so on.

In an ideal world, this makes the most sense of course. However, proponents of this solution fail to recognize that this will be exceptionally costly.  There are the initial costs of development of such software. But there will be additional hidden costs to such a solution.  EVERY health care provider in the province will have to get re-trained on this new software.  We’re talking all 30,000 doctors, 100,000 nurses, goodness knows how many PSWs, Pharmacists, Pharmacy Technicians, radiology technicians, clerical staff etc.

Unfortunately, the reality is also that when people go from one system to another, mistakes are going to be made and there will be a number of errors.  These errors will also have a cost to them.

But what can be done then?  Clearly the current system of archaic faxing is unacceptable. Turns out there is a solution that is relatively easy, relatively in-expensive and has already been piloted with great success in my neck of the woods (Georgian Bay, Ontario).  The government should mandate that all health care software providers must have an Application Programming Interface (API) that meets a rigid province wide standard, by the end of this year.

As I’ve written about before, when I was Chair of the Georgian Bay Family Health Team, my colleague Dr. James Lane piloted a project that allowed pharmacies limited access to our Electronic Records and allowed secure communication between pharmacists and physicians. There were numerous efficiencies and safety benefits, including an unexpected 90% reduction in drug diversion (selling/stealing of opiod prescriptions).

In 2014 we used an API to allow us to communicate securely with our nursing homes.  The result was an over 50% reduction in admissions to our local hospital from nursing homes.  The cost of the API was about $35,000 a year. The funding ended in 2018 and for whatever reason our LHIN has chosen not to continue funding it – and of course hospitalization rates are going up again.

Having a provincial standard for an API can be done easily (there are multiple existing standards out there).  Forcing the software providers to add this to their software will take a little intestinal fortitude, but I suspect the current government has that.  By doing so, it means that a physician, can continue to use whatever EMR he has, but transfer relevant data electronically to home care, public health, hospitals and so on.  It will mean that the agencies can communicate directly and quickly with each other on the patient’s chart, without the mess that was caused by faxing. Our system was actually compatible with smart phones, so home care nurses could message a physician’s office right from the patient’s home.  And, it will be far less expensive than developing a brand new system.

The time to mandate a Provincial API Standard probably came 8 years ago.  Hopefully 2019 will be the year it happens.

Premier Ford Is Taking Promising Steps

Editorial Note:  This article was submitted for publication to the Huffington Post.  They published it yesterday (my thanks to the editorial team their for feeling it was worthy).  I’m republishing it here for those of you who don’t read Huff Po.

Ontario Premier Doug Ford sent a New Year’s letter to all members of the Ontario Public Service recently, announcing his three main priorities for the next year.  Happily, for those of us who provide front line health care, fixing Ontario’s troubled health care system continues to be one of those priorities.  Ford also specifically emphasized “embracing change and innovation, deploying technology more effectively, and committing to new models of collaboration and patient care.” But what exactly does that mean?

There’s been much written about the rather unique, even disruptive, style of the Ford government to date.  However, from a health care perspective, while Ford has moved quickly, he also, to date, seems to have moved pretty fairly – the hiccup around arbitration with the Ontario Medical Association aside.

First, he appointed Christine Elliottas Minister of Health (MOH). She’s clearly one of, if not the most experienced Minister in his cabinet.  Immediately after, deputy Health Minister Bob Bell retired, and was replaced by Helen Angus.  Helen Angus herself is a consummate professional and very highly regarded amongst the health care community.  There was clearly a feeling that steady hands were going to be on the tiller when these appointments were announced.

The first thing that Elliott and Angus did was streamline the MOH bureaucracy, reducing the number of Assistant Deputy Ministers from what looks like 21 to 11.  What’s that you say?  Didn’t former Liberal Health Minister Helena Jaczek state that that it was a myth that the MOH had a bloated bureaucracy?  Come to think of it, didn’t the former deputy Health Minister, the aforementioned Bob Bell, write that this was a myth too? Oops.

The next step was to hire Dr. Rueben Devlin to be the Chair of the Premier’s Council on Improving Health Care and Ending Hallway Medicine. I’ve had the opportunity to meet Dr. Devlin a couple of times. He’s smart, down to earth and has a strong background himself in providing front line patient care.  More importantly, he has a proven track record in embracing change, and deploying technology effectively.  He created the first fully digital hospital in the continent.  He showed me how some things work at his hospital, and I confess, I was drooling over how advanced they were.

It was just leaked to the media that the Government is looking at dissolving the dreadful Local Health Integration Networks (LHINs).  I’ve written about just incompetent LHINs were in 2016, so I personally am very glad to see them go.  The money saved from these wasteful behemoths of bureaucracy can be divested directly into front line care.

So, what’s next?  Having read through a bunch of information, I think we can expect the Premier’s Council to do the following:

  • Implement an IT plan of some sort, that has teeth to it. Ontario’s health care IT infrastructure was left in a complete mess by the previous Liberal government.  It is ridiculous that a patient in the Georgian Bay region has their health care team securely emailing each other about their case, but that nobody else in the Province can have this.  The fact that we still use fax machines (!) leaves us squarely in the dark ages.  The IT infrastructure already exists to modernize and streamline things.  We just need somebody in charge to say “make it so.”

 

 

  • Hopefully there will be an outreach to front line health care providers in their communities. Many of them know how the system is failing and have insight and ideas on how to fix things.  Giving them a true voice is important.

 

Premier Ford has a big challenge ahead of him with health care.  Our population is aging.  Health care technology is improving at a rapid pace.  Cost of care continues to rise.  But to these old eyes at least, it seems he has taken some reasonable first steps into getting a handle on the problem.  For the sake of all Ontarians, let’s hope he succeeds.

How Governments Try to Take Away Binding Arbitration

Binding arbitration. For Physicians across Canada it represents the only meaningful tool in a labor dispute with government. For moral and ethical reasons physicians are not willing to strike.  Physicians are an essential service for all Canadians. I believe the public recognizes and supports that.

Furthermore, not only does the Canada Health Act support binding arbitration for physicians, but so does a legal interpretation by Justice Emmet Hall, in his landmark review of medicare.  From Goldblatt Partners:

  • the Supreme Court of Canada has ruled that “binding arbitration must be made available to essential service providers, whenever society concludes that disputes over their compensation or working conditions should not be resolved by strikes”
  • Justice Hall rejected any notion that government could unilaterally reduce or determine payments to doctors, characterizing it as “wrongful conscription” of physician services. He concluded that, if legislation is to prohibit doctors from opting out of medicare (or extra-billing), it must also provide that “when negotiations fail and an impasse occurs, the issues in dispute must be sent to binding arbitration”.

Yet, Provincial Governments have been historically resistant to provide this tool for physicians. BC, Quebec and the Yukon still don’t have some form of arbitration for their physicians.  Nova Scotia tried to take it away from physicians in 2015, under the Public Sector Sustainability Act.  Of course, nothing unites doctors better than fighting a militant government (see Ontario under Kathleen Wynne!) and once the dust settled in Nova Scotia, there actually was negotiated agreement.  But the ensuing bad feelings seem to persist to this day as reports suggest there is still a “fractured relationship” in Nova Scotia, and needed health care reforms are being jeopardized as a result.

Why the resistance to arbitration?  Because some governments want to set a pay scale, rather than accept an arbitrator who will independently, and after thorough research, come up with a value of what a service is worth.

In Ontario, we are now seeing a few doctors taking steps that may well jeopardize the future of binding arbitration. As most physicians realize, a small group of specialists is attempting to break away from the Ontario Medical Association (OMA) and form their own bargaining group. Separating from the OMA would be a violation of the Representation Rights Agreement and of current legislation.

As I’ve mentioned previously, I really value my specialist colleagues. They’ve bailed me out on numerous occasions with sick, complicated patients. I couldn’t practice without their support.  But I think that in their anger over certain decisions made by OMA Council, they are not seeing the big picture here.

Any government is unlikely to have an interest in self-determination for specialists, or in picking sides. There’s no reason for any government to get involved in a “family squabble.”  All governments want a positive working relationship with doctors (on governments’ terms of course!).  To that end it makes no sense for a government to work with a small breakaway group, knowing it will upset the rest.  There’s no political gain there.

Ontario was the most recent province to get binding arbitration.  It took years of refusing to back down by physicians to get it. Even after then Premier Wynne offered it to physicians, it took months to negotiate the final binding arbitration framework (BAF).  The government wanted to include some unreasonable clauses in the BAF.

  1. They wanted to ensure there was a hard cap in the agreement (as opposed to letting the arbitrator decide if one was needed).
  2. They wanted the fiscal situation to be the main determinant of the award (not the actual value of the services provided).
  3. They wanted the award to be based on sustainability (the only way to sustain the system would be to cut physicians more).
  4. Most importantly, the government did NOT want CMPA rebates to be arbitrable (this would enable them to get rid of these in the future without negotiations).

It was only because the OMA Negotiations Team held fast to their principles that we got the fair BAF that we did.

So now, if some specialists try to separate, what then?  In an FAQ they distributed on Sunday, they have admitted the next step is to ask the government to repeal the Representation Rights Agreement (RRA) that the OMA has with the government.  And surprise surprise, guess what happens to be an appendix to the RRA, and would have to be deleted as well?  Why none other than the BAF (yes folks the BAF is part of the Rep Rights Agreement).  Essentially, if you repeal the RRA, you rip up the BAF for ALL physicians.

Frankly it seems unlikely to me that ANY government would  willingly offer a new BAF to any group of physicians.  Again, in their FAQ the small group only “believes the government shares the same view” on BAF as them, but they have offered no written proof.  To my mind, if any government does offer a new BAF to doctors, it seems likely that the ‘new’ BAF offer would have some or all of the limitations that the Liberals tried to force on us back in 2017.  (I would do the same if I was government.  That whole “all’s fair in love and war” thing).

I hope for the sake of my colleagues that physicians take a good long look before risking the unravelling of binding arbitration by supporting the break up of the OMA, and handing government the tools to undermine what we have achieved under our Representation Rights Agreement. We’ve been treated unfairly and fooled too often in the past.  Let’s not add to our woes by making it easier for any government to take advantage of us in the future.

Specialists in Ontario are Being Played…

Looking through my in box, I see:

  • A report from an interventional radiologist, who performed a percutaneous vertebroplasty (injecting a bone in the spine with a form of cement) on a patient of mine with severe back pain.  She now walks without a cane.
  • A report from an interventional cardiologist who performed a very difficult cardiac stenting procedure (insertion of tubes in the blood vessels to the heart) on a patient of mine with unstable heart pain – probably saving his life
  • A report from an ophthalmologist, who expertly fixed my patients cataracts. She can now see her grandchildren clearly for the first time in years.

I think of colleagues like these (and many others) when I read about how Dr. David Jacobs, a radiologist and former Ontario Medical Association (OMA) Board member, would like to start a separate organization to represent specialists.  Dr. Jacobs is well known in the profession for his actions during what’s become known as the tPSA fiasco of 2016.  The former leadership of the OMA negotiated a deal with the despicable Kathleen Wynne government, but there were many questions about the process.  Dr. Jacobs exposed the situation in the press, and helped to stop a deal that would have effectively destroyed health care in Ontario.  It’s well known that I worked with him to stop this bad deal.  However, I think he’s on the wrong path this time.

I can appreciate how hard it must be for some specialists to feel good about the OMA right now.  On October 21, OMA Council passed an advisory motion recommending that the top three specialties might get cut by up to 6 per cent more (1% per year until 2024) than they have been already.  Most Ontario physicians unilaterally had their gross incomes cut by 7 percent by the desultory Kathleen Wynne.  Some of the higher paid specialties were cut more due to what’s known as targeted cuts.  If the OMA Board agrees to the Council motion, some specialists would be even more angry at the Association.

But the reality is that if Dr. Jacobs is successful in his endeavor, specialists will get eaten alive by government.  Any government.

The best example of split associations is in Quebec.  Specialists and Family Doctors each have their own associations. One can certainly see the appeal of going that route when you read stories about the big “raise” that specialists in Quebec got in 2015.  The “raise” was so large that some doctors actually protested it as being too much (no really) and wanted to give some of it back.

But one has to look at the facts first.  The deal was meant to compensate doctors for the fact that there was NO increase from 2007 to 2015 (fat lot of good having two associations did then).  Now, before the bulk of the “raise” sets in, a new government is in place and plans on eradicating it.  Who do you think can fight against governments more? Two small groups or one large one with more resources than either one?

Additionally, I’m not convinced that most specialists are aware of what the OMA is asking for in arbitration.  The OMA is asking for a repeal of all the cuts (targeted and otherwise), and normative increases (raises).  By contrast the small specialist group seems to only want the cuts repealed.  They have not asked for raises.  Why would specialists want to join a group that is asking for LESS at arbitration than the OMA is?

Here’s where this really hurts the specialists.  If I was the government, I would look at the fact that I was in arbitration with the OMA.  Faced with the possibility of physicians being paid more than I was willing to pay, I would try to divide the OMA.  I would probably send some sort of official to talk to the disgruntled doctors to encourage them on.  See if I could cause dissension in the OMA while I was fighting them in arbitration. If I was able to split the OMA, I would happily start to advertise the high gross billings (while ignoring their overheads) of this group of specialists and then use that to cut their billings even more in the future.  It’s called playing the long game.

Some specialists are understandably upset right now.  But under the current Arbitration process with the OMA, they still have the potential to recoup more of their lost income than this new group suggests.  Council also approved exploring potential dispute resolution mechanisms for relativity in arbitration.  If this can be organized in time, they would have a fair, impartial avenue to address their concerns.  Specialists will not have access to Binding Arbitration if they form a small separate group.  What are the chances that any government would freely offer a valuable bargaining tool like Arbitration to a newly minted organization?

Many doctors are frustrated with the pace of change at the OMA.  As someone who’s been accused (not altogether incorrectly I might add) of being too impatient himself, I understand that.  The OMA has made significant strides in the past year. More is planned.  But to bail out in anger only hurts people in the long run.

I worry that joining this group out of frustration and anger is going to further harm the specialists that I rely on to treat my patients.  They’ve taken a huge beating (as have all of us) the past few years.  The beating has not only been financial, but psychological and emotional as the loathsome Wynne government heaped scorn on doctors at every opportunity.

But in their anger, they are allowing themselves to be played by the government, and I fear they will be much worse off in the long run as a result.