Why Does The Old Country Doctor Hate Non-Physician OMA Board Members?

My last blog supported Dr. Paul Conte’s four motions that he is presenting at the upcoming Ontario Medical Association (OMA) Annual General Meeting (AGM). At the heart of the motions is a strong desire to course correct the governance changes at the OMA that have gone too far. The OMA is taking physicians authority to govern themselves away. Dr. Conte’s motions are excellent and I am very proud to be the seconder on all four of them.

However, the questions I keep getting asked about in that blog all pertain to the non-physician Board Directors. What exactly do I have against the non-physician Board Directors? Why do I not like them? Is there a grudge of some sort? Do I not recognize that they can contribute skills to the Board that most physicians just don’t have?

I guess that’s a symptom of some of the “spin” that is likely quietly being put out there about the motions and the blog. It’s easier to portray this as someone with an axe to grind rather than encouraging people to read the blog. My previous blog clearly stated that as the founding Chair of my local Family Health Team – I absolutely ensured and supported having non-physician members on our Board. They really provided some valuable guidance during the formative years of the FHT.

To be completely fair, a casual look at the resumes of the current three non-physician Board Directors, suggest some very impressive backgrounds. I’m obviously not on the Board, but on paper it sounds like they could contribute to many of the discussions there and bring different, but important perspectives.

Here’s the thing. The OMA Board ALWAYS has had experts in areas where physicians didn’t naturally have proficiency. The best example would be the negotiations counsel. They are experts in their field. They frequently present to the Board on how things are going with the negotiations process. At the Board level they inform the discussions and yes, they do try to persuade the Board to make certain decisions. All of which is fine as far as I’m concerned. That’s they way things should work and this applies not just to the negotiations counsel, but to a whole host of other experts who present at the Board.

But.

The one extremely important distinction is that at the end of the day, the negotiations counsel does not have a vote at the OMA Board (nor does any other external expert). They can persuade, cajole, entice and coax all they want. But the Board will ultimately have the final authority on whether to accept their recommendation (which is also as it should be). There were times when I was on the OMA Board where we did reject their advice (much to their chagrin).

This to me is the BIG difference. Currently, all three of the non-physician Board Members will not only provide advice based on their expertise, but will then vote, and thus, have a degree of authority and control over physicians.

The OMA Board is currently comprised of seven elected physician Board Directors, the OMA President, and the three non-physician Directors. The manner of how the three non-physician Directors have been chosen has evolved far away from what was intended. Initially there was an election for the position. Then last year we were told that one wasn’t needed for a non-physician Director if it was just a term renewal. Then this year a preferred candidate (preferred by whom??) was presented to the membership for “approval”.

These three NON-physicians, selected and recruited by the OMA as an organization, and NOT by the members, can effectively hold the balance of power in decisions that determine how the OMA advocates for physicians livelihoods. Having been on the Board and seeing diverse opinions amongst physicians, it is not at all hard for me to envision a scenario where 5 physicians oppose a staff recommendation, 3 are in favour, and then the 3 non-physicians would line up as a block to support a staff recommendation. In essence, despite a MAJORITY of physicians on the Board opposing something, it would still get passed.

This is just wrong, and was why I had advocated (and lost) from the start that non-physicians should not vote on the Board. Dr. Conte’s first two motions will correct this mistake.

What Dr. Conte’s Motions will NOT do

Just as important to realize is what Dr. Conte’s motions do NOT do. There is an argument to be made that having non-physicians on the Board on an ongoing level is a good thing. It will allow them to see the full dynamics of what goes on at the Board, and provide ongoing advice. Fair enough. The Georgian Bay FHT that I chaired certainly benefitted significantly from just that same concept. And there is nothing in Dr. Conte’s motions that will prevent the OMA from enacting a similar structure for their own Board.

At the Georgian Bay FHT, we called those Directors “ex-officio”. For some reason that I never understood that term was frowned upon by OMA Legal and the consultants that we hired during the governance transformation. Fine. Create a new position. Call it “Board Advisor”. Call it “Board Mentor”. Call it whatever you want. Have three of those positions available. Bind the candidates to Board confidentiality rules. Let them talk at the Board.

But do not let them vote.

Only physicians should have voting authority over matters at an organization whose main goal is to advance the interests of physicians. Only physicians inherently and intuitively understand the challenges faced by physicians. Yes, they should hear out external voices and weigh their opinions thoughtfully. But only they should be making decisions.

Since proxy voting is not allowed, I once again encourage all Ontario physicians to attend the OMA General Meeting and support Dr. Conte’s motions. You can attend virtually. Just click here to register, and let’s correct this mistake and bring voting authority at the OMA back where it belongs.