How Governments Try to Take Away Binding Arbitration

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Specialists in Ontario are Being Played…

Looking through my in box, I see:

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

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

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

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

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

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

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

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

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

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

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

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

Credit Where Credit Is Due

The College of Physicians and Surgeons of Ontario (CPSO)

As those of you who have read my blogs know, I have been quite critical of the CPSO. I respect the fact that their primary mandate it Is to protect the public.  However, in many cases I (and many other physicians) feel that they’ve going overboard in their investigations process.  Worse, I recently attended the Canadian Medical Associations National Health Policy Conference. I spoke my colleagues from across the country.  It became apparent that the relationship Ontario physicians have with their College is the worst in all of Canada.

Having said that, I confess to being pleasantly surprised at the recent introspective attitude of the CPSO. They presented on physician burnout at the International Conference on Physician Health. One of their own representatives, Dr. Peter Prendergast, noted the adverse effects on physicians of the protracted complaints process in Ontario. The additional burden they’re placing on physicians by not expeditiously dealing with frivolous cases, and how this contributes to the burnout crisis in medicine.  He acknowledged the need for changing a toxic system.

BurnoutToxic

This is the first time in my 26 years of practice that I can recall the CPSO making such a comment. I am grateful that they’re doing so. I suspect that this is because the CPSO has a new Registrar, Dr. Nancy Whitmore, who appears to be slowly changing (for the better) the way things are done there.  Many physicians will say there’s much more they can do, but I’m grateful for these first steps.

Canadian Medical Association (CMA)

Similarly, the CMA has been under a lot of fire from physicians recently. Tweets like this one, from former Ontario Medical Association president Dr. Scott Wooder, highlight the betrayal many physicians felt in this organization.

Wooder

Having said that I also need to acknowledge that the CMA has put a very strong emphasis recently on physician burnout. They were the sponsors of the International Conference on Physician Health.  CMA president Dr. Gigi Osler has been doing yeoman’s work to highlight this issue in the press.  At the National Health Policy forum that I attended, the CMA dedicate a lot of time on this issue, and is developing plans to tackle this growing crisis.

If the CMA continues to make dealing with physician burnout its main priority, it will do much to regain the trust that it is lost from its members. I sincerely hope that this will continue, and confess to being cautiously optimistic.

Ministry of Health (MOH) Reorganization

Last week, Global news obtained a copy of a letter from Deputy Health Minister Helen Angusindicating major restructuring at the MOH. The letter itself contained at the usual bureaucratic jargon, like this line:

“centralizing the responsibilities for LHIN managed health services under an associate aligned with key capacity, workforce and planning functions allowing for end-to-end management of health services for better outcomes and improved integration.”

The headache that I got from trying to figure out exactly what that sentence mean was not curable by a combination of 600 mg of ibuprofen and 650 mg of acetaminophen. However, a quick Google search shows that the object of the letter was to indicate a streamlining of bureaucracy.

Here’s an organizational chart of how the Ministry of health used to function:

Pre

Here’s an organizational chart how the Ministry of health will function now:

Post

Many people (myself included) will undoubtedly feel that this reduction in streamlining in bureaucracy does not go far enough. But it still represents the first reduction in bureaucracy at the MOH that I can remember in my 26 years of practicing medicine. It is a laudable first step.  MORE please!

One Last Thing:

As mentioned in the title to this blog, it’s important to give credit where credit is due.  The changes I listed above appear to all be steps in the right direction.  Perhaps I should allow myself a small amount of optimism for the future.

Or maybe….

Brown

 

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.