Anger Leads To Bad Decisions

There were some interesting reactions to my last blog on the College of Physicians and Surgeons of Ontario (CPSO).  The most common (private) comment I got of course, was from colleagues saying they really liked it, but were too scared to share it in anyway on social media.  They didn’t want to be targeted by the CPSO.

The one comment that really stood out from me was by Dr. Darren Larsen, currently the Chief Medical Information Officer at Ontario MD.  Dr. Larsen wrote, “As professionals, why don’t we just treat each other with the same kindness and respect we would hope to be treated with by our peers and thereby stay completely off the CPSO radar screen?”  Dr. Larsen is right of course.  Having met him, I can also say that Dr. Larsen is genuinely one of the nicest people I know, and he absolutely always seems to live his life by the credo of being kind and respectful.  I’m happy for him that he’s able to do that.

Unfortunately, we are not all able to balance our lives like he has.

Currently physicians are overworked from trying to keep the health care system afloat.  When you crunch the numbers, Ontario has about 2.2 physicians for every 1,000 people.  In comparison, Germany has 3.8 physicians for every 1,000 people.  Heck even Bulgaria (!) has more physicians per capita than Ontario.  Coupled with an aging population and increasingly limited resources and bureaucratic inefficiencies, this leads to a significant increase in workload.  Physicians in Canada currently work over 50 hours a week plus call of between 20-25 hours a week.

The results of this crushing workload is entirely predictable.  The Medical Post recently did a survey on the best Province to practice medicine in.  My thanks to Dr. Dennis Kendel for tweeting out the chart below:

Work:Life

The most telling line is the one on work life balance.  Not a single province scored higher than “C” on this one.  Four provinces (including Ontario) got “F”.  A most telling table that gets to the heart of the issue of physician burnout.

Being human, physicians of course are subject to the same flaws as everyone else.  They don’t like to admit it mind you, but when the work/life balance gets skewed, physicians get irritable, depressed, make mistakes, and yes, say dumb things on social media that they wouldn’t otherwise.

More recently, I have noticed this irritability turn into anger amongst physicians.  In Ontario, physicians are going on over five years without a contract.  While we are still getting paid, the uncertainty of the situation is weighing on us.  Middle aged to older physicians are feeling the effects of years of mistreatment by the previous government and getting increasingly bitter with each passing day.

Even younger physicians have been affected.  Many trainees that I’ve spoken to (I’m a preceptor with the Rural Ontario Medical Program) are uncertain if they’ll be able to practice.  Turns out that despite an aging population, Ontario has unemployed physicians.  The situation is particularly acute in family medicine, where the government unilaterally slashed the number of Family Health Organization spots in half, leading to a new crisis in Family Medicine.  So even newer docs are feeling bitter.

I worry a lot about my colleagues.  We all know that making decisions out of anger and bitterness will generally lead to bad outcomes.  This applies equally to whether we are making decisions on patient care, or on issues like contracts, negotiations and especially medical politics.  We must base our decisions and actions on facts, and not frustration, no matter how justified that frustration may be.

Dr. Larsen also wrote: “….it is a privilege to be part of a self regulated profession. With that privilege comes responsibility.”  Again, absolutely a true statement and one that is hard to argue with.  But I happen to feel that the responsibility should apply not only to ourselves as individuals, but to regulatory bodies like the CPSO and also to member organizations like the OMA.  The OMA is planning a Task Force on the burnout issue, and will hopefully make some meaningful recommendations that can help with this issue.

To my colleagues, I once again ask that you do your best to look after yourselves.  Eat right.  Exercise regularly.  Take regular breaks from work.  Don’t feel guilty for taking a day off now and then.  Ask yourself if the decisions you are making are from anger, or based on facts.  Above all, try to be kind to your fellow colleagues.  They are probably feeling just as frustrated as you are.

Can The CPSO Regain The Trust of Physicians?

Disclaimer:  As always, the views below are mine, and do not represent those of the OMA, even though I happen to be the President- Elect.

The College of Physicians and Surgeons of Ontario (CPSO) governs, licenses and oversees the conduct of Ontario’s physicians.  Through a combination of a tone deaf, paternalistic attitude, and fear that “bad press” will lead to a loss of something called self-regulation, the CPSO has sadly lost the respect of physicians across Ontario.

Instances of poor physician behaviour continue to be (thankfully) very rare.  Despite this, it is safe to say that the CPSO has been under siege in the media.  Some of it is their own doing.  The CPSO actually once went to court to try to get a decision that their own Discipline Committee made enhanced – in effect they sued themselves.  Some of the media siege is due to zealous reporting (stories of “rich” doctors doing bad things sell newspapers).  Regardless, the media has clearly not been kind to them.

The CPSO response to the media was shockingly defensive.  Rather than trying to ensure a fair complaints process,  they decided to double down and severely prosecute physicians for truly ridiculous reasons.  The perception amongst front line physicians is that the CPSO is trying to “look tough” to get the press off their backs.

The most egregious example of this by the CPSO occurred during the debacle that surrounded the failed tentative Physician’s Service Agreement (tPSA) of 2016.  Emotions ran high in the profession  and physicians, being human, said things that they would not normally say.

Some of these things were clearly inexcusable no matter what the situation.  The CPSO was right to discipline physicians who repeatedly sent abusive emails to former Ontario Medical Association (OMA) President Dr. Virginia Walley.  But they went overboard in many cases.

When someone comes to my office who is angry, and using foul language, the CPSO expects me to show some compassion, try to find out why they are feeling the way they are, and work with them to reform them.  Yet the CPSO refused to extend that humanity to physicians who committed minor infractions.  Would it really have hurt the CPSO to ask these physicians if they were feeling burnt out, considering the magnitude of the physician burn out crisis?

I will not embarrass these physicians more by linking to media reports, but I will state for that record that the following physicians were disciplined, paid at least $10,000 each to the CPSO, and publicly shamed:

  • one physician, who replied to an anonymous email address with “stop sending me these f$%@#$ emails”
  • A physician who called Health Minster Eric Hoskins a “reichmaster” on facebook
  • Another physician who called Hoskins a “F@$% P#$&*” on facebook
  • A physician, who told a clearly inappropriate joke on a private electronic forum

NO patients were harmed.  NO medical incompetence was exhibited.  NO threat to the public.  And NO humanity exhibited by the CPSO to see if these physician were feeling all right.  If using the “f” word is cause for discipline, then judging by her Twitter feed, Dr. Jennifer Gunter, a leading expert in the fight against pseudoscience, had best not re-apply to practice in Ontario.

Worse, the CPSO exhibited a clearly one sided approach to how they meted out discipline.  In the aftermath of the tPSA, the OMA Executive faced a non-confidence vote.  Dr. Philip Berger, who has a well deserved reputation for social activism, decried the leaders of the non-confidence motion as “right wing coup plotters”, “dictators”, “fanatics” and so on.  Full disclosure, he is referring to me, current OMA president Nadia Alam and others.

In response, one physician on a facebook forum suggested Berger should take Ativan (a mild tranquilizer) and another suggested a stronger tranquilizer.  Guess who the CPSO decided to investigate, even though a formal complaint was NOT laid? (The CPSO can investigate at the discretion of their Registrar).  Guess who DIDN’T get investigated for making unprofessional comments about another colleague at the discretion of the Registrar?  The message from the CPSO was clear.  You can disparage another physician only if you have the right political view point.

For the record I will not lodge a complaint against Dr. Berger for disparaging me.  It would be a stupid, idiotic waste of the College’s time, and it was pathetic for the CPSO to wade into this in the first place.

More recently, workers striking at a family practice clinic wrote an open letter to the CPSO complaining about physician behaviour in a clear negotiations tactic.  Instead of realizing it for what it was, the CPSO instead sent their communications director to follow up and “offer support in filing a formal complaint.”  The fact that they were completely blind to this being simply a negotiation tactic is befuddling.  This was proved when the doctors in Owen Sound stated that the union withdrew the complaints as part of the negotiated settlement.

In fairness, new CPSO Registrar/CEO Nancy Whitmore appears to be trying to change all that.  She has promised efficiencies in the painfully long complaints process.  This would allow her staff more time to deal with serious complaints about physicians’ competency and misconduct, while quickly dismissing frivolous ones.

Additionally, I confess that I’ve been pleasantly surprised at how co-operative the staff at the CPSO have been with the OMA to modify the Continuity of Care Policy.  The original policy would have placed unreasonable bureaucratic burdens on physicians, and might have killed off family medicine and walk in clinics.

These are welcome changes in approach and should be lauded by every one.

I do feel Dr. Whitmore genuinely cares for physicians, and wants a fair process to help them and protect patients.  However, this might be seen as too little too late by many members.  The CPSO has governed the profession by fear (instead of respect) for so long that physicians are extremely jaded about the organization.  Public dissatisfaction with the CPSO doesn’t help either.  Here’s hoping that Dr. Whitmore can maintain the reform minded approach she has initiated.  It will be best for patients, physicians, and the CPSO.

Open Letter From Owen Sound Family Doctors

Disclaimer:  The following letter was written by the twenty-two family physicians in Owen Sound, who were recently the subject of a major labour dispute.  The doctors feel that there were many aspects of the dispute that were incorrectly reported in the media, and have asked me to publish their letter on my site so they can present their view.  Opinions are theirs.

The doctors of the Owen Sound Family Health Organization (FHO) feel they have an obligation to provide an update to the community with regard to the recent ratification of an agreement with OPSEU local 276.

After our employees decide to strike in May, we discovered that many of the practices we had been using to support the provision of patient care were inefficient and frustrating for physicians and patients.  We advised OPSEU of this in July.

Among the many improvements we made are better management of patient records, phones, web bookings and communications with patients.  Patient Kiosks have been established that many people use on presentation for an appointment.  Some redundant and inefficient activities during patient interaction were identified.  All of this was done while the workers were on strike.

OPSEU was advised of our plan to reorganize and institute two positions that we felt would better meet our needs.  We developed a position called a Patient Flow Co-Ordinator to help patients navigate our clinic.  We plan to hire Medical Office Assistants who ARE College certified to meet our other needs.  OPSEU ultimately agreed with our plan to move forward with these hires.  We’ve also hired 2 Clinic Managers.

Out of respect for the work done in the past, we offered the employees that remained a severance package (through OPSEU) that would provide financial support as they seek employment better suited to their skill sets.

OPSEU has produced much information during the negotiations, strike and ratification process.  Their details do not fit our understanding of what has happened.

We categorically deny any allegation of harassment, bullying or threats by the employers or its representatives, as OPSEU alleged (without foundation).  We feel that these allegations were advanced by the union and its supporters against physicians, patients and replacement workers in failing attempts to generate support for the strike.  This was horrifying and exceeded anything we would have expected in a workplace dispute.

One person who attended the health centre alleged that because she did not roll down her window to speak to strikers, her car was subject to $4,150 in damages.  She provided the picture below (complete with accessible parking permit in her dashboard).

BrokenWindshieldCut

Another incident involved a veteran who was attending the health centre and stated he was subject to abuse at the picket line.  He has provided a letter, but is too traumatized to allow his name to be printed.  There were many other incidents.

OPSEU has attempted to promote misinformation during the labour dispute.  It even filed a complaint of unfair labour practice with the Ontario Labour Relations Board.  We defended the complaint and it was ultimately withdrawn by OPSEU.  It had no merit.  Our response is attached.

OPSEU’s President also filed official complaints about 3 physicians with the CPSO (our licensing body) even though he never had any direct contact with those physicians.  We feel these complaints were used in attempts to intimidate the physicians.  In the end, we stood up for health care and the complaints were withdrawn.  They were without merit.

OPSEU’s President misinforms when he states that “public money” was used to hire legal support and security.  Physicians are paid for the services they provide.  Physicians then hire staff to support the provision of patient care as well as cover usual business costs (rent, utilities, equipment, etc).  When faced with complex legal and human resource management issues like this, we had to get appropriate legal support.  Given OPSEU’s tactics, security was essential to try to protect our patients.

Additionally, OPSEU did target the 3 physicians who were on the negotiation team as being “owners” of the organization.  This is untrue.  We are a group of 22 physicians who operate in a FHO and have formed a business partnership to manage our expenses.  We rent our premises and essentially own nothing.

Some of our former employees did not support the actions of the union and did end their employment with us citing a lack of support for the union.  Almost 45% resigned during the strike.  We regret that many good employees have had their lives disrupted in this way, but unfortunately there was nothing we could do within this system to rectify that.  Once employees are unionized they have to support their union or are threatened with major financial fines.

We feel that we have been transparent, respectful and honest during this process.  We have received overwhelming support from our patients and public and are enormously grateful for that.  Letters to the editor like this one have resonated with the community.  We hope we can move forward as a group and support each other to provide better, more efficient care.

Yours truly,

The Doctors of the Owen Sound Family Health Organization

 

 

A Few Random Thoughts

Disclaimer:  As always, just a reminder that while I am President-Elect of the OMA, the opinions in the blog are mine, and not necessarily representative of either the OMA as a whole.  I just like to tell people what I’m thinking.

Changes at the Ministry of Health (MOH)

Interesting change at the MOH.  Nancy Naylor, who was the second in command, has left the Ministry.  She is going over to the Ministry of Education.  I had the opportunity to work (briefly) with Ms. Naylor when I was on the executive of the Section of General and Family Practice.  I found her to be a very knowledgeable person and easy to work with.  I certainly wish her well.

However, as my loyal fans (both of them) know, I don’t particularly believe in co-incidences (Bob Bell suddenly “retired” when the Liberals lost?  Yeah, right).  At the MOH Ms. Naylor was the person the LHINs reported to.  Leaving that role during a transitional period is very curious timing.  Given that Premier Ford has instituted a hiring freeze on bureaucrats, that means that the LHINs don’t currently report to any one other than new Deputy Minister Helen Angus.  Frankly, looking after the LHINs as well as doing everything else the Deputy is required to do is a lot to ask.  Unless (and this is pure speculation on my part) this foreshadows the long hoped for elimination of the bureaucratic quagmire that are known as LHINs.  Be interesting to see how this plays out over the next couple of months.

Changes at the Canadian Medical Association (CMA)

This week, the CMA is holding it’s annual general meeting.  Dr. Gigi Osler takes over as President.  I had the pleasure of meeting her (however briefly) at the OMA Annual General Meeting in April.  Dr. Osler is a remarkable woman with more accomplishments in her pinky finger than I have in my whole body.  That the CMA is going to be led by her this year is unquestionably a benefit for the organization (given all their troubles this past year) and for physicians across the country.  Dr. Osler is an incredibly passionate advocate for physicians health and well being, and we are all lucky to have her speak out on such an important topic.

I do wonder how she is going to handle the internal politics of the CMA.  Based on the interview given by outgoing President Dr. Laurent Marcoux, it really seems to me that the old guard at the CMA (which still populates much of the Board and management) really doesn’t understand just how much they’ve alienated their members.  You would think the uproar created by their flawed “Vision 2020” mandate, not to mention the sale of MD Management, would have made them at least reflect on their path.  Physicians need a national advocacy association that places their interests first.  I hope the CMA recognizes that Dr. Osler’s popularity is because she speaks to that need, and that the old guard doesn’t try to silence her.

More Thoughts on the Strike in Thunder Bay

The strike at the Port Arthur Clinic was finally settled last week, after a bitter, acrimonious period that included a fence being put up, and criminal activity being committed by somebody.

I still worry about what this means long term for the Port Arthur Clinic.  They are all human beings there, and I can’t imagine that it will be easy for them to get back to work. It certainly will take years for the trust to rebuild.  I suspect, sadly, that we haven’t heard the last out of issues coming from this clinic.  I hope that first and foremost, the patients get the care they deserve.

Ontario Medical Association (OMA) Becoming More Outspoken

It’s been a couple of turbulent years at the OMA.  However, it’s nice to see that the leaders of Association speaking out more and more on physicians issues.  It started last year when Dr. Shawn Whatley was President and he advocated strongly for physicians first.  Through his many blogs (which are required reading for anyone interested in medical politics) and his multiple TV and radio appearances, he really got the ball rolling.   His simple mantra that you can’t improve health care by disparaging physicians, while self evident, really struck a chord and needed to be said.

This year of course, we have the incredible Dr. Nadia Alam.  Another ridiculously accomplished young physician, she has moved quickly on her belief that the OMA must defend physicians when they are attacked, and defend patients when their care is compromised.  This was most recently seen in her quick reaction to the strike in Thunder  Bay.  Whether in the news, or her personal blogs, she has repeatedly been speaking out on issues where physicians voices are compromised.

While there is still much more to be done at the OMA, it’s refreshing to see that the organization is speaking out on areas like this.  It means I have huge shoes to fill next year, but I can honestly say I’ve been inspired by the actions of the last two Presidents.

 

Health Care Will Suffer in Owen Sound, Thunder Bay For Years

“That’s the thing about trust. It’s like broken glass. You can put it back together, but the cracks are always visible–like scars that never fully heal.” 
Hope Collier

A fifteen year old comes to my office.  She’s pregnant.  She’s petrified because her mom and one of my staff are good friends, and her mother doesn’t know.

A thirty year old man, with a long history of mental illness finally admits he was sexually assaulted as a child.  He didn’t tell me sooner as the abuser worked with the husband of one of my employees.

A couple is having marital problems.  There are affairs and now sexually transmitted diseases involved.  They’re trying to work it out, but were scared to seek help as one of my staff goes to the same Church.

I’ve seen all of this, and much more, practicing medicine in a smaller centre.  I would not have been able to manage these tricky situations if it had not been for the trust that I have in my staff.  Like all family physician’s staff, mine have access to a great deal of personal information.  I cannot effectively do my job without implicitly trusting them to ensure that confidential information stays confidential.  I rely on them to skillfully do tasks I assign them for patient care.  But I also trust the judgement that they have about certain situations and certain patients (they have a wealth of social knowledge that is invaluable to me).

This implicit trust is the hallmark of a high functioning health care team.  Each member of the team is valuable, and each carries out their duties, knowing the other member will carry out theirs.  This does not mean that we always agree on everything.  Healthy discourse is important.  But it means that at the end of the day, we know we will act in a patient’s best interests.

Which brings me back to the miserable situations in Owen Sound and Thunder Bay.  In Owen Sound, to try to make up for his failure as a leader, OPSEU President Warren “Smokey” Thomas wrote to the College of Physicians and Surgeons (CPSO) to complain about the alleged tactics used by the physicians in the dispute.  Let’s be clear, when you complain to the CPSO, you are threatening a physician’s career.  A complaint should only be made in an egregious situation (for example sexual assault) and not over a pay dispute.  Smokey himself is a nurse.  He should have known this.

The situation in Thunder Bay is worse.  Last week, under the leadership of Unifor President Jerry Dias:

Ontario Medical Association President Dr. Nadia Alam, stated that over 1,000 appointments were cancelled.  Many had travelled 100s of kilometres.  Many had been waiting for months for their appointments due to the severe lack of specialists in the North.  Cutting the power caused loss of vaccines and, as the only fertility clinic from Sudbury to Winnipeg, also a loss of sperm and egg samples.

Eventually, these disputes will end one way or another.  But what will never, ever be the same, is the trust between physicians in these clinics and the staff.  How are the doctors in Owen Sound going to trust employees who threatened to end their careers?  We are not talking about large corporations that make widgets where workers on the line never meet their boss.  We are talking about smaller, intimate offices where everybody knows everybody.

In Thunder Bay how exactly are the doctors there supposed to trust employees whose actions, however indirectly, led to alleged assaults, physical threats and intimidation and vandalism?  Unifor is denying responsibility for the vandalism, and no doubt will disavow assault/harassment as a tactic, but the blunt reality is that without the fence, none of the other stuff would have happened.  No wonder a number of physicians are considering leaving Thunder Bay.

Worse, what does this mean for the type of health care that is going to be provided in these areas?  The patients of Ontario have a right to high quality health care.  As mentioned, when there is no trust within a team, health care will suffer.

The stories of Owen Sound and Thunder Bay have gone viral in the medical community.  Both areas are short of doctors.  How they will now recruit new physicians in the current environment is beyond me.  The reality is that physicians are fortunate to have multiple options when they choose an area to practice.  Why would any sane person go to these toxic environments?  How will Thunder Bay replace physicians who leave?  The stench from these messes will take years to fix.

The biggest losers are the employees of these clinics.  They made a legitimate request for raises and improved working conditions.  Unfortunately, they put their faith in two Union men, who clearly didn’t have a clue about how health care offices work.  They used tactics more suited for factories, not physicians offices.  The tactics have failed miserably (four months and no contract yet).  In Owen Sound, 40% of the employees have quit, recognizing Thomas’ inability to get the job done.  In Thunder Bay, if physicians leave, there will be job losses amongst employees there as well.  Worse, the employees will be blamed for worsening access to health care, if doctors do leave.

The employees of these clinics deserve strong, effective and appropriate representation.  Sadly for them, they are not getting it from OPSEU and Unifor.

Nightmare in Thunder Bay

Not a full blog this time.  But for those of you who don’t follow me on twitter (@drmsgandhi), I just wanted to bring your attention to two blogs.  Both deal with the deteriorating situation in Thunder Bay where a union (in this case Unifor) has, as a result of their actions, denied health care to over a 1000 patients.  Many of these patients were elderly, and many had waited months for a specialist appointment.

The first blog is by the President of the Ontario Medical Association, Dr. Nadia Alam, and can be read here.

The second is by the Past President of the Ontario Medical Association, Dr. Shawn Whatley, and it can be found here.

I encourage you to read both of them.

View story at Medium.com

“Smokey” Thomas Fails His Members

Authour’s Note:  Once again, I would like to state that while I am President-Elect of the Ontario Medical Association (OMA), I have not spoken with any of the Family Doctors in Owen Sound about this situation.  I did email them to ask permission to write this.  All of my thoughts are strictly based on reports in the media, and news releases (all of which are hyperlinked).

Last week I had suggested that Ontario Public Services Employees Union (OPSEU) President Warren “Smokey” Thomas should change his approach on how he dealt with physicians in union disputes.  Sadly, Smokey has doubled down on his tactics.  In doing so, not only has he utterly and completely failed his members, but he risks endangering health care in Owen Sound.

In Owen Sound (population ~ 21,000) there are 22 family doctors who have organized themselves into a Family Health Organization (FHO).  The FHO is a fairly common payment model that consists essentially of a salary and performance bonuses.  Like all other payment models the FHO models experienced years of deep cuts to their budgets during the desultory tenure of Premier Kathleen Wynne.  Cuts to physician payments, mean cuts to patient services.  Hence, the FHO focused on controlling expenses as best it could.

The staff at the FHO chose to unionize (which is their right) but unfortunately chose to do so under OPSEU, and became Local 276.  OPSEU and Smokey have absolutely no experience in dealing with intimate small office settings, and the necessary collegiality that is essential to providing high quality front line care.  As a Family Doctor, you MUST trust everyone from the receptionist, to the nurse and even the cleaning staff.  While disagreements occur, and are often healthy, the trust cannot be compromised, or patient care will suffer.

Smokey and OPSEU’s lack of experience showed almost immediately. Their bargaining team agreed to a contract and recommended it for approval to the FHO staff in May.  That’s right folks, OPSEU actually reached an agreement.  But the agreement was rejected by the FHO staff, a clear repudiation of OSPEU’s leadership.

This appears to be when Smokey went off the rails.  He (and OPSEU) could have taken a hard look at themselves and asked a simple question – “How could we be so out of touch with the members we represent, to have endorsed a deal they rejected off hand?”. But they didn’t.  Instead, in what seems to be an effort to prove to their members that they really are relevant, they doubled down and started hurling insults and threats.   Doctors were “punch drunk with greed” they screamed.

The FHO staff then went on strike, and the results appear to be disastrous for them.  Firstly, OPSEU should have told them that doctors office are not factories that make sprockets and cogs.  They provide essential medical services and they cannot be shut down.  The physicians continued to work, with legally allowable replacement staff (albeit at reduced levels).  All a picket line would do is harass patients, and that won’t win you public support.

Reports of harassment and even a serious medical event involving a replacement worker appeared, although it’s unverified.  Again, instead of stopping to think “What exactly are we accomplishing here?” Smokey, doubled down, increased his insults to physicians, demanded that the Health Minister and Owen Sound Town Council get involved (he failed miserably).  He also made a ludicrous allegation that physicians were “private and for profit”. Has Smokey not read the Canada Health Act?  Physicians haven’t been private since 1984.

Apparently, ten of the 30 FHO staff got wise to what a lousy job Smokey and OPSEU were doing, and actually quit their jobs.  Yet another opportunity for OPSEU to reflect on their own failures as a bargaining agent.  But yet again, Smokey lashed out, this time by asking the College of Physicians and Surgeons of Ontario (CPSO) to get involved.

Let’s be clear, the letter written by OPSEU is a collection of hearsay without naming any one physician. As such, it cannot possibly be investigated by the CPSO.  If they were to do so, it would diminish the already poor standing the CPSO has in the eye of most physicians, and would send a pall over the entire profession. They would almost certainly faced increased calls from physicians to lose self-regulation if there was anything other than a cursory “thank you, but this is outside of our purview” type response.

But the reality also is that a letter to regulatory body like this takes you beyond any hope of restoring trust in your team.  It’s the one thing that has potential to destroy careers. It’s the one action that essentially screams “irreconcilable differences”.  By going down this road, in what seems to be a desperate attempt to prove his worth, Smokey has caused a toxic meltdown to the point where there is no hope of a resolution.

The members of OPSEU Local 276 would do well at this point to really ask themselves if this is the kind of leadership they signed up for.