justanoldcountrydoctor

Local Medical Schools Will Help Address Doctor Shortages

Old Country Doctors Note: I was a teacher with the Rural Ontario Medical Program for three decades. It was founded by Dr. Peter Wells, and based on the principle that putting trainee doctors in smaller communities will enhance the chance of them working there. It’s been wildly successful. On that same note, Dr. Butt feels that putting a Medical School in Barrie will help increase recruitment to smaller centres, and I think he’s right. His Letter to the Editor appeared in the local press, and he’s given me permission to reproduce as a guest blog here.

Dr. Atif Butt (pictured inset) guest blogs for me today. He’s one of these ultra smart characters who not only has and MBA (McMaster 2003) but also and MD (McMaster, 2011) and a CCFP (EM). He’s retired from the Military (Major) and works in ER in Alliston, and Urgent Care in Barrie and does sedations in an endoscopy clinic in Innisfil. Apparently he’s quite the dancer too.

Barrie has been home to my family and I since the fall of 2013. It is a wonderful area to raise a family and offers everything that a mid-size community requires but also the peace and quiet lacking in larger urban areas. It is also the gateway to cottage country.

I am surprised at how fast the city is expanding as demonstrated by the numerous condo buildings and townhouses being erected, especially on the Barrie/Innisfil border. A growing city will result in many consequences, some positive (e.g., more cultural diversity, more revenues for local businesses, etc.) but also some negatives (e.g., traffic headaches). It will also mean a growing population that will place greater demand on local health-care resources.

I have been practising medicine in several health-care organizations in the Barrie/Innisifil/Alliston area since 2013. I am impressed by how much demand is placed on local health-care organizations, yet they continue to persevere through. The success is fundamentally thanks to the heroic work of the health-care workers including physicians, nurses, and other allied health-care workers who band together to serve patients, often sacrificing their own nights and weekends. But we all have our limits and simply cannot do more.

Currently, almost six million Canadians (out of which over two million are in Ontario) do not have a family doctor. More specifically, it is estimated that over 55,000 people in the Simcoe County area do not have a family doctor. Almost every day, there are news reports of lengthy wait times in the ERs, which are frankly longer than plane flights from Canada to Pakistan. Attempts have been made to address such shortfalls by the use of nurse practitioners, physician assistants, and pharmacists and I am grateful for the work they provide. Nonetheless, physicians cannot simply be replaced by non-physicians and more are needed. That is why I am proposing that either a new medical school be created in the Barrie/Innisfil area or, preferably and more cost-effectively, seats from an existing Ontario medical school be expanded to our area.

I am encouraged to see that some efforts have already been made to expand medical school seats in Ontario. Examples include the 2025 opening of the Toronto Metropolitan University medical school and the upcoming opening of the York University medical school in 2028. I appreciate that such endeavours can be costly. For example, the federal government just announced almost $2 million to expand medical seats and services for the Northern Ontario School of Medicine. While this will greatly support the north, sadly, Barrie and the surrounding area seemed to be left out.

Despite investments in new medical schools, the demand far exceeds supply. For example, the newest medical school at TMU had 6,416 applications in 2025 but total projected class size in 2026 is 94. That means 1.5 per cent of applicants got accepted. Most medical schools in Ontario roughly seem to have on average about a three- to five-per-cent acceptance rate. While adding medical seats in Barrie/Innisfil maybe a drop in the bucket, it will hopefully lead to an ongoing pool of locally trained physicians that will want to practice in our area. Return of service contracts, where physicians have to practice locally for four to five years after training, can be a condition for acceptance into a medical school here.

Canada in general and Ontario in particular have a lot of talent, yet we are losing out. On a regular basis, I come across undergraduate students who have high GPAs/marks, extraordinary extra-curriculars and experiences, scored high on their MCATs, have applied multiple times to Canadian medical schools, yet are unable to even get an interview (let alone acceptance) into a Canadian medical school. Their families are often spending hundreds of thousands of dollars per year (in U.S. dollars) to send them abroad to the U.S./Caribbean/Europe so that they can pursue their dreams of becoming a physician. Even after they graduate from an international medical school, there is no guarantee that they will obtain a residency spot in Canada since preference is given to Canadian-trained grads. Hence, they may be forced to practise elsewhere like the U.S. Would it not be better if we could retain and train such talent who invested their tuition locally and then stayed to practise?

Intuitively, when medical trainees train in a particular geographical area, many will choose to stay and practise in that area. While in Barrie we have the Family Medicine Teaching Unit for training family medicine residents and the expansion of some ER residency spots at Royal Victoria Regional Health Centre, I believe that the next logical step is to have medical school seats in the Barrie/Innisifil area. This will allow us to recruit and retain future physicians in the local area.

I find that the simplest goals are often the most achievable and realistic. A brand-new expensive medical school with new infrastructure may be a costly pill for any government to swallow. Thus, simply expanding, say, a dozen seats, from an existing Ontario medical school to our area using existing hospitals or other health-care facilities may be much more palatable. Students will be able to virtually watch online any didactic lectures that are delivered at main campuses to obtain theoretical knowledge. Any practical knowledge and skills can be completed with assigned preceptors and through core rotations (e.g., ER, family medicine, obstetrics, general surgery) and elective (e.g., plastics, radiology, etc.) at several of the amazing and existing local hospitals and health-care facilities from Orillia to Barrie and Alliston to Newmarket. After doing three to four years of medical school and assuming they do a two-year family medicine residency in the Barrie/Innisfil area, I suspect many will choose to stay and practise in our wonderful area.

I have already reached out to several governing officials including the Office of the Premier of Ontario and the provincial minister of health to share my proposal. While their offices have provided some appreciative yet general responses of their broader investments, I truly believe that it is through greater and ongoing public support and engagement that expansion of a medical school in Barrie can be achieved. In other words, while I as a physician can write a prescription and explain the risks and benefits of the medicine, it is up to the patient to actually take the prescription. In this case, my prescription is the expansion of medical school seats to the Barrie/Innisfil area and I am asking you, the patient, to engage the government in filling this prescription.

Why the OMA Annual General Meeting Matters This Year

I was thinking about what to say about this years OMA Annual General (AGM) meeting. As a die hard Star Trek fan, my thoughts went back to the excellent Next Generation episode, “The Drumhead“. After foiling the ambitions of a Federation official to twist things for her own benefit, Captain Jean Luc Picard reflects that “vigilance is the price we continually have to pay.”

It’s the same for the OMA. Things go off the rails IF members don’t pay attention. Given how big, complex and convoluted the OMA is, well, members do tend to ignore some of the goings on (I am just as guilty of this as other people).

The governance changes at the OMA are a great example. What started out as well intentioned (and badly needed) changes to modernize the organization, in the aftermath of the debacle of the mid-2010s, has been turned into something worse than what was intended. For a bunch of reasons, I personally continue to think that it is still better than the previous structure – but a course correction is needed. We’re now in a situation where the staff seemingly control everything, regardless of what members want. Because, let’s face it, as a whole, we physicians didn’t pay enough attention to the OMA. Thus, the organization was able to repeatedly put changes in place that benefited the organization, ahead of the rights of front line physicians.

It’s gotten so bad that two OMA Board members, Drs. Paul Conte and Paul Hacker, resigned their roles early. These are not just ordinary Board Members. Dr. Conte is a former Board Chair, and also Chaired the Governance and Nominations Committee of the Board. Dr Hacker Co-Chaired the Governance Transformation Committee when all of these changes were put in place . They are absolute experts in the field, and if they say something is wrong with what’s going on, well, you can bet it is.

This is why you should all virtually attend the OMA’s Annual General Meeting (AGM). Dr. Paul Conte has come up with four motions (which I am seconding) to present to try and get the organization back to where it should be. There is some wordy legal jargon in the full motions so I’m only going to list what each motion hopes to accomplish and why. The full motions should be in the meeting package you receive when you register.

Motion 1 and 2: Removal of references to non-physician members and increase physician directors to 10

Some background. I was the founding Chair of the Georgian Bay Family Health Team. When we put the team together we knew that there were some skill sets, information and knowledge that physicians just didn’t have. Finances, negotiations, business plans and so on. So we had non-physicians on the Board of the team to help provide those insights. But we also realized that you cannot have a situation where non-physicians governed physicians . As a result, those non-physicians were what we called ex-officio Board Members. They could contribute and offer suggestions at the Board level, but they were not able to directly make decisions.

When the OMA began the necessary governance transformation process, I begged the staff of the OMA and the consultants to do the same thing with non-physician directors. They refused. I was told “Board Members had to vote” under ONCA (Ontario Not for Profit Act). This is twisting things. If you really want a non-voting person on the Board you can create a separate category – say “Board Advisor”. But the staff and consultants just didn’t want to, regardless of what the duly elected representative of the profession said. Then Covid got in the way, and ……….

By passing these motions we will eliminate non-physicians from having voting authority at the Board Level. The OMA can still have them there as consultants if they want – but non-physicians will not have the ability to govern physicians anymore.

Motion 3: Removal of the Screening Process for Board Directors

This year’s election process was an absolute travesty. Not only did the OMA unilaterally screen and short list candidates for Board Director, and only allow members to vote for the candidates THEY felt appropriate, they impugned the reputation of one of the President Elect candidates, by putting up a subjective opinion of their social media posts. It’s up to each individual physician to judge a candidate, NOT the OMA.

By doing so, not only did they harm a reputation, they’ve bastardized the whole election process and by default have tainted the victory of Dr. Haroon Yousuf.

This motion will put a stop to this nonsense.

Motion 4: An end to the Nadia Alam Rule

When I was on the OMA Board, it was quite obvious to me that many of the Board Members were extremely jealous of the popularity of Dr. Nadia Alam, who pretty well skyrocketed to fame because she spoke up and inspired others (including a certain grumpy curmudgeon who was going to sit the dispute with the government out). As a result they forced the implementation of a rule that says that anyone who held the role of President can no longer run for Board, even if they have less than 6 years on the Board (the current term limit).

Dr. Nadia Alam

The stated rationale for this goes something like “we give our presidents all sorts of publicity and it’s an unfair advantage if they run.” This is, of course, a load of cow manure. There are a whole lot of Past-Presidents who got lauded by the OMA and would get exactly one vote if they ran for anything ever again. This rule assumes the membership is too stupid to recognize who can inspire them and who can’t – and really is telling the membership they aren’t smart enough to know who to vote for.

Furthermore, Ontario is THE ONLY Provincial Medical Association that has this rule. (For that matter, no other Provincial Association screens Board candidates like this or puts subjective comments on election packages.)

Time to end this rule as well.

What happens if members don’t show up and the Motions Fail?

As members, we have a choice. We can spend a couple of our hard earned hours investing in and attending the AGM, hearing arguments both pro and con, and voting in the best interests of physicians. Or we can sit passively by, in which case the motions will likely fail, and the OMA will be emboldened, and continue to make choices for us, rather than the other way around.

Since my friend Paul Conte prefers the other, far inferior space franchise, this will be akin to the end of Revenge of the Sith, where Padme Amidala realizes:

Let’s not let that happen

If you are an Ontario Physician, I urge you to register for the AGM here:

https://web.cvent.com/event/c17ccc6c-d186-4ab8-985f-2e48127b4ffb/summary?sfmc_id=7563168

Springing Forward Into Stupidity: How British Columbia Traded Science for Convenience

There’s a particular kind of modern arrogance required to look a room full of experts squarely in the eye and say: “Yes, yes, very interesting, but have you considered that people find it inconvenient?“

The Government of British Columbia has that arrogance. In a bold act of democratic self-determination, BC has moved to lock in permanent Daylight Saving Time (DST), essentially agreeing, as a society, to spend half the year pretending the sun rises an hour later than it actually does. No more fussing with clocks twice a year! No more groggy Monday mornings in November! Progress, at last!

In fairness, that decision is partially based on some good evidence that there is no need to change clocks twice a year. It does not reduce energy consumption as previously thought. It’s overall harmful to people’s health. BUT, in a trend that has been growing ever since the Covid Pandemic, there appears to be more and more ignoring of the actual science, in the name of convenience.

The scientific consensus on this is about as settled as it gets outside of climate change and vaccine safety. Study after study links permanent DST (as opposed to permanent Standard Time) to increased rates of depression, cardiovascular events, metabolic disruption, and a general dimming of the human spirit that no amount of “extra evening light” can compensate for. The medical community has been remarkably consistent: Standard Time is the one that actually aligns with human biology.

But BC picked the wrong one because the evenings feel nicer.

The 10,000 Lux Future We’re Sleepwalking Into

Here’s a prediction: within a decade, the market for bright light therapy lamps that blast 10,000 lux of artificial sunlight directly into your face, will quietly explode across British Columbia. Families will gather around them at breakfast, bathing in simulated dawn while the actual sun crawls reluctantly above the horizon sometime around 9 AM in December. It will become as mundane as having a coffee maker on the counter. A morning ritual for a society that engineered itself into needing one.

The irony is exquisite. They rejected a scientifically sound way of avoiding clock changes in the name of convenience. Now the next generation will be purchasing expensive medical devices to compensate for what their own circadian rhythms are desperately trying to tell them. The body, it turns out, doesn’t care what the clock says. It cares about the sun. When you spend six months of the year eating breakfast in the dark because a legislature decided that post work golden hours were more politically palatable than morning light, well your body will not be happy. Fatigue, depression, and the nagging sense that something is profoundly off will follow.

Where Were the Adults in the Room?

This, of course, raises the obvious question. Why didn’t anyone listen to the science? The honest answer is that our political culture has largely burned through its reserves of thoughtful, deliberate governance. This was exemplified by the Covid pandemic, when large swaths of people decided to reject the consensus that Covid was airborne , because they just didn’t like wearing masks. Political prices for following evidence that the general public didn’t like were paid. Politicians noticed.

Governments now seemingly use a cocktail of impulsiveness and ideology to make decisions. The boring, unglamorous work of actually reading the evidence, consulting experts, and acting accordingly is rejected. Into this vacuum has rushed something far less useful, the politics of framing. Instead of a straightforward public health question, “which system produces better health outcomes?”, we now have debate on what sells well with the general public. “But I like to golf at night!” “I want to sit on my patio till late!”

In that environment, experts might as well be speaking ancient Incan.

Governance today often seems to attract people operating at an almost feverish pitch. Rather than slow deliberate study of an issue, we have reactive, ideologically committed decisions allergic to nuance. Political culture now treats careful consideration as weakness and impulsiveness as authenticity. In that environment, it’s not surprising that a decision with clear scientific guidance instead got made on the basis of “vibes.”

How Did We Get Here?

That’s perhaps the most unsettling question of all. This is happening in all fields, not just public health. Urban planning, the aforementioned climate change, immigration policy, you name it. Experiences and facts say one thing. Politics, convenience, or ideology says another. Convenience wins. Our society absorbs the consequences.

This has been particularly fuelled by the rise of social media. At its worst, social media is well known to promote a culture of instant gratification. Which has profoundly impacted decision making. “Oh, I may get Covid tomorrow, but I don’t feel like wearing a mask today”. “Maybe I’ll be depressed in six months, but I want to golf tonight.” Etc.

The sad thing is that I think that deep down, most of us know this. We know that good governance requires scientific literacy, patience, and a willingness to accept inconvenient truths. We know that political culture has drifted away from those qualities. We know that we are, collectively, making ourselves worse off.

But we allow governments to do it again anyway.

The Clocks Are Wrong, and So Are We

There’s something almost poetic about using time itself as the canvas for this particular failure. Time is the one thing nobody can argue doesn’t affect them. Every person in British Columbia will experience the consequences of this decision in their own health, every dark winter morning, without exception. The evidence on that is pretty clear.

So go ahead and enjoy your long summer evenings. The light really is lovely. In November, when the alarm goes off and the sky outside is pitch black and your body is quietly staging a protest you can’t quite articulate, you might find yourself idly browsing light therapy lamps from online stores.

They work pretty well, actually. The science on that is solid.

Not that it’ll stop us from ignoring the experts next time.

Open Letter To Dr. Cathy Faulds and Ms. Kim Moran: Why Should Members Bother Voting?

To: Dr. Cathy Faulds, Board Chair, and Ms. Kimberly Moran, CEO, Ontario Medical Association

Dear Dr. Faulds and Ms. Moran,

I’m writing to express my extreme displeasure about how the OMA has handled the elections process. The past couple of years have seen more and more that the OMA, as an organization, has sought to limit the ability of front line members to choose their representatives. This has had the effect of further disenfranchising the hard working physicians whom you are supposed to serve.

In the past couple of years, the OMA as an organization has put in extremely restrictive rules on candidates, particularly for Board Director. Candidates were not allowed to “campaign”. Candidates for Board and President can only offer up a brief statement that answers certain questions, and not much else. Town Halls were controlled with Orwellian like micromanagement. All candidates could only submit a pre-approved list of skills. No one is allowed to let their personality show through.

Even asking candidates a question, like I did last year, is verboten. The penalty for daring to ask candidates to answer a difficult question was to have your career and livelihood threatened by a code of conduct complaint.

This year, the elections process is markedly worse. Instead of letting members choose who they wish, you shortlisted candidates. (NB – please spare me the nonsense about hiring an “independent” third party to review the candidates – we all know that “independent” consultants get guidance from the organization they are hired by. They just do the dirty work of the hiring organization).

I will NEVER criticize a candidate for running (I may criticize their position or views – but not for choosing to run). It takes a lot of guts to stand up and bear the slings and arrows that inevitably come your way. BUT, the blunt reality is that your “shortlisting” process is by default going to create an entirely bland, non-confrontational and non-outspoken Board. It will create a Board that will not provide appropriate oversight to the OMA.

For example, one of your approved Board candidates was asked on Social Media if elected they would commit to change the direction of the OMA so that it would stop speaking out against expanding the scope of practice for pharmacists and others. (The questioner has been very vocal that allied health care providers can do much more). Your approved candidate replied with a response (I’m paraphrasing):

“I will always be on TeamPatient. We need to follow the evidence where it leads.”

The questioner was quite happy and obviously didn’t realize that the exact same response could be given if someone had asked the candidate: “Will you get the OMA to be MORE forceful in preventing expansion of scope of practice to allied health care professionals.” It’s the type of bland, non-specific, non-controversial response that is often taught in various “Leadership” courses and “Director” courses. You know, the type that is designed first and foremost to not offend anyone, while making everyone on both sides think you agree with them in the hopes that this will somehow make you able to enact change.

(I’m not naming the candidate because truth be told, overall I actually like the person and if it wasn’t for the shenanigans that the OMA has been doing, would likely have voted for them – It was just too good an example to illustrate my point to pass up).

What’s worse is how you have treated the current list of candidates for President Elect. While I absolutely would agree with doing a social media search (along with other reasonable background searches for a position of such importance) – the decision should simply have been one of if a candidate is appropriate or not. And if not – they should not be allowed to run, and the OMA should deal with the consequences.

Instead, the OMA, under your leadership, has chosen to promote a document that characterizes one of the P/E candidates in a negative manner. (Yes this was the third party view – but you already know what I think of third party views). This negative characterization can, and should, open you up to legal action (whose defence will be paid for by my dues – which I find even more objectionable). Attaching subjective comments to the profiles of eligible candidates is outside of established governance norms.

ALL of these actions smack of the OMA as an organization self selecting candidates that the OMA finds suitable (not the members). It reeks of the organization wanting a complacent Board, a Board that simply rubber stamps what “experts” bring in front of it, rather than a Board that provides true oversight. True oversight demands that the Board ask hard, uncompromising and uncomfortable questions of the staff when appropriate. I can’t see a thing in your Board vetting process that would suggest you let candidates with these skills through.

You are undoubtedly aware that as a result of the actions of your current leadership, both Dr. Paul Hacker and Dr. Paul Conte have publicly resigned as Board Directors. Historically, the last Board Director that resigned under similar tumult was Dr. Shawn Whatley in 2016 . That was the same time as the disastrous tPSA fiasco. He was one of 25 (ish) physicians, or 4% of the physician Board Directors. You’ve lost two of 8 physicians – or 25%. That’s a critical blow. (Dr. Alam resigned a month early as well – but that was with much less fanfare).

What’s worse is the calibre of Directors that resigned. Dr. Hacker co-chaired the Governance Transformation committee of the OMA. Dr. Conte not only chaired the Governance and Nominating Committee, but was Board Chair. Having worked with them, I can tell you that both members have extremely high levels of integrity and both are extremely well versed in governance. They are absolute titans of good governance principles. They KNOW when governance is going off the rails, and for them to take this steps speaks volumes about your leadership.

In summary then, it appears the OMA, as an organization, has taken well meaning attempts to reform it, and make it more member responsive, and instead turned it into a way to only allow certain, pre approved members to be in charge. Outspoken, critical voices are not allowed. Strong opinions (however well stated) are unwelcome. Independent thought must give way to complacent behaviour.

All of which is my long way of asking, given that you have undemocratically preselected candidates, and impugned those you find wanting, why should any member bother to vote?

Yours truly,

A very very annoyed Old Country Doctor.

Which Pharmacy Should You Use?

My patients are increasingly expressing unhappiness with their pharmacy. I’m not surprised. A recent study by JD Power showed a 10-point drop in customer satisfaction with brick and mortar pharmacies in 2024 alone. This is attributed to problems with systemic pressures, health human resources challenges, burnout amongst pharmacists, increasing drug shortages, and competition from online pharmacies. (N.B. I know this was a US survey but I believe the results would be similar in Canada as many of the pressures are the same).

In the past, I would tell patients to choose whichever pharmacy they want. The College of Physicians and Surgeons (CPSO) has some pretty strict rules around who/what I can recommend to patients. They are particularly stringent if there is even a perception of a conflict of interest. This would be why I never insist patients use the pharmacy in the medical centre I work at. Most doctors are very reluctant to run afoul of their licensing body (and I’m no exception).

However, the actual CPSO rules around prescribing drugs states:

“Respecting Patient Choice When Choosing a Pharmacy

13) Physicians must respect the patient’s choice of pharmacy.

14) Physicians must not attempt to influence the patient’s choice of pharmacy unless doing so is in the patient’s best interest and does not create a conflict of interest for the physician“

It seems like I can give some advice to patients. The short version: Stay away from “Big Box” pharmacies.

To understand why I give this advice, it’s important to know what I think of the role of pharmacists. This will surprise those who have been critical of my position on expansion of pharmacists scope of practice, but I actually truly believe that pharmacists are an essential part of a patients health care team. In my area, the smaller, independent pharmacists and their staff all know the patients well. They feel very comfortable messaging me with issues. I often get updates from them about changes to medications a specialist has made (often before I hear from the specialist!). And I’ve always gotten great advice on what alternatives are out there for medications that aren’t unavailable (an increasing problem these days).

The smaller pharmacies always flag drug interactions well (for me and the patient), know which patients react to which medications (even the over the counter ones), have provided great individualized advice on how to take medications. If for some reason, I’m doing something “off label” – they have been very supportive of that.

I (and more importantly, my patients) get that level of support, because the small pharmacies have consistent staff, who have, over time, built up great professional relationships with our mutual patients.

In contrast, dealing with some of the big box pharmacies is getting worse all the time. Some issues are just plain annoying. For example, I generally give a one year supply of medications for patients of mine who have stable medical conditions (three months for diabetic patients). I cannot tell you how many times I’ll get a message from one of the big box pharmacies (the red ones in our area are particularly bad) asking for a renewal three months later, even though we clearly have an electronic record that shows those pharmacies got, and downloaded, a one year prescription. Essentially, the pharmacy refuses to give needed medications to my patients, because of their error inputting my prescription.

It’s gotten so bad that my replies to the pharmacies have, over the past couple of years, gone from informing them of their error, to asking them to fix their internal process, to being rude. I haven’t quite hit unprofessional yet – though the pharmacists may beg to differ.

The big problem with big box pharmacies is that their staff are under pressure to first and foremost, generate profits for their chain. Patient care is actually secondary.

Shot of a mature pharmacist expressing stress while working in a pharmacy

It’s been reported (by pharmacists and staff) that corporate pressure from Shoppers Drug Mart (SDM) head offices led to their pharmacists doing unnecessary MedCheck reviews (and billing the taxpayer $75 per review). Shoppers head office of course denied the accusation and stated all MedChecks were necessary. Yet just one month later the CBC wrote “Shoppers Drug Mart says it doesn’t have medication review targets, but records show it does.“

The Toronto Star had an excellent report in November 2024 outlining just how much pressure corporate pharmacy staff were under. The report showed that:

pharmacists were asked to rush through minor assessments for their new expanded scope of practice in under 5 minutes (Kathleen Leach, a Hamilton pharmacist recognized that this would degrade care)
85% of pharmacists felt compelled to meet service quotas
there was strong concern about how the big chains had stripped back support staff from pharmacists, affecting care
It also outlined how patients were encouraged to have health assessments, even when not necessary, to try and increase revenue

This appears to be a Canada wide problem. The Ontario College of Pharmacists is exploring legal options to address allegations of corporate pressure. The BC College of Pharmacist 2024 report on Workplace Practice clearly showed that pharmacists in corporate and franchise settings experience more time pressure than independent pharmacists. The Toronto Start article above also indicated the Saskatchewan Pharmacy College recognized that focusing on business targets leads to errors and increased patient risks. In New Brunswick a pilot program for expanding pharmacy care fell apart, in large part because a virtual care company that SDM had heavily invested in (Maple), overwhelmed pharmacies with referrals.

Kristen Watt, who’s the current Vice-Chair of the Ontario Association of Pharmacists, wrote a blog in the Medical Post strongly supporting expanded scope of practice for pharmacists. While I have, and will continue to, fundamentally disagree on that, I was struck by her comment in that blog:

“Granted, the government roll-out video, shot in a noticeable big box pharmacy, didn’t help us. There are lots of cries of foul about billings going to shareholders of large corporations.”

It’s the kind of statement that clearly suggests some awareness of issues, without getting oneself into hot water. And certainly left me wanting to know more.

As I mentioned previously, a good pharmacist, and their staff, are integral parts of your health care team. They need to know you as a patient. They need to know some of your medical history. Over time they need to develop a professional relationship with you to provide you with the best advice. At the Big Box pharmacies, you are often getting different pharmacists and different staff every time you visit. Due to some of the corporate pressures above, there is a lot of turnover in those pharmacies.

At a small local pharmacy, you’ll get someone who knows you and says “Dr. Gandhi always gives a one year supply of medications, so I’m sure you’ve got refills.” Whereas at a big box, you’ll get some new staff who mindlessly will tell you “Ok, I’ll message him, you’ll have to come back in 48 hours” because the previous person didn’t enter data properly. Or you’ll get advice from different people at different times, which is NOT the same as having a consistent relationship with one pharmacist.

So my advice, to you dear reader. Find yourself a nice small pharmacy. Make sure they are independently owned. Ensure they have a consistent staff. Build a professional relationship with them. Your overall health deserves it.

Bonus: Red Flags When Searching for a Pharmacy:

Pharmacies that sell groceries.
Pharmacies in department stores or grocery stores.
Don’t fall for “points” schemes – not worth sacrificing good health advice for
They have different pharmacy staff every time you go

Artificial Intelligence is Naturally Stupid

Over the past two years, there has been an explosion in the amount of artificial intelligence (AI) software available, not just to healthcare professionals like myself, but to the general public. In many ways, AI has been quite helpful. I myself have been using AI scribe software in my office for close to a year now. The software listens to the conversation I have with my patient, and automatically generates a clinical note.

The AI scribe has been an enormous benefit to me. My medical notes are much better (also somewhat more detailed). I also save one hour of admin time a day (!) As an aside, this is actually a reason why the government should fund AI scribes for physicians. Under the new FHO+ model, we are paid an hourly rate for administrative work. Surely, saving five hours of physicians time a week is worth the government purchasing a scribe for physicians.

There are also some significant benefits for patient care. Another piece of AI software I use (that’s restricted to health care professionals) helps me with challenging cases. I am able to put the symptoms and test results into the software and it generates a list of potential diagnoses, and suggestions for next steps. It can also recommend treatments for rare conditions.

The general public can also benefit from AI. I recently had a little bit of trouble with my trusty 13-year-old SUV. I put the make and model of the SUV into a commercially available AI, put the symptoms in, and it generated a list of potential causes based on known issues about my SUV.

To be abundantly clear, I would never attempt to fix a car myself. Just as, with all due respect, patients should never, ever attempt to implement a treatment plan for themselves. What AI did do is give me the ability to have an intelligent conversation with the auto mechanic about the situation. And, dare I say it, allowed me to ensure that the mechanic was not trying to pull the wool over my eyes. (My vehicle is now fixed and running very smoothly.)

But along with the many benefits of AI software, there is, of course, potential for harm. This can range from ludicrous to dangerous.

The phenomenon of AI scribe hallucination is well known to physicians like myself. I have seen it in my own software, and it is the reason why I always read the note before I paste it into the patient’s chart. Admittedly, some of that is laughable :

Hopefully this is an AI hallucination of my skills, as opposed to the software’s judgement!

Additionally, the reality is that AI scribes can’t often put a patient’s lived experience (which is so important to building a relationship with a patient) into a note. My colleague Keith Thompson had a superb post on LinkedIn talking about how the AI scribe failed to recognize his personal interactions with an Indigenous patient, particularly with respect to understanding generational trauma.

Sadly, there have been cases where actual harm has been caused by AI. Grok is currently being investigated for generating sexualized images without consent, including those of minors. This causes severe emotional distress and real harm to the victims. There have also been concerns that AI chatbots are helping or suggesting people harm themselves. No one wants any of this stuff to happen, including the people who write AI software. But it has happened.

All of which reminds me of something that my computer science teacher in high school was fond of saying. (Note to my younger readers, and particularly my sons if they ever read my blog: Yes, there actually were computers when I was a teenager. I am not that prehistoric!)

How I’m viewed by my younger colleagues and my children!

The redoubtable Mr. Williams always implored:

“Do not forget, computers and software are actually very very stupid. They can do some things very fast, but they can only do what they are told.”

It’s a piece of wisdom that still holds true today.

With processing speeds almost infinitely faster than when I took computer science, computers can do multiple calculations very very fast. My desktop computer, which is a few generations old, can run 11 trillion operations a second. Heck my phone, which itself is 4 years old, could probably run a fleet of 1980s Space Shuttles. Speed is not the problem now.

The problem is that these computers and software still don’t actually have the ability to “think” outside of their parameters. They only do what they are programmed to do. If for example, they are programmed to answer questions asked by a user, but they are not given specific rules to avoid illegal answers, well, they will answer the questions directly. If the programming contains an inadvertent error (someone entered a “0” in the code, instead of a “1”), well, then the software will NOT be able to realize that was a mistake, and will carry out calculations based on the wrong code.

It is true that software is increasingly being taught to “look” for errors. But again, the software can only see the errors it is programmed to look for. It can’t find inadvertent errors and it can’t “think outside of the box.” They are, for lack of better wording, too stupid to do so.

All of which is my fancy and longish way of saying that while these new tools are great, at the end of the day they simply cannot replace the human experience. Just as the software couldn’t recognize the generational trauma of an Indigenous patient, there is a lack of “gut instinct” present. That feeling you have when you are missing something, and you know a patient is sicker than they may seem. It’s a trait that seen in our best clinicians, and one that no programming can replace.

Using an AI tool is just fine. But for my part, I’m going to agree with Mr. Spock:

About Dr. Elaine Ma: We’ve Been Here Before, and Didn’t Fix It…

My thanks to Dr. Mike Goodwin (pictured inset) for guest blogging for me today. Dr. Goodwin is a retired family physician who held numerous roles in medical politics including (but not limited to) being a member of the Coalition of Family Physicians, a member of the Section of General and Family Practice Executive and an OMA Board Director. He brings a historical perspective regarding medical audits to this blog, and I am grateful for his contribution.

I admire our courageous young colleague Dr. Elaine Ma, she of the seemingly never-ending OHIP billing/auditing dispute with a media savvy beyond her years. Dr. Ma’s impeccable sense of public health propriety during COVID has earned her a growing band of supporters. It has hopefully gained her financial support from both the Ontario Medical Association (OMA) and the Canadian Medical Protective Association.

But what Dr. Ma and younger colleagues may not appreciate is that OHIP’s abuse of doctors, utilizing its antiquated billing payment and auditing processes, has been ongoing for a long time. Between the years 2000 through 2005, a hundred odd doctors every year in Ontario were being subjected to the same sort of unfair retroactive audit, which Dr. Ma is currently experiencing.

Back then, just like now, we had a Schedule of Benefits (SOB) badly in need of an update, a pettifogging bureaucracy unwilling to interpret said schedule with any modicum of common sense… vague auditing rules which conferred the burden of proof upon the accused rather than the province, and the same one-sided authority to claw back payments or garnish future accounts receivable. OHIP even had computers back then, almost certainly the same ancient models they still use today (which they claim can’t possibly be configured to pay doctors in a timely manner after the award of binding arbitrated pay increases).

Administrative abuse of the profession in the very early aughts was rampant. OHIP had enlisted the help of the CPSO, because the College had administrative and regulatory authority, beyond criminal law, over all physicians pertaining to the practice of medicine. Actual auditing and enforcement of decisions was done by an entity of the College called the Medical Review Committee (MRC). It apparently escaped everyone’s notice at the time, and still today, that medical billing to OHIP was and is based upon definitions contained within an official MOH document called the OHIP SOB. The OHIP SOB is, at least in theory, derived from agreements negotiated between the province and the OMA, not the College! One might argue, logically, that any dispute concerning rules and definitions documented within the SOB should always be addressed in the first instance between the Ministry and the OMA.

At any rate, anger and despair over the medical billing and auditing system in that far away time came to a head when a gentle Welland paediatrician, Dr. Tony Hsu, committed suicide. I suspect that Tony felt he had lost face by going public with his own particular auditing horror story. The concept of “face” is important in the Chinese diaspora, and Tony, who worked a one in three (sometimes one in two) on call rota at the Welland County General Hospital (without any on-call stipends in those days), in addition to maintaining a community practice, was forced to repay $96,000. He had to take that out of his retirement savings.

Public and political outrage at Tony’s death, particularly in the Niagara region, was immediate and intense. Then Health Minister George Smitherman was pressed to call for a “public inquiry” into medical billing and auditing. By happy accident, retired Supreme Court Justice Peter Cory was available and appointed to the task. Those of us acquainted with Mr. Cory’s reputation silently cheered.

Former Health Minister George Smitherman

And when Cory’s very comprehensive report was published, nine months later in April 2005, the indecent OHIP billing auditing system finally came to an end.

Or so we thought!

In his report “Study, Conclusions, and Recommendations Into Medical Audit Practice in Ontario,” Mr. Cory did not mince words. “The medical audit system in Ontario has had a debilitating, and in some cases, devastating effect on physicians and their families,” he said. “It has had a negative effect on the delivery of services, and has undermined Ontario’s attractiveness as a place to practice.”

Also, and very pointedly, the honourable Cory recommended the appointment of a new independent audit board, while declining to take up an offer from the College to continue auditing medical billings as they had been doing prior to his inquiry. In all, Justice Cory made 118 separate recommendations, and I reproduce only the first four, below, since they were (possibly) the most important:

Jurisdiction and structure: the responsibility for conducting the audits of physicians fee claims should be conferred on a new and independent board. See recommendations (1) to (4).
Purpose of the audit process: The audit process must be employed only for the purpose of determining the appropriateness of physician fee claims. The audit system itself must be accountable. A biennial stakeholders forum should be established to receive reports on the operation of the new audit process and to receive and consider proposals for its improvement. See recommendations (5) to (7).
A new emphasis on assisting physicians to comply with billing requirements: The primary goals of the new audit system should be (1) education to facilitate compliance with billing requirements, and (2) identification and elimination of false, fraudulent, and egregiously erroneous billing in a fair and effective manner. See recommendations (8) to (9).
Schedule of benefits: The schedule of benefits must be revised and adapted. It must also be interpreted flexibly so that a physician is not deprived of payment for a service that is medically appropriate and that complies substantially with the requirements of the fee code. See recommendations (10) to (14).

(NB – as the report cannot be found online, Dr. Goodwin used his own personal copy of the report as a reference – Old Country Doctor)

In the wake of the Cory report, Minister Smitherman ceased audits immediately and promised changes. But no one at the MOH or College lost a job. And ministries or bureaucracies (like the CPSO) are resistant to any change from age-old ways of doing things. That’s particularly true when change might reduce influence, or even more important, authority and funding.

So when I joined the OMA board in 2005 as a newbie director, the ministry was already flooding the zone, as they did, with multiple new issues demanding our attention. Promises made didn’t materialize, and almost none of Mr. Cory’s recommendations, especially the most important, to “confer responsibility for conducting billing audits on a new and independent board,” were implemented. Months became years, and “the Cory report” gradually disappeared from sight, consigned to death by inattention. You can’t find it anywhere today, even with a Google search. Not even on the OMA website: for shame!

I’m convinced that if a significant part of Mr. Cory’s report had been adopted in 2005, much of the shoddy bureaucratic shenanigans from OHIP would have been fixed (including, maybe even their ancient computers). Dr. Elaine Ma would not be undergoing her current marathon persecution. Nor would we be seeing those cases where OHIP seems to let grifters get away with corrupt billing over multiple years before it (OHIP) picks up on the scam. How does that work, by the way?

It’s not every day you get support from a retired Supreme Court justice at your back… particularly such clear, sensible, workable recommendations from arguably the most influential liberal justice of the post-constitutional era in Canada. Peter Cory was famous for his kindness, and for his defence of human dignity at every opportunity…though he definitely had an iron fist in a velvet glove when the need arose. For anyone (like me) who ever had the good fortune to meet him, he was just an unforgettably decent man.

Memo to the OMA:

If you really want to fix this auditing problem, something which I and my colleagues failed to do, Peter Cory’s report from 2005 would still be a great place to start. Dr. Elaine Ma has provided you a good crisis: let’s not waste it.

What’s Behind OHIPs Persecution of Dr. Elaine Ma?

In over 3 decades of medical practice, I’ve seen so much stupidity from government bureaucrats that I really shouldn’t be surprised by the dumb things they do anymore. And yet, every once in a while, they do something so colossally, mind numbingly and egregiously idiotic, that I’m still left stunned. Such is the situation with the ongoing persecution of Dr. Elaine Ma. Last week, the general manager of OHIP recommended, and the Minister of Health agreed, to appeal the decision of the Divisional Court that gave Dr. Ma a partial victory in her seemingly endless dispute with OHIP.

Picture of Dr. Elaine Ma, family physician from Kingston, Ontario — Dr. Elaine Ma

I’ve written about this before, but a brief summary follows. Links are provided for people who want more detail. My three loyal readers can just skip the next paragraph.

Dr. Ma organized, set up and paid for dozens of Covid Vaccination clinics in 2021. She billed the codes for organizing the clinics to OHIP (since she paid for all the overhead). A couple of years later OHIP told her that she should have billed an hourly rate and demanded over $600,000 in fees back. Their reasons for saying she inappropriately billed varied seemingly from week to week. The clinic was outside, not inside! She used Medical Students! Different people injected! etc.

The case eventually made its way to Divisional Court. I never thought I’d see a more laughably ludicrous comment from bureaucrats than when the Ministry of Health’s negotiations team announced there was no concern about a lack of comprehensive care family doctors. But, as Einstein once said, stupidity is infinite and these OHIP bureaucrats outdid the MoH crew by suggesting that there were “no extenuating circumstances” warranting the setting up of these Covid Vaccinations clinics. The whole country was in the midst of a pandemic, there was the largest public health crisis in my lifetime, the country was locked down, travel had ceased and so on. But these were not extenuating circumstances in these eyes of these rigid, automaton bureaucrats.

However, it was also at the Divisional Court hearings that I personally feel that we may finally have seen why OHIP is so intent on tormenting Dr. Ma. The court did scold the bureaucrats for the absurd suggestion that extenuating circumstances didn’t exist. But, as I mentioned in my last blog, the court also found:

“…that the wording of section 17.5 does not limit relief to unpaid claims; it only requires the presence of extenuating circumstances. Since OHIP typically pays claims first and reviews them later, a restriction on unpaid claims would effectively nullify the provision. The court called this interpretation unreasonable.”

Section 17.5 of the legislation that governs OHIP (which in it’s current form is found buried in Bill 138) states:

“The General Manager shall refuse to pay for an insured service if the claim for payment for the service is not prepared in the required form, does not meet the prescribed requirements or is not submitted to the General Manager within the prescribed time. However, the General Manager may pay for the service if, in the General Manager’s opinion, there are extenuating circumstances.“

I mentioned last time that OMA lawyers really need to take a deep look at this ruling as it likely had implications for other billing disputes. And, indeed, the court’s interpretation of Section 17.5 appears to be main basis for OHIPs appeal.

According to a report by Michelle Dorey Forestell (who has done an excellent job reporting on this issue over the years), the General Manager of OHIP is appealing because:

“section 17.5 contemplates discretionary payment decisions only before funds are issued, noting that other provisions of the act expressly address recovery and reimbursement of payments already made……the court’s broader reading will make physician payment disputes more complex and uncertain.”

AND

“the case raises issues of public importance, given the potential impact on how physician billing disputes are assessed and adjudicated and on the administration of OHIP.”

This, in my personal opinion, is the real reason that OHIP is fighting Dr. Ma tooth and nail now, despite having (deservedly) lost at Divisional Court. It may have started out as bureaucratic ineptitude. But it’s no longer about recouping the money. Heck bureaucrats have wasted far more on various schemes.

No, the clear sense I’m getting is that OHIP bureaucrats, having botched their attempt to bully and harass Dr. Ma, they now find themselves in a position where they may be forced to make changes to their review process. If the Divisional Court ruling holds, it means that OHIP would have to modernize how they review payments (gasp!). Who knows, they might even need to buy some new billing computers that can more efficiently review physicians claims (double gasp!). But worst of all, it means OHIP bureaucrats will actually have to do real work (triple gasp!) to develop new processes.

Dr. Ma deserves better. By acting so quickly during the pandemic she ensured Kingston was one of the most highly vaccinated areas in Ontario. She not only saved lives, she prevented many hospitalizations. She undoubtedly saved the health care system far more than $600,000 by her actions.

Unfortunately for her, rigid thinking bureaucrats were unable to use some basic common sense and recognize how urgent things were in 2021. She has been egregiously wronged as a result.

But the sliver of hope is that she may actually have the last laugh. If the appeal is denied, or she wins at a higher court again, the bureaucrats will be forced to confront their own incompetence. They will need to develop a fair, modern and rational review process. If they don’t many other physicians will use her case as precedent by saying OHIPs review of their billing comes from an unreasonable process.

By not yielding to common sense, the OHIP bureaucrats may have wound up giving themselves much more headaches. And as far as I’m concerned, it’s entirely well deserved.

The Appalling Treatment of Dr. Elaine Ma Is Hurting Health Care in Ontario

I’ve written about the horrific treatment that Dr. Elaine Ma has been subjected to by the bureaucrats at Ontario Health before. The situation is so ridiculous that it could be a story presented at the Theatre of the Absurd.

What happened?

Dr. Ma is a family physician from the Kingston area. During the Covid pandemic she realizes the need to immunize as many people as possible to protect the community. She organizes a number of outdoor mass vaccination clinics, which resulted in Kingston being one of the most heavily vaccinated areas of the province. For her efforts, she wins the very well deserved the praise of many, and an award from the Ontario College of Family Physicians.

There are two billing codes for providing Covid vaccinations. One for physicians who work in a vaccination clinic that someone else set up (e.g. public health). Another for those who set up the clinics themselves, and paid for staff/heating for outdoors/tents/internet etc. Since she paid for all of that, Dr. Ma bills the second code.

Fast forward a couple of years and the callous and unthinking bureaucrats at OHIP decide that she has billed the wrong code and demand she pay back $600,000. I won’t restate all the steps she went through to fight this. I will state that the reasons for them wanting the money paid back varied between the clinic being outdoors instead of indoors, medical students being involved and so on. But eventually the case winds up at Divisional Court.

On Dec 16, the court handed down a ruling supporting Dr. Ma. What I had failed to realize before is that the Ontario Health bureaucrats main argument appears to be that there were no extenuating circumstances during the time of the Vaccine Clinics that Dr. Ma set up. Yes, you read that correctly. The whole country was in the midst of a (hopefully) once in a lifetime pandemic. Canada was effectively shut down for business. People were not allowed to visit loved ones in hospital or nursing homes. Travel had ground to a halt. But, in the minds of the soulless and spiteful bureaucrats, none of this constituted “extenuating circumstances”.

Thankfully, Divisional Court Justices Matheson, Varpio and O’Brien were having none of this nonsense. They clearly stated the decision by bureaucrats that there were no extenuating circumstances was “unreasonable.” (I would have, and will, call that decision much worse things). The Justices pointed out the obvious. There was clearly a public health crisis at the time, and that many leaders, including politicians were calling on physicians to get the vaccinations done.

More importantly they stated something the OMA’s legal team really needs to take a deep dive into:

…”that the wording of section 17.5 does not limit relief to unpaid claims; it only requires the presence of extenuating circumstances. Since OHIP typically pays claims first and reviews them later, a restriction on unpaid claims would effectively nullify the provision. The court called this interpretation unreasonable.”

Currently OHIP pays physicians whenever they bill. Later, OHIP decides if it was reasonable or not, and if OHIP feels the situation is unreasonable, they demand the money back. The justices seem to be saying this process is not fair. Which has implications far beyond this one case. Obviously, this would not apply to clear cut cases of fraud. It is a much much needed kick to the slow, incompetent, and spiteful OHIP review process. I can’t possibly understand the potential future implications for this – but I suspect there will be many.

Finally, the justices let their displeasure be known by ordering OHIP to pay Dr. Ma $10,000 in court costs. This strongly suggests to me that they were peeved at the OHIP bureaucrats for taking it this far, and really didn’t think it should have gone there.

How is this hurting health care now?

Ontario is currently seeing an unprecedented surge in flu cases. Flu season has come early. The current variant appears to be extremely strong. It is circulating at “sky high” levels among young people. Three children (at least) have died. Hospitals have declared outbreaks and wards are closed. Visitation has stopped.

Sign on the door to the Medical Ward of my Hospital

You know what would really help? If only some people would come up with some innovative ways of getting their communities vaccinated against the flu. Yes this year’s flu shot is a bit of mismatch for the current strain, but it still provides some protection and keeps you from getting really ill.

Or how about an innovative idea for where to safely look after patients like was done during the Covid crisis. My friend Dr. Bryan Recoskie set up a unique 18 bed ward in our local Legion, to look after non-covid patients while the hospital wards were shut with covid positive patients.

And yet, I don’t see any of that happening right now. Don’t get me wrong, doctors continue to go to work. We continue to care for the sick and continue to comfort those in need. We continue to do our best in these trying circumstances.

But I can’t find any evidence (please correct me if I’m wrong) – of where people are doing unique out of the box things to try and mitigate the currently unfolding nightmare. Given the potential exists that IF you try something unique, you may wind up undergoing two years of pure hell by bitter, ruthless and depraved bureaucrats – can you blame people for not trying?

To quote a good friend of mine, “The damage has been done. Nobody is going to stick their necks out now.”

What should happen (but won’t):

First, under no circumstances should OHIP appeal the decision from Divisional Court. The mercilessly inhumane bureaucrats need back down. Second, Health Minister Sylvia Jones needs to do what she should have done a year ago – and direct the bureaucrats not to seek any recovery at all from Dr. Ma. It’s just the right and decent thing to do.

Finally, it would really help if Minister Jones issued a formal apology to Dr. Ma for how she has been treated by the bureaucrats. It’s not just the OHIP bureaucrats. Jones’ own communications director, Hannah Jensen claimed Dr. Ma had “pocketed the funds“, a statement that clearly suggested malfeasance.

Do that, and maybe, just maybe, physicians would once again feel comfortable coming up with out of the box solutions for crises that are occurring.

Maybe.

More on the OMA Elections

I don’t often reply to critiques of previous blogs. My opinions are my own, and disagreements are part of life. However, there were a couple of consistent themes in critiques to my last blog, OMA Manipulates Board Elections and Weakens Members Voices. I think it is worthwhile to address those.

Is “Relational Advocacy” a Concern?

The first theme was that it was distracting to express concern that people who work at the OMA would be inclined towards what’s been called relational advocacy. This would be to suggest that they may not be as aggressive as needed on some issues, due to concerns about implications for potential future career prospects with government. More than one person told me off about this.

In order to know for sure whether this is something to be aware of, or whether it’s just the rantings of a miserable grumpy old bugger, one would have to do an exhaustive search of people who went to work for government after working at the OMA. It would require extensive resources to search things like LinkedIn profiles, available public employment data bases, and the like.

It being 2025, I therefore had ChatGPT do the search. My initial ask was to see how many employees left the OMA to work for the Ontario government from 2000-2025. This turned up 12 verified people (I won’t print their names). Even I would admit that doesn’t seem like much of a concern.

I then realized I had done the search wrong. I should have asked how many OMA employees went on to work for the government OR any government funded agencies. Agencies like hospitals, Ontario Health at Home, Family Health Teams, Public Health etc etc .

The results of this much more comprehensive search? Up to 80 people. The software had to do a fair approximation due to not everyone having searchable info. (The OMA has about 300 employees).

Should we hold it against those people for seeking other employment? No. People should be able to make decisions in the best interests of their careers (you would too in their shoes). Should we suspect they are not working diligently on behalf of physicians while at the OMA. No, no, no, a thousand times no. The vast majority of employees there really are passionate about advocating for physicians and I’ve seen that firsthand. Should we question their integrity? Again, no, no, no, a million times no.

BUT – should the OMA Board at least be aware of the fact that up to a quarter of the employees may one day work for government (in some way or another)? Should the Board keep it in the back of their minds when reviewing strategy presented to them? Especially if it comes at a time when relationship with government is adversarial? Human nature is human nature….

To be fair, ChatGPT also helpfully suggested (without prompting) that up 220 physician leaders had roles in some capacity with the OMA and then moved on to government/government agencies during the same time period. So it’s not like we don’t need to re-think how we as physicians choose our own leaders either. Which brings me to the next point.

How Independent is Promeus?

The other main critique was that my assertion that the OMA staff would vet candidates for Board was off base. After all, the OMA has hired an “independent third party firm” called Promeus to screen candidates. Promeus would decide who was most suitable for Board positions, not the OMA staff.

Let’s get real here. The consultants will be told what the criteria are. Those of you who work in a hospital can relate to this. Do you know how when the CEO of your hospital is facing, say, a budget deficit or a revolt around some program? The CEO knows that he/she has to lay off nurses or cut a program or change leadership. But not wanting to be “the bad guy”, they hire a consulting firm. The consulting firm then “reviews the information”, helpfully provided by the CEO. The firm then recommends that a bunch of nurses get fired, or programs get cut. The CEO then says “based on the recommendation of the expert consultants we are going to….” (The CEO doesn’t say they would have done that anyway, but are glad to have someone else scape goat the decision for them).

Similarly, the criteria for what is “needed” will be provided by the OMA to Promeus. I don’t doubt for a minute that Promeus will do a good job of reviewing candidates and has experience doing this. But they will choose candidates based on the OMA criteria.

This kind of tactic is common in all organizations, both public and private. Those interested can look up Robin Hanson’s theory of young consultants or if you want a denser read, go look at Killing Strategy.

As an aside, a few people have contacted me saying they’ve been approached to run for Board. They are all strong leaders, and I respect them. But they are also people who have roles in government funded organizations.

The counter argument will be that 39 candidates was “too many”. I think the fact that 39 candidates ran for Board shows that members have strong interest in making the OMA better. Are some candidates better than others? Sure – let the members decide. Let the candidates campaign (currently not allowed) to explain their positions. Is it messy? Sure, but heck democracy is messy. As Winston Churchill said:

In short, I would once again state that the changes the OMA Board has allowed to happen will not serve members well. We are going to get a weakened, Board that is very good in speaking politically and saying, well not much. The strong passionate member voices will be sidelined in favour of the milquetoast and bland. And physicians will not get the representation they deserve.