Nothing Wrong With Advocating For Physicians

Authour’s note:  This opinion piece of mine was published in the Medical Post.  However, many physicians are unable to access that as you need a dedicated account.  I’ve reproduced it here.

The Canadian Medical Association (CMA) has been embroiled in controversy this past year.  It first started with the announcement of “Vision 2020”, the new strategic plan for the CMA. What’s the first priority of the plan? “Consistently bring a patient perspective to the work of the CMA.”  The second priority?  “Engage in courageous, influential and collaborative dialogue and advocacy.”

This all sounds nice, and politically correct and oh so socially conscious.  Except for one thing.  The CMA is supposed to represent physicians and their needs.  That’s the whole reason for its existence.  Instead, physician representation is third on the priority list, and even there, it’s couched in phrasing like “based on empowering and caring for patients, promoting healthy populations and supporting a vibrant medical profession.”

From the perspective of the CMA’s leaders, I suppose the needs of the general membership don’t really matter.  The recent sale of MD management to ScotiaBank has provided the CMA with a significant amount of revenue.  So much so that they likely don’t even need members anymore.  It’s worthwhile noting that the first $15 million from the sale has been earmarked for a building for health care innovation, as opposed to, you know, a program to look at the alarmingly high burnout rates of physicians.  Certainly the changes made at CMA Governing Council (no more motions to direct the organization) prevent the CMA Board paying attention to silly little things, like the duly elected representatives of physicians across the country.  (NB – it would be unfair of me not to acknowledge that at least the General Membership will be able vote on all the Board members for the CMA.  However, I’m curious to see what the criteria are for becoming a candidate for CMA Board).

There is similar pressure to advocate for patients and health care policy, being placed on the Ontario Medical Association (OMA), particularly on social media.  Recently the OMA has been asked by various physicians to:

– sign letters opposing the separation of children from parents of migrants

– condemn the changes to sexual education curriculum made by Premier Doug Ford’s government

– speak out against the pause to Vaping rules, also made by Doug Ford’s government

– express concerns about the health care for trans gender patients

– and a bunch more.

There are merits to all of those causes (the separation of children from parents is the one I feel strongest about – it’s just child abuse). There is also the argument that physician’s organizations should use their authority to advocate for social issues, as it increases our standing in the eyes of the public and makes us “leaders”. This enhanced standing will supposedly help us when we advocate for ourselves.  The cynics, especially those of us burnt by the previous Ontario government will strongly disagree with this.

But here’s the thing, there are so many good causes out there to advocate for.  And they will keep coming.  How should the OMA, which unlike the CMA, continues to need broad member support, choose?

There is already disagreement about vaping rules/sex ed curriculums and so on.  What happens when the OMA is presented with information about the poor health care Rohingyan women receive?  Or the damage the contaminated water in Flint Michigan has caused?  Or if you want controversy, how about the malnutrition and mental health issues suffered by Palestinian children?  The OMA is supposed to represent 40,000 members with a diverse range of views, not just those who are motivated by one particular issue.

Many Provincial and Territorial Medical Associations (PTMAs) offer media training and advocacy courses.  The OMA for example, has long been asking physicians to become advocates.  Perhaps rather than criticizing on social media, those who feel passionately about various issues can receive the training to allow them to become leaders in their areas of interest.  They can then directly get their message across to the public and work for whatever their cause is.  They are still doctors, and they will still be seen in the public’s eye as doctors taking a lead on health care issues.

As for the PTMAs is it really too much to ask that they focus on membership advocacy first and foremost?  There is absolutely nothing wrong with advocating for meaningful action on high burnout rates, fair contracts and improved working conditions with less interference from bureaucracy.  It’s what these organizations are supposed to do.  The simply reality is that you cannot have a high functioning health care system without happy, healthy and engaged physicians.  Surely advocating for the same is not unreasonable.

Can Helen Angus Save Ontario Health Care?

Health Care in Ontario has been in a state of crisis for many years now. I’ve practiced Family Medicine for 26 years, and I’ve never seenwait times so long, nor have I seen such a dismal moodamongst health care providers. Clearly, a major transformation of how health care is delivered needs to occur.

Ten days ago we saw a new government in Ontario. By glancing at twitter feeds and media reports, the biggest news in health care seemed to be about the appointment of new Health Minister Christine Elliott. Minister Elliott is an excellent person and will bring the kind of common sense to the Health Ministry that was completely absent during the Kathleen Wynne/Eric Hoskins years. BUT, the most important announcement last week (and one widely ignored by the media) was actually that of Helen Angus to role of Deputy Health Minister. She takes over for the widely dislikedBob Bell, who suddenly retired once the Liberals lost the election. Curious timing that retirement, considering the post is supposed to be apolitical.

You see, the Health Minister is the person who produces high-level strategic directions for health care service delivery. But it’s the Deputy Minister who actually carries out the grunt work and implements the processes to carry on these strategic directions. Having been part of many organizations, I’ve seen bureaucrats both greatly benefit – and greatly hinder – the implementation of these strategic directions. It will be up to Ms. Angus to do the heavy lifting, and transform the Health Care system.

Is she up to it? Her bio shows she has been heavily involved in health care for many years, including various roles at the Ontario Renal Network, Cancer Care Ontario, the Ministry of Health and others. She was actually the interim Deputy Minister of Health for five months, until the aforementioned Bob Bell was hired. Then she suddenly left the health care field altogether to help out the Ministry of Citizenship. (More curious timing there). So with that experience there is a sense that she will bring a steady hand to the position.

Based on her speech to the “Breakfast with the Chiefs” she also has the ability to “speak the language” of health care bureaucrats. Phrases like “shared accountability”, “transformation secretariat”, and “stream of work” fluidly roll off her tongue. Personally, I find these phrases vapid and incomprehensible (eHealth Ontario for example is not “still a journey” as she states, it’s a disaster). However, this kind of verbiage is needed to communicate with other health care leaders, so I’m glad that she is able use it.

What does she truly believe in as far as health care goes however? Assuming she wasn’t just towing a political line, it also appears from her speech that she recognizes the need to transform health care and break down the various silos in health care. Silos refer to the fact that we have a bunch of different organizations in health care, e.g. hospitals, home care, your doctor’s office, that operate independently, and often not in a co-ordinated manner.

When I was the Health Links lead physician for South Georgian Bay, I recall Deb Matthews referring to Ms. Angus as “the silo-buster”. Ms. Angus of course, never got to work on that because as mentioned, she suddenly left health care altogether when Bob Bell became the Deputy Health Minister. Bell, under the guidance of the pitiful Eric Hoskins and the forlorn Kathleen Wynne never got around to busting silos. Instead the three of them thought it would be better to get into a toxic, pernicious, and vexatious relationship with Ontario physicians. We all saw how that worked out.

Ms. Angus spoke of the need to make health care more patient centred, and improve access for patients. Part of that will require a significant streamline to Ontario’s bloated health care bureaucracy. Part of that will require she forces a dollop of common sense down her bureaucrats throats (why does it take two years to make a change when everybody agrees something is a good idea?).

The good news is that she appears to have some cover in that current Premier Doug Ford wants to run a fiscally responsible government and reduce bureaucracy (though by natural attrition as opposed to layoffs). More good news is that the Ontario Medical Association (with whom she must partner if any transformation is to occur), recently decided to temporarily suspend the arbitration process they are involved in, in order to hear the new governments position. As a gesture of good faith, they didn’t even ask for a concession for this move. If she can help to repair the noxious relationship created by the Liberals, and give doctors a meaningful say in how health care is delivered, she will be able to move more effectively in her goals.

It’s a big job ahead for her. For the sake of all Ontarians I wish her well. Our health care system is too important to be allowed to flounder any longer.

Good company in a journey makes the way seem shorter. — Izaak Walton

post