Negotiations – Page 2 – justanoldcountrydoctor

MOH Pleasantly Surprises (!) and OMA Disappoints in Arbitration Briefs

As I write this, yet another round of Arbitration has begun between the Ministry of Health (MOH) and the Ontario Medical Association (OMA). This time, the goal is to provide a contract for years 2-4 for the Physicians Services Agreement (PSA). As was pointed out to me on social media (thanks Jane and Lisa), year 2 of this current PSA cycle began on April 1, 2025. Yet again, physicians are going to be due retroactive pay for whatever the Arbitrator decides.

Lawyers from both sides have prepared rather thick legal documents called “briefs”. (Proof number 4,638 that lawyers have a rather weird sense of humour). These briefs are public.

I’d be lying if I said that I had thoroughly understood the briefs from both sides. The excruciating agony in trying to parse the language in these things would make having a kidney stone preferable. But these are my humble thoughts from trying to do so….

The MOH team appears to have learned their lesson from last time.

To be abundantly clear right off the bat, the MOH offer for physicians is too low. They are clearly undervaluing doctors in their stance and if the Arbitrator was to accept their position, it would spell further disaster for health care in Ontario.

But….

As I mentioned in my last blog, offering low is what you expect from the other side. It’s part of posturing for the Arbitrator and I’m genuinely not ruffled by it. What would have been unacceptable is they had refused to recognize the severity of the health care crisis like they did last time. Or if they had once again repeated the truly stupid statement that they weren’t concerned about the shortage of comprehensive care family doctors.

Additionally, the MOH has actually agreed to enhance family medicine models through the “FHO+” program, and has agreed to spend a large chunk of the funds on family physicians, an area of the health care system that is dire need. In essence, they admit that there is a problem with a shortage of comprehensive care family doctors. (NB – I will have my thoughts on the FHO+ model sometime early next week).

To re-iterate, there are still a number of problematic issues with their arbitration proposals, including the too low wage increase, the hopelessly complex method of “accountability” in the FHO+ model, a laughable statement that attachment bonuses for Complex patients will begin on July 1, 2025 when the Arbitrator won’t even rule on this until September or October of this year.

But their position is at least not stupid, and certainly not enough to make me go off like last time.

2. The OMA Disappoints With Their Brief

Once again, to be fair, there is a lot to like in the OMA Brief. There is a good analysis of the economic picture in Ontario, a great analysis of the the delays in care, the crisis in family medicine, hard hitting information about the challenges of recruiting and retaining physicians, superb advocating to relieve the admin burden and a clear explanation of why many Alternate Payment Plans are outdated.

Alas, there is once again a “but” here…..

All of the above is what one should expect from a representative organization. One should however, also expect that organization to advocate strongly to make sure their members get their increases in a reasonable time. And it’s here that the OMA falls (badly) flat.

One of (if not THE biggest) issues for physicians these past couple of years has been the constant delays in getting the increases the Arbitrator awarded them in a timely manner. Just recently the MOH unilaterally announced a delay in paying the retroactive funds owed physicians. This is amongst a series of delays all attributed to an ancient and decrepit computer system at the government. (They’ve been making this statement for well over a decade, and very tellingly, have NEVER bothered to upgrade their system).

While the last 4 pages of the OMA Arbitration Brief does a nice job of outlining the issue for the Arbitrator, including the consequences of the MOH incompetence (physicians will simply stop doing certain procedures), the remedy the OMA seeks is milquetoast at best. From the Arbitration brief (edited):

“As a result, the OMA requests, as is normal and customary, that this Board of Arbitration remain seized with respect to any issues arising from the implementation of this Award……….“

“….with the OMA reserving its right to seek appropriate remedies (e.g. interest) in the event that the Ministry fails to meet agreed upon or directed implementation dates, particularly where the Ministry is unable to provide justification for any delay, or otherwise where the delay is unreasonable and unwarranted.”

That’s it?? All this means is that WHEN (not if – we all know the MOH can’t get their act together) the next payment delays show up, all that will happen is the OMA will complain to the Arbitrator, then there will be more hearings, and those hearings will go on for months/years and then finally, the Arbitrator MAY announce penalties to the MOH. The only good that will come out of this is that a bunch of lawyers will get rich going to repeated hearings.

What’s worse is the OMA readily admits they know the Arbitrator “favours accountability measures” in their video on the new FHO+ model (around the 3:36 mark). So doctors have to be accountable to follow an agreement, but the MOH can wiggle out and delay? The OMA can’t advocate for accountability to go both ways?

EVEN worse is that in reading the MOH briefs, they actually clearly lay out what accountability measures they want from physicians. Page 92 specifically outlines what accountability they expect from family physicians in the new FHO+ model, and how the penalties will be implemented if physicians don’t meet those accountabilities. No “seizing of the Arbitration Board” or any such thing. Now I disagree wholeheartedly with the MOH stance on this – but at least they clearly outlined what remedies they are seeking without the need for further drawn out processes. The OMA couldn’t have done the same thing??

Overall, this Arbitration hearing appears less contentious than last time, and the gap in asks is smaller overall. Hopefully this means a quicker resolution. But while there is a lot of good stuff in the OMA brief, it’s hard not feel let down by the subservient, almost nonchalant attitude the OMA is taking on payment delays. Sure looks like a golden opportunity to address this was missed.

What to Look For in Next Weeks Arbitration Hearings

As I write this, it appears that once again, the Ontario Ministry of Health (MOH) and the Ontario Medical Association (OMA) have been unable to agree on a contract for physicians. We are again heading for Arbitration on June 30, with hearings all next week. A slim chance exists that a last minute deal will be struck – but I highly doubt it.

Up until now of course, the negotiations have been held under a strict cone of silence. There is no public knowledge of what has really been said between the two sides. But Arbitration in Ontario is public. The MoH and the OMA will have to publicly disclose what they are asking the Arbitrator to award.

Some Things to Remember:

These arbitration hearings are a continuation of last years hearings. Last year the Arbitrator only set an award for the total dollar amount to be given to physicians for the FIRST YEAR of a four year contract. This year’s hearings were originally slated for March of this year, but the Arbitrator delayed them until June. He wrote:

“The issues discussed have been far-ranging and include various implementation matters, the allocation of the Year 1 targeted funding, and complex and significant physician compensation issues for Years 2, 3 and 4.”

and:

“…the Board of Arbitration is now directing that the arbitration proceedings over any remaining Year 1 targeted allocation issues, and over physician compensation and all other issues for Years 2, 3 and 4, now take place over four days during the week of June 30. ”

These hearings will be a lot more complex than last years, and will have a lot of moving parts. Not only will the Arbitrator decide on how much of an increase will be allotted to physicians in years 2-4, but he will decide on how the targeted funds are distributed. Remember that 30% of the year one Award (approx $480 Million) was to be “targeted” for areas of health system need. Because of the malignant obstinacy of the MOH’s negotiations Team, the OMA and MOH have not arrived at an agreement on how to distribute these funds. So now the Arbitrator will rule on that.

Not only that, but there is the issue of how much of an increase each specialty should get. There was general agreement between the MOH and OMA the last couple of times that 25% of any increase would be given to across the board raises for all members, and the remaining 75% would go to relativity based increases. But the two sides have never really agreed on how the 75% would be split between various specialties. Reading the statement from the Arbitrator makes it sound like he will decide that too this time. (Of course now that I write this there probably will be yet another process announced after this which will mean more negotiation and arbitration).

Last year by my very rough count, the OMA and MOH submitted over 1,400 pages of documents (ironically called “briefs”) just to determine what percentage increase should be given to physicians. I can’t imagine how big the “briefs” will be this time. I won’t be able to go through them without gouging my eyes out but I do know what we should be looking for.

Has the Ministry of Health’s Team Smartened Up?

Look, both sides are going to “posture” for the Arbitrator. As part of that, the MOH will significantly undervalue physicians and offer a pittance. We should expect that and NOT get all worked up about it.

Unless…..

Last time, the MOH team went far beyond posturing. They showed nothing but contempt for physicians and an utter and complete lack of understanding of how health care works in Ontario. The MOH teams statement that there was “no concern” about a shortage of comprehensive care family physicians while the media was full of pictures of people lined up for hours for the mere hope of getting a family doctor, set a new bar for stupid government statements. The fact that they lied to the Arbitrator saying there was no crisis in family medicine until being forced to release documents proving otherwise made me wonder if a Court Jester was their spokesperson.

A Court Jester who, given the accuracy they present, could probably be a great MOH Spokesperson

It will also be telling when reviewing the MOH briefs exactly where they feel health care is most lacking in Ontario. Do they propose more investments in family medicine? How much for each specialty? In the last couple of negotiations the MOH has tried to alter the Family Health Organization (FHO) contracts on how family doctors are paid. What changes do they propose this time?

Finally – it will be VERY telling how the MOH wants to spend the $480 million in targeted funds. Will they try to skirt paying physicians for it? For example, will they propose to pay certain physicians to hire an allied health care practitioner, saying “well it will reduce your workload”, all the while demanding copies of proof you are paying that person in triplicate? Or some such thing.

I appreciate the above may sound far fetched, but the MOH Team has proved itself to be so incompetent and borderline vengeful that a scenario like that wouldn’t surprise me in the least.

What About the OMA Briefs?

In comparison, the OMA’s job is relatively easy. They simply have to advocate for increases that will make each of their many sections 100% satisfied and not complain……

OMA Negotiations Chair Dr. Nikolina Mizdrak

In all seriousness, OMA briefs will also tell the profession a lot. I imagine each of the sections of the OMA will pour through the documents and send information to their members. But in short order we should all see how much of an increase the OMA has concluded each specialty warrants, and how the OMA plans to handle the perpetually thorny issue of relativity.

Additionally, the OMA has repeatedly point out that we have a shortage of comprehensive care family doctors. They’ve used the word crisis more than once to describe this. So as a family doctor, I am eager to see what changes they propose to the FHO model as well.

Most importantly, will the OMA be aggressive in defending its members? These last couple of months had seen absolutely unacceptable unilateral decisions by OHIP, delaying payments to physicians and making mistakes on their remittance . The OHIP bureaucrats blame their old outdated computers. Of course, when they plan to recoup the 9.95% they overpaid for the preventive care bonuses this past month – the OHIP computers magically managed to figure out how to get the money back immediately.

Will the OMA finally demand in their Arbitration briefs some sort of penalty for OHIP screwing up? Remember, the fee changes as a result of this contract are to come into effect on April 1, 2026. Given the Arbitrator likely won’t hand down a ruling until the fall, there is no way OHIP will get their act together in time without……..encouragement. Penalties/Interest for delayed payments should absolutely be demanded by the OMA.

All in all, next week, physicians will learn just how both the OMA and MOH feel about them. Buckle up folks……

Study of Family Doctors Choosing “Other” Work Leaves Me with Mixed Feelings

Last week, a study published in the Annals of Family Medicine revealed what those of us in medicine knew all along. More and more, physicians who are trained in comprehensive family medicine, are choosing to do other things. There are a myriad of reasons for this (ranging from poor remuneration, lack of respect from government, incredible admin burden and more). But the blunt reality, which is very very bad for the people of Ontario, is that despite having enough family doctors, not enough of them are practicing comprehensive care family medicine, and more are expected to stop.

There was of course, a large amount of press interest in the study, and rightfully so. Probably the best interview given by one of the studies authors was by my friend Dr. Kamila Premji (who is brilliant) and can be listened to here.

I was fortunate enough to be asked about this issue last week on “Toronto Today” with host Greg Brady. As I explained to him, I personally am left with decidedly mixed feelings about the report.

The Hope

It’s not like people haven’t been talking about this for a long time. Heck I wrote about how Ontario does NOT have a shortage of family doctors, just over a year ago. I pointed out that family doctors were leaving to do other things then.

But now that there is a comprehensive study done on the matter, maybe, just maybe, the bureaucrats at Ontario Health will finally do something positive about the matter. (I won’t bet the mortgage on it – but there is a teensy little bit of hope).

The Frustration

It’s precisely because people have been talking about this for such a long time that I was also frustrated that this issue hasn’t been dealt with yet. Dr. Premji herself warned about this issue years ago. My friend Dr. Mathew (another doctor much smarter than I) pointed out how the system has been deteriorating since 2012 . Dr. Nadia Alam, a former President of the Ontario Medical Association (also a dear friend much smarter than I) wrote in 2018 about the fact a crisis was coming in Family Medicine. And yes, a certain grumpy, miserable and cantankerous old bugger wrote back in 2017 about the need to support Family Medicine and warned that the shortage of comprehensive care Family Physicians was going to get worse if nothing was done.

All of these doctors were ignored. When Dr. Alam wrote her blog, “only” 800,000 people in Ontario didn’t have a family doctor – we are over 2.5 million now.

Thinking about how much better off we would be if the bureaucrats at Ontario Health hadn’t unilaterally ignored these doctors makes my blood boil.

The Fear

Which brings me to my biggest fear in all this. When I look around at some of the Ontario Health staff, and see some of the reports/decisions and directions given by various committees/panels/departments of Ontario Health, I see frankly, a lot of the same old names and faces. The same bureaucrats that ignored Dr. Alam and others for over a decade, and have made bad decisions and recommendations ever since, are still in charge. Many have been promoted. All of them are going to retire with full pensions. And yet now, they will likely be tasked to find a solution to the very mess that they failed to foresee and in many cases aided and abetted in creating.

If I may paraphrase Albert Einstein a little bit, to expect the same people who consistently and repeatedly made wrong decisions over the past ten years to suddenly not make a mistake with the next set of decisions is surely the definition of insanity.

So What’s Next for Family Medicine in Ontario?

As I think most of us know, Dr. Jane Philpott has been tasked by Ontario Premier Doug Ford to lead the new Primary Care Task Force. Her stated goal is to ensure every resident of Ontario has primary care within the next five years. She has a strong relationship with Dr. Tara Kiran, one of the more visible authors of the study on family doctors. Both seem to be working closely together.

Both of them seem genuinely passionate in their support of family medicine. They also understand the foundational importance of family medicine in a strong health care system. I believe they both have the desire to fix this crisis as soon as possible. We should all want them to succeed, because success means a healthier population for all Ontarians.

But…..

To date, I haven’t seen in either of them the willingness/ability/chutzpah/brass necessary to tell off our woefully incompetent bureaucrats at the Ontario Health and tell them which direction we need to go in. As I mentioned above, we just cannot rely on the advice the bureaucrats are giving anymore – nor the processes they have put into place.

One small example of ongoing bureaucratic incompetence if I may. It’s been know for over fifteen years now that our health care IT systems are completely disorganized and don’t talk to each other. The situation is so bad that healthcare is the ONLY major industry in which fax machines are still used (seriously). It’s so wasteful that it’s been estimated that we could save $2.1 billion dollars a year if we unified our health IT systems. (Which ironically is about how much Dr. Philpott has been given to fix the family medicine crisis).

Recently, Ontario Health announced that it would develop an electronic referral system to get rid of faxes. Sounds great. But unfortunately, a deep dive of their plan suggests that each of Ontarios 180+ health teams is to pick their own software. Which means you could have a situation for someone like myself, who has patients from two different areas, being forced to use two different electronic referrals systems. Which will do absolutely nothing to reduce my admin burden, the same admin burden that the study’s authors admit is driving physicians away from comprehensive family practice.

The family medicine crisis desperately needs to be fixed in Ontario. It will take a combination of a seamless electronic record system, processes in place to reduce paperwork, increased pay for family doctors (including pay for admin work and retention bonuses) and yes teams where the family doctors guiding them. But I don’t think any of that can happen until we clean out the bureaucrats at Ontario Health.

Survey on Delayed OHIP Payments

NB: The following is a guest blog, written by the (anonymous) author of the survey I referenced in, “Will the OMA Learn Lessons from OHIPs Latest Attack on Doctors?“. While it’s true these surveys tend to attract negative responses by their nature, the rather large number of respondents (especially compared to some of the OMAs own Thought Lounge surveys), suggests the OMA really needs to pay attention to the extreme dissatisfaction this issue has caused. My thoughts follow at the end.

The purpose of this survey was to highlight to the OMA the need to take this issue more seriously and to outline the impact the delayed payments had on members. The OMA’s response to this has been tepid. At the time the survey responses were collected, the payment timeline for November and December, 2024 retroactive pay was set as November, 2025. This was changed to August, but this does not alter the fact that the MOH has repeatedly delayed payments for physicians over the years.

Even with a signed, public agreement, the MOH has not managed to uphold its obligations, yet the OMA seems resigned, on behalf of its members, to accept whatever delays happen, based on whatever excuse the MOH provides. The members are not the cause of the MOH’s problems, yet they pay, over and over, for these deficiencies.

The survey results are summarized below. As a practicing physician, my time is at a premium, so I utilized AI to summarize the main findings of the survey.

Technology willing, the full survey results are here. Survey Monkey dashboard is here.

AI-Generated Summary of the Full Survey Document:

The survey responses reveal widespread dissatisfaction among Ontario physicians regarding delayed payments, systemic issues in healthcare administration, and inadequate advocacy by the Ontario Medical Association (OMA). Key themes include the impact of late payments, financial hardship and impact to personal finances.

Many respondents reported being unable to meet financial obligations, pay taxes, or fund discretionary purchases due to delayed payments. Some had to take on debt or cancel planned expenses like maternity leave benefits, vacations, or home down payments.

Clinic Operations:

Clinic owners faced cash flow disruptions, inability to pay staff, and delayed renovations. Others mentioned the administrative burden of tracking payments and rejected claims.

Mental and Emotional Toll:

Physicians expressed feelings of moral injury, frustration, and discouragement, with some considering early retirement or leaving the province entirely. The delay has eroded trust in the Ministry of Health and the OMA.

Lack of Accountability:

Respondents described the Ministry as untrustworthy, disrespectful, and adversarial, with unilateral decisions that breach agreements. Many called for interest payments on delayed funds and legal action to hold the Ministry accountable.

Systemic Issues:

Complaints included outdated payment systems, rejected claims, and lack of transparency in billing processes.

Weak Advocacy:

Many respondents felt the OMA failed to advocate strongly for physicians, with delayed and insuﬃcient responses to the payment issue. Some called for legal action, media campaigns, and stronger negotiation tactics.

Loss of Trust:

Physicians expressed frustration with the OMA’s perceived lack of power and transparency, with some questioning the value of membership dues.

Declining Appeal to Practicing in Ontario:

Many respondents are considering leaving Ontario or medicine altogether due to poor compensation, lack of respect, and systemic challenges. Some noted that other provinces offer better pay structures and support.

Family Medicine Crisis:

Respondents highlighted the lack of investment in family medicine and primary care, with concerns about burnout, scope creep, and inadequate funding.

Rejected Claims:

Physicians reported valid claims being rejected by OHIP , causing financial losses and administrative burdens.

Delayed Payments:

Delays in flow-through funding, parental leave benefits, and relativity-based fee adjustments were frequently mentioned.

Outside Use Penalties:

Respondents criticized penalties for outside use, especially when patients sought care elsewhere due to hospitalizations or urgent needs.

Recommendations for Advocacy:

Demand Accountability:

Push the Ministry to honour agreements, pay interest on delayed funds, and improve payment systems.

Increase Transparency:

Advocate for clearer communication about payment timelines, rejected claims, and billing processes.

Strengthen Negotiation:

Take a more aggressive stance in negotiations, including legal action and public campaigns to highlight the Ministry’s failures.

Support Physicians:

Address broader issues like rejected claims, outside use penalties, and inadequate funding for family medicine and specialists.

Conclusion:

There have been severe financial, emotional, and operational impacts of the delayed OHIP payment. There is an urgent need for the OMA to advocate more forcefully with the Ministry of Health to address late payments and systemic issues affecting Ontario physicians. Physicians are calling for immediate action, including interest payments, stronger advocacy, and accountability from the Ministry of Health and the OMA. The dissatisfaction expressed by respondents highlights the risk of losing physicians to other provinces or professions if these issues are not resolved.

An Old Country Doctors Thoughts:

While the above was written by my colleague, my personal thoughts on the survey is that I’m not really surprised by the results. I try to “keep my ear to the ground” so to speak, and there is a broad level of dissatisfaction with how the MOH repeatedly gets away with violating its own signed contracts, and the frankly abject level of incompetence at the MOH. The incompetence is unfortunately, not limited to just their payment systems/processes, but also how they run health care in general.

I’m also not surprised by the negative comments towards the OMA. Admittedly (as mentioned before) these surveys tend to cater to negative responses. However, there is a real sense of defeat on the ground about how physicians are being treated by the current government (protracted arbitration, stupid statements about the family physician shortage, and more). My sense is most physicians are resigned to defeat and are disengaging from health care – which is bad for the whole health system.

It does not help frankly, that a few short days after being told physicians would not get paid on time, OMA CEO Kim Moran was quoted in an Ontario Government News release on Primary Care saying:

“Ontario’s doctors are encouraged by this announcement and look forward to working with government to ensure that every Ontarian has access to a family doctor. We will do everything we can to accelerate this goal by collaborating with Deputy Premier and Minister of Health Sylvia Jones, and the lead of the Primary Care Action Team, Dr. Jane Philpott. It’s a long road ahead but this is a positive step forward to protecting Ontario’s valued health care system.”
Kimberly Moran
CEO, Ontario Medical Association (OMA)”

A very well respected physician from another province told me after seeing this: “It’s a bit pathetic. Screw us over and we’ll still be nice to you”. Personally I think Ms. Moran should look up “Stockholm Syndrome“.

I’ve repeatedly said you cannot have a high functioning health care system without happy, healthy and engaged physicians. These survey results suggest that that isn’t the case in Ontario.

Will the OMA Learn Lessons from OHIP’s Latest Attack on Doctors?

Last Friday (May 2), in what was a classic Friday afternoon bureaucratic dump, the OHIP bureaucrats at the Ministry of Health announced that they wouldn’t be paying the full amount of back pay owed Ontario’s doctors, as per the arbitration award. This was a unilateral decision on their part. It was contrary to what was in a signed agreement, and the OMA Board was notified at the last minute. (OMA CEO Kim Moran’s email is attached to the bottom of this blog). The bureaucrats promptly ran away an hid for the weekend hoping this issue would go away (kind of like how Sam Bennett cowardly hid from the press after putting an elbow to Leafs goalie Anthony Stolarz head).

This is, in my opinion, the latest attack on physicians as a whole from Ministry of Health (MOH) bureaucrats, who clearly are more interested in trench warfare than working co-operatively with Ontario’s doctors to improve health care for the citizens of Ontario. Don’t believe me? Consider the following:

The bureaucrats had the option of realizing that provinces like Manitoba/BC/Saskatchewan and even Alberta(!) recognized the need to work with their doctors and come up with a funding formula for them. Instead they chose to drag Ontario’s physicians through a protracted (going on three years now) and highly antagonistic arbitration/negotiations process.

Not only that, in response to now multiple stories of people lining up to find a family doctor in the press, their response was that there was “no concern” about the shortage of comprehensive family care physicians. (Seriously, how out of touch must they be to think that that type of Orwellian double speak is going to work in Canada).

People lined up hoping to get a family doctor in Walkerton. Photo originally posted in the farmers forum.

Frankly, this inept, combative and dismissive treatment of physicians is just par for the course for this bunch of bureaucrats. It saddens me, but it doesn’t surprise me.

No blame for this decision should fall to the OMA. They did negotiate a signed agreement (as per Ms. Moran’s email) and they clearly were not notified about the unilateral change until far too late. So the unilateral action is not their fault.

But….

What the OMA can, and should be held accountable for is how they proceed from here.

I don’t want to seem overly difficult here. If I truly was an obstinate person, I’d try to get a job at the Ministry of Health – perhaps on their Negotiations Team. The reality is that I actually have a long history of working co-operatively with government to improve health care in my neck of the woods.

I’m serious. In 2001 I helped bring in the first stage of Primary Care Reform called the Family Health Group. In 2004 I was one of the lead physicians who brought in a capitation model of payment for family physicians (it was initially a Family Health Network and it eventually evolved into a Family Health Organization). From 2007 -2013 I was the founding Chair of the Georgian Bay Family Health Team and From 2013-2015 I was the Health Links lead physician in my area.

And in each of these roles I worked closely and co-operatively with government to try to improve the health care needs of the patients in my area.

But – in those days, the bureaucrats wanted to work with doctors. They wanted to co-operate to improve health care and they were genuinely concerned about the lack of family physicians providing comprehensive care. They didn’t want to play power games with physicians or harass them or do dumb things like the current crop just did.

It’s important for the OMA to (finally) realize that there really is no hope that they can work with the current lot. They’ve already dragged us through three miserable years of negotiation/arbitration and fought us (thankfully often times stupidly – as even the Arbitrator pointed out) – for the sake of…….. I don’t know why really. Maybe it’s a power play? Maybe there are just bullies?

Recognizing the obstinance of the MOH bureaucrats is why I was proud (and still am) to have my name on an Op-Ed in the Toronto Star last year advising Family Medicine Residents to NOT start a practice in Ontario at this time. But I have to tell you the blowback from the OMA was saddening to me. I will not mention names – but one senior exec told me that the OMA was working well with the Government. Worse, one senior physician leader texted me the following:

Text from a very senior physician leader at the OMA

Remember – at the time this text was sent to me – we had already been locking horns at the negotiations table for two years and the government had done absolutely nothing to solve the family medicine crisis. Perhaps the physician leader felt the relationship was “best ever” because at least they weren’t sabotaging doctors left right and centre like the abhorrent Eric Hoskins did.

Despite all of that, there was some movement forward with arbitration. While no where near what other provinces got, it at least recognized the need to fund health care better, and provided hope for funding for offices, clinics, and frankly other badly needed resources.

Now the MOH has decided unilaterally to not pay, or pay whenever they feel like it, so we are back to – do NOT start to work in Ontario.

At any rate – as mentioned, while the OMA cannot be judged on decisions by the Ministry, what the organization does next will be telling. Will they finally recognize that the current lot of bureaucrats simply cannot be dealt with by reason? Will they recognize that physicians are essentially being bullied by these ruffians and the best way to deal with a bully is to stand up to them? Will they take legal action (according to Ms. Moran’s email – there was a signed agreement which the MoH is now in violation of)?

I don’t know the answer to any of the above. But I can only hope that the current Board recognizes that there is no hope of working in good faith with this lot of bureaucrats and that strong, frankly militant actions, are needed to support the members.

Addendum: After I published my original blog, an anonymous colleague asked that I publish a link to a survey about this issue. I’ve therefore appended my blog and ask all Ontario physicians to click on the link below and honestly reply to the questions:

https://www.surveymonkey.com/r/W2ZPMCC

Re-Post: Hoskins Won’t Survive The Mess He’s Made Of Ontario Health Care

NB. The following is a re-print of a blog I wrote for the Huffington Post, published originally on July 10, 2017. It’s being republished here mostly for my own record keeping.

Recently, one of my medical school classmates (now a cardiologist) was awarded the Society of Thoracic Surgeons top rating for patient care outcomes. A great honour for her, and well deserved. Unfortunately for the rest of us, she practices in South Dakota, one of the many physicians who left Ontario during the protracted battles with Ontario Governments in the 1990s.

Back then, as I mentioned in my first blog, many health ministers continued to insist that physicians in Ontario were the highest paid in all of North America. Yet we lost physicians in droves. The reality is that while physicians wanted to be paid a fair wage (who doesn’t?), what they really wanted was to have a say in how health care was delivered and be able to advocate for their patients.

So when the then Ontario government of Bob “Super Elite” Rae made unilateral decisions about health care, physicians left for jurisdictions where they were paid less (according to then Health Ministers Frances Lankin and Ruth Grier). But at least they had a say in how health care was delivered.

I mention this because it appears that current Ontario Health Minister “Unilateral Eric”Hoskins and his Deputy Health Minister Bob Bell have been unable to grasp this fundamental concept. Hoskins (and, to a lesser extent, Bell) have based their whole political strategy on portraying the dispute in the media as one of doctors wanting endless sums of money. If only the doctors would take less, the health-care system would improve. They appear unable to grasp the fact that doctors VALUE the ability to advocate for their patients and contribute to health care decision making.

From a purely political point of view, the strategy had some benefits for Hoskins and Bell. They were able to pass both the Patients First Act and the Protecting Patients Act. There was muted public response because they were able to portray physician opposition to these Acts as physicians protecting their incomes. The fact that the Patients First Act does nothing but increase bureaucracy and that the Protecting Patients Act actually violates Charter Rights of all health-care workers, and will likely be the focus of a Charter challenge, meant nothing to Hoskins and Bell. Good PR in the face of mounting, repeated, ongoing evidence of the collapsing health-care system was all they wanted.

Surely the Hoskins/Bell duo thought their troubles were behind them when the OMA ratified the BA framework. Not so.

It must therefore have come as a shock to Hoskins and Bell when, after giving Physicians Binding Arbitration (BA), physicians actually increased their attacks on the Liberal Government mismanagement of the health-care system. Now to be clear, giving BA is not the same as awarding a contract. The Ontario Medical Association still has to negotiate a contract for physicians.

But central to Hoskins and Bell’s way of thinking was that all physicians cared about is money. And the spectre of BA does force both parties to negotiate fairly.

Also in fairness, it’s pretty evident that Hoskins himself didn’t want to give physicians BA. Not only did he deride physicians for asking for it and fight it in cabinet, but when the Ontario government sent a press release indicating they want to return to negotiations with the OMA with the first order of business being to develop a BA framework, it came from the premier’s office, not Hoskins’ office.

Regardless, surely the Hoskins/Bell duo thought their troubles were behind them when the OMA ratified the BA framework. Not so.

Wait Time Series: Cataract surgery patients are finding themselves on longer #waitlists as funding fails to meet demand in Ontario. #ONpoli pic.twitter.com/Nh466RND1k

— Ont. Medical Assoc. (@OntariosDoctors) July 5, 2017

Since then, the OMA has become even more aggressive in its attacks on the Liberals. Have a look at their Twitter feed where they attack wait times for cataract surgery and joint replacement surgery.

Also, a grassroots group of doctors have now begun tweeting multiple barbs at the Liberals. Saying that doctors are required to put the pieces of health care together, they’ve used inventive and creative images to drive home the point that the Liberals don’t know what they are doing in health care.

Finally, OMA President Dr. Shawn Whatley openly wrote in his blog that physicians need to be champions, not doormats, and fight for health care for their patients. Surely poor Hoskins and Bell never expected this when they actually gave the OMA a path to a fair contract via BA. Goes to show you just how much they misjudged physicians’ desire to advocate for their patients and for a fair health-care system for all of us.

Hoskins and Bell are now, as the old joke goes, officially “post turtles.” This joke compares a (usually inept) politician to a turtle balancing on a fence post. You know he didn’t get there by himself, he doesn’t belong there, he doesn’t know what to do while he’s up there, and you just want to help the poor thing get off the post.

Ontario Premier Kathleen Wynne basically has little choice now. Hoskins and Bell are just too easy targets for the mess that they’ve made of health care and the way they’ve badly misread physicians passion for protecting their patients. The differences are irreconcilable.

Hoskins is the easier of the two to deal with. Wynne needs to shuffle her cabinet and move Hoskins on to minister of sanitation or something.

Bell, being an employee, has certain rights and can’t just be fired. However, the anonymous surveys done by Quantum Transformation Technologies indicating how unhappy his own bureaucrats are should be enough evidence for Wynne to order a formal administrative review of the senior management team at the ministry of health. Maybe they can be salvaged with administrative coaching.

But what’s clear is that as the health system fails, Wynne needs front line physicians to help put its pieces back together. Wynne needs to regain their trust. The way to do that is to bring tangible change to the leadership of the ministry of health.

OMA Does a Disservice to Members with Veiled Threats to Board Candidates

OMA Elections will soon be upon us. This year the possibility of significant change to the organization exists as half of all physician Board Director positions are up for grabs. A review of the OMAs election page shows that there are 58 (!) candidates running for 4 Board positions.

My three loyal readers know that I have long felt that the first and foremost responsibility of the OMA is member advocacy. Many have heard me say time and time again that you cannot have a high functioning health care system without happy, healthy and engaged physicians. The OMA needs to consistently and effectively promote physicians.

Unfortunately the government of the day continues to disrespect physicians by forcing us into a never ending arbitration process. It also, despite the correct warnings of the OMA, continues to expand the scope of practice of non-physicians. I therefore wanted to see which of the Board candidates would be willing to take a more aggressive approach to this issue. So on a bunch of Social Media forums, I posted a request for all Board Candidates to sign a pledge if elected.

#medtwitter Are you a candidate for Board Director of @OntariosDoctors? There are 58 candidates for 4 positions. In order to help me choose my preferred type of candidate – there is a pledge I'm asking all candidates to sign. DM me for details. (spam DMs will be blocked)
— Dr. Sohail Gandhi, MD (@drmsgandhi) December 24, 2024

What exactly was this “pledge”? Was it a demand to remove the compulsory dues that all physicians have to pay to the OMA? Was it to split the OMA into two organizations- one for specialists and one for family doctors like they have in Quebec? A demand to fire certain staff?

Nope. It was a pledge to get data on how much allied health care providers (in this case NPs) cost the health care system when they try to do the work of family physicians. See below:

Now, did I think the culture of the OMA, that has been put in place by and is overseen by the current Board, would be happy with this? Of course not. Despite what my kids tell me, I’m not that out of touch. I expected some sort of push back suggesting this was (in their view) inappropriate.

But I confess I was taken aback by not only the factual errors in their response, but what quite frankly can only reasonably be perceived to be a veiled threat to myself and Board candidates. Here’s a copy of what I got:

The first factual error is to conflate the governance transformation (which I supported, and still do) with the elections process. The governance transformation was about reducing the size of the Board, and making it electable by and therefore responsible to the membership as a whole. This is opposed to the mishmash of ways people got on the Board before. It was also about sunsetting OMA Council (which had long served it’s purpose) and putting in a better, more co-operative General Assembly system, along with a Priorities and Leadership group to advance the needs of the members.

I did, and continue to support all of that (trust me, the old system was much worse). BUT – that is completely separate from the elections process itself. The intense over regulation of what candidates can and cannot say or how they can act during elections is NOT governance transformation, it’s micromanagement.

The second error is to suggest that it is because of my previous role at the OMA that I am “viewed as a leader”. Apart from the obvious fact that I have a bunch of detractors, the blunt reality is that there are a whole lot of ex-OMA Presidents out there who would not have influence because of the title itself. They have influence because of who they are/what they advocate for/actions they take outside of any past title.

The email to OMA Board Director candidates was almost as bad:

The underlying message is quite clear. Sure you can run for Board Director. BUT, if in OUR opinion, you “campaign”, or take a position WE don’t like, or speak out of turn – WE disqualify you. Intentionally or not, it creates the impression that the organization only wants a certain kind of Board Director. Not a strong independent type who can think on their own, and, dare I say it, take a bold stance that perhaps requires come chutzpah (like signing the pledge would!) But rather a benign, meek, Board Director – who will simply rubber stamp what’s been presented to them.

Unacceptably, in my view, is the more subtle threat of damaging our careers. The comment that this is”not in keeping with OMA’s code of conduct and civility”can really only be viewed as a veiled threat. Charging someone under a code of conduct violation has the potential to be extremely damaging. Many physicians, when they apply for new positions have to answer questions like “are they now under investigation” for such and such, even if there has not been a ruling yet. Being charged with this would force them to answer yes and potentially damage career options.

To be clear, I actually support the code of conduct and civility. I saw in the aftermath of the miserable 2017 tPSA debacle some incredibly unprofessional comments made towards the OMA staff (and others). I also am aware of many instances since where staff have been verbally abused by members and that is completely unacceptable. The staff are a very hard working bunch – who follow the direction and the culture the Board puts in place. It’s the Board that should be – respectfully – held into account.

But to tell a potential Board Director candidate (and me) that stating an opinion that might be viewed as controversial and advocating for that as part of an election process might see them charged?? Especially when there was absolutely no foul/derogatory/demeaning language used in the posts? Sorry but that simply comes across as attempting to censor a view point that you don’t happen to like. And that’s just wrong. Worse, it gives credence to the many critics of the policy who feared it would be used to suppress discussion.

Members deserve a strong, independent thinking and bold OMA Board. An elections process that goes to these extremes to prevent candidates from taking a stand on issues, advertising to members their skills (or lack thereof!) and their philosophy does not serve the membership at all. It will only disenfranchise them and lead to more voter apathy. About the only thing members can do at this point is NOT vote for any incumbents for Board Director and hope that will trigger some changes to this process.

As for me, I will try to get through the elections material – and pick candidates who I think will work to change the organization for the better. I will let you know my thoughts in a later blog.

OMA’s Recent Messages to Family Physicians are Disappointing and Misleading

Last week, Alberta, the province that once had a health Minister who went to a physicians house to berate him in person, created a new pay model for their family physicians. Even Alberta, the province whose premier told the health service to not talk about vaccines, realized the obvious. Family physicians need to be paid commensurate to the foundational work they do, and the role they play, in a high functioning health system.

Alberta Premier Danielle “Covid? What Covid?” Smith

I’ve taken a look at the new Alberta model. Some of the specifics are gated but the rough overall numbers are public. My back of napkin math suggests there is about a 24% increase in gross income for family physicians with a practice size of 1200. This includes payments for indirect work (checking labs, reviewing reports, supervising staff – all the admin work that Ontario refuses to recognize) and increased payments for more complex patients. I congratulate my colleagues in Alberta on this accomplishment. It WILL stabilize not only family medicine, but their whole health care system.

In response OMA CEO Kimberly Moran sent out an email on Friday Dec 20th. (A complete guess on my part is that she saw some of the responses to this deal on Social Media). I personally was offended (but not surprised) by the manipulation of figures and data in her email. While it’s true that every thing she wrote in the email was technically correct, the manner in which it was presented created an impression of successes that just aren’t there when it comes to advocating for family physicians.

I hate to talk numbers, this stuff gets confusing. But here’s a short set of data you need to know (numbers rounded for simplicity).

2022/23 is the BASE YEAR for all future increases negotiated/arbitrated going forward
The 2022/23 physicians budget was $16 billion
For 2023/24 (the last year of the previous agreement) the OMA negotiated a 2.8% ($448 million) increase
for 2024/25 the Arbitrator awarded us 9.95% compounded to the 2.8% from 2023/24 – which winds up being 13.03% more than the BASE YEAR ($2.08 Billion more than 2022/23)

So what’s the problem? Well for starters Ms. Moran states that the OMA “successfully” advocated for a 9.95% increase without mentioning that the OMA asked for 22.9%. Getting less than half of what you ask for is successful? But more importantly she went on to tell family physicians that they will receive a higher increase than the arbitration award of 9.95%. (11.75 – 13.54% depending on the practice model). But here’s the thing, the arbitration award was the increase for one year only (2024/25). The increase that family doctors are getting is an increase from the BASE YEAR (2022/23) – so it reflects your increase for two years not one like the arbitration award. The two year increase to the physicians budget is, as mentioned above 13.02%.

Now I completely respect the fact that the numbers that I’m quoting do not reflect the fact that the the award is meant to be split 70/30 between fee increases and targeted funds (but neither did Ms. Moran’s email!!). A very brief summary of how targeted funds are supposed to work:

70% of the $2.08 billion are supposed to go to fee increases ($1.456 billion)
the other 30% is supposed to be targeted ( $624 million)
of the $1.456 billion, 25% ($364 million) is supposed to go to across the board (ATB) increases for everybody. Crunching the numbers means everyone gets a 2.27% increase to their 2022/23 (BASE YEAR) income. The rest of the increase is based on relativity. Ophthalmologists for example get an additional 0.18% for relativity, and family doctors get between 9.48 – 11.27% additional for relativity. But again – that’s the increase for TWO YEARS, whereas the 9.95% was just for the one year.

This type of sophistry in messaging from the OMA regarding family medicine is sadly all too common. For example, the OMA has said that Ontario Family doctors have the highest capitation rates in Canada. Is that statement true? Of course it is. BUT – what’s also true is that no other province has deductions for outside use. Also, at a bare minimum family physicians in British Columbia, Saskatchewan, Alberta and Manitoba (with Manitoba being on top) pay family physicians more. Maybe Nova Scotia as well. Ignoring that while trumpeting higher overall capitation payments is unsettling.

While I sadly did expect such sleight of hand over numbers from OMA central, I must admit I was very disappointed in the SGFP email that came shortly thereafter. The SGFP has recently really gotten quite a bit stronger at advocating for family doctors and done some good work. But even they sadly fell into the trap when SGFP Chair Dave Barber told members in his letter:

“…Family doctors will receive increases greater than the 9.95% arbitration award announced earlier this year”.

David Barber – Chair of the Section of General and Family Practice

Again, technically a true statement, but very inappropriate. I don’t know what he was thinking signing off on that.

The really sad thing is that it didn’t have to be this way. The OMA (and SGFP) could have been completely forthright and honest and simply laid out the facts as I did above. This still shows family doctors getting a relativity bump more than a lot of other specialties. And they could have said that they want a good chunk of the targeted funds to go to Family Medicine but the government continues to fight them. Finally, they could have blamed the government for not recognizing the seriousness of the crisis. All of that still would have talked about the positive work being done, without creating the impression that they were trying to hoodwink the members. But alas……

What can we done? Well, I’ve said it many times before. Only the members can change the OMA if they want to. This year in particular, four physician members are up for election for Board Director – which represents half of all the physician positions. There are also multiple candidates running for SGFP executive positions. This really represents the best opportunity in a long time to continue to change the culture at the OMA so that we don’t get disingenuous messaging like this.

I’ll have my thoughts on the election in an upcoming blog.

Arbitration Part IV: What to Make of the New, Updated Payment Schedule

Disclaimer: The payment schedule below is based on my personal analysis of information from the OMA as of December 6, 2024. It would not surprise me if there were more changes. Do NOT use this as your sole source of planning. Contact info@oma.org with any questions.

On Nov. 1, 2024, OMA Board Chair Dr. Cathy Faulds announced an update on how the arbitration award for Year I of our PSA (Fiscal 2024/25) is going to be paid out. The plan was to have final numbers in a couple of weeks. Follow up information didn’t come until December 6 in an OMA news alert. Some things never change.

Wait old country doctor! Didn’t you already do a blog on the Arbitration Award?

Yes, parts two and three of my Arbitration analysis did say what was planned. But the blogs were filled with with statements like “allegedly” “supposedly” and chances of some of the changes happening were “slim to none”.

So we read all your previous work for nothing?

At the risk of sounding somewhat less than humble – most to the stuff I wrote about has come to pass – including splitting the increase with 75% of the amount going towards relativity, and 25% for across the board (ATB) raises.

Well what changed then?

There are a couple of delays (of course) to some of the retroactive payments. But the big change is changing the amount of your increase based on your specialty. I don’t know who came up with the idea of doing this, and suggested it to the OMA’s Negotiations Task Force, but whoever it was deserves the thanks of our profession.

This method is not perfect, because some billing codes are used by more than one speciality. For example, I’m a family physician, but I do joint injections. So do orthopaedic surgeons and rheumatologists. But the billing code (and thus payment) for doing a joint injection is the same. Applying an increase to that code will affect at least three specialties. Therefore, by given specialty specific increases instead, some of the lower relativity specialists will get more of an increase sooner.

The “permanent” changes to the fee codes will now not happen until April 2026 (!!). So expect your income to fluctuate some more then.

Don’t tell me you’re are going to toss large numbers and calculations at me!

I’m going to toss large numbers and calculations at you.

Here are numbers I needed to understand the contract. Numbers rounded for simplicity.

Fiscal Year 2022/23 is the base year for calculations. Physicians budget was $16 billion.
2.8% increase agreed to for 2023/2024 (from last PSA) = $448 million
9.95% awarded by arbitrator for 2024/2025 when compounded with 2023/2024 – total value =$2.085 billion
The plan was to spend 70% on fee increases, and 30% on “targeted” investments. For 2023/2024 this would be $314 million for fee increases, $134 million for targeted investments. For 2024/25 – $1.460 billion for increases, $625 million for targets.
Finally, as of now, it appears that we are going to stick to 25% of the total for fee increases (not the targeted money) will go to across the board (ATB) raises, and the rest based on relativity.

Wait a minute Old Country Doctor – didn’t everyone get the same percentage increase this year?

Yes. Under the terms of a previous agreement, if the OMA and government were not able to sort out how to divide the money for a fiscal year, ALL of it would be paid ATB on a temporary basis. Emphasis on temporary. So we all got a 2.8% increase for 2023/2024 (you should have gotten the retroactive pay in November). Additionally your monthly remittance should be 2.8% higher beginning on the MAY 2024 statement (The increase took effect April 1, but of course, that gets paid out on May 15).

For this fiscal year (2024/25) the OMA and government have conceded they won’t come up with a plan on how to divide the funds, and so everyone will get an ATB of 13%(1.028 x 1.0995). The way it’s paid out will be a mix of monthly increases and some retroactive pay.

However for fiscal 2025/2026, there will be specialty specific increases. Each physician will get another temporary increase in their billings, based on their specialty. The OMA and government will continue to ~~argue~~ negotiate. Probably need arbitration for this. The exact fee code changes are scheduled to be in place April 1, 2026 (!!)

You’re going to bring back Drs. Alpine and Valley to explain this aren’t you?

Of course dear reader. It helps to put a “face” to the numbers. However, on this occasion, let’s assume Dr. Alpine is an ophthalmologist (speciality chosen only because they appear to get the lowest increase) and Dr. Valley is a family doctor in a capitation model (for reasons that will become clear shortly).

I won’t restate the assumptions for my calculations (please refer to my previous blog on this issue). Assuming that Drs Alpine and Valley see the exact same number of patients every year – this is what their gross income will look like.

Time Period	Dr. Alpine	Dr. Valley
Monthly billings 22/23	$100,000	$30,000
Monthly billings 23/24 (increase not applied yet)	$100,000	$30,000
Monthly billings April 2024 till Dec 2024 (2.8% finally applied)	$102,800	$30,840
Nov 15, 2024 (retroactive pay added)	One time payment of $33,600 in retroactive pay for 23/24	One time payment of $10,080 in retroactive pay for 23/24
Jan 15, 2025 – 2.8% lowered to 2.55% as part of agreement to use funds to increase HOCC	$102,550	$30,765
Feb 15, 2025- April 15, 2025 – OHIP will finally given 1.0995 on top of the 1.0255 now	$112, 754	$33,826
May 15, 2025 retroactive pay for April -December	One time payment of $89,583	One time payment of $27,549
May 2025 – April 2026 monthly billings	$102,452	$33,525

WAIT A MINUTE! Capitated Family Doctors gross will go down as well??

Yes. As mentioned above, for 2023/24 and 2024/2025 the OMA and government could not agree how to divide up the now $2.085 billion, so it was given ATB on a temporary basis. This was meant to get some money into doctors hands sooner otherwise Allah/God/Yahweh only knows how long we would have to wait for the process to complete.

However, 30% of the $2.085 billion (or $626 million) was meant for “targeted funds”. The expectation is either through negotiation (very unlikely IMO) or through arbitration, a decision will be made on where to spend that $626 million for fiscal 2025/26.

Therefore, there is only $1.459 billion for general increases for 2025/26 (plus whatever increase the arbitrator gives us). Of that, 25% ($365 million) will go ATB. So everyone will get 2.03%. The remaining $1.094 billion is distributed via relativity.

With less money to distribute – well, there is less of an increase. Now of course the possibility exists that some of the targeted funds will be spent on captitated family medicine too, but who knows at this point? This is why virtually every specialty sees a decline in 2025 when you look at the OMA’s spreadsheet.

Keep in mind the fee increases for April 1, 2025 to March 31, 2028 have yet to be negotiated (more likely arbitrated) so there will be more money in the future – we hope.

I’m not a family doctor or an ophthalmologist- how do I find out my numbers?

I suggest you go to the table that the OMA has prepared for you. Use your base 2022/23 monthly income to figure out your projected numbers. If you have specific questions about your situation, I urge you to contact info@oma.org. The organization can’t really answer questions if they don’t know what they are. Also please register for the live Zoom Webinar on this process, and ask your questions there.

So this is the final word on this issue?

Nope. I suspect there will be more to come. And that it will be just as confusing.

You’re just a bundle of joy Old Country Doctor.

I aim to please dear reader. I aim to please.

Sunday Snippets: Dec 1, 2024 (ft. Bonnie Crombie, Vaccines, Microplastics and more)

Item: More and more family doctors are turning to AI scribes to reduce their workload. Many physicians in the article state time saving is the main driver for adopting these scribes.

My thoughts: I’m piloting an AI scribe right now with my Health Team. It can reduce the number of hours spent on paperwork. However, one does need to review the note dictated to ensure it’s accurate (a few examples of mistakes so far). The notes also tend to be wordier than my own notes. Finally, it’s really important to review the examination section of the notes – as the scribe has no way of knowing what a patient “looks like” and it’s up to you to ensure accuracy.

There are of course some privacy concerns. That’s why I like the fact that the scribe I’m using is not integrated into my Electronic record. That way the patients name/date of birth/health card/other identifying information does not get sent into the ether when the scribe generates a note.

My hope is the government settles on one scribe (after appropriate vetting) and pays for all physicians to use it. This will have significant positive benefits for health care.

Item: Ontario Liberal Party Leader Bonnie Crombie has launched her first campaign ad. She blames current Conservative Premier Doug Ford for the shortage of Family Physicians.

My thoughts: It’s a bit rich for the Liberals to blame the current government for the doctor shortage when most of the problems with family medicine began during their tenure. But, just as federal/national elections are won based on the cost of living/inflation (the big reason why Trump won), provincial elections in Canada are often lost based on how the current government is managing health care. And this truly is Doug Ford’s Achilles heel.

I know it seems like Ford’s handlers have him convinced that he can win a third term if only he calls an early election. But the blunt reality is that an early election call will be viewed as cynical even by people who will vote for him. Similarly the $200 Ontario “rebate” cheques are going to be viewed as a bribe.

Will Ford win a third term? I don’t know. But I doubt it will be as easy as he or his handlers think. He really needs to take some significant steps between now and the spring on health care. If only some would give him advice, and on more than one occasion.

Item: We’ve all heard about the rise in measles cases across the country and in the U.S. It seems that now Whooping Cough is also on the rise.

My thoughts: Jeez. Get vaccinated and get your kids vaccinated already people.

Item: On that note, it seems very few adults in the United States are getting updated Covid/Flu and RSV vaccines, even in high risk populations like nursing homes.

My thoughts: Life expectancy in the United States continues to fall. These two articles are not unrelated.

Item: Microplastics have now been found in the human brain.

My thoughts: Not nearly enough attention is being paid to this story. There are significant red flags for the harm that microplastics can do to human health including increasing the risk of dementia/heart disease/stroke and reducing fertility and sexual function. While it’s true that most of the studies raising alarm have been in labs or in animal models that don’t give a complete picture of the effect on humans, there are just too many concerns to ignore. We need an urgent review of microplastics (along with a review of all the processed garbage in the North American diet).

Item: A great article in the Annals of Family Medicine shows that when your doctor is away, there is LESS downstream use of ER and associated health care costs if you see a doctor in the same group practice than in a walk in clinic.

My thoughts: This is yet another reason why expansion of scope of allied health professionals is a bad idea. Rather than getting your care fragmented between health care workers who don’t have your full health history – the ideal is to support your family doctor to make sure whoever is covering can see that information, to give you better care. And on that note….

Item: Ontario is going to allow the further expansion of scope of nurse practitioners. PEI is going to allow physiotherapists to order X-rays.

My thoughts: Go read the article from Annals of Family Medicine above. This move (to expand scope) will eventually be shown to have been a big mistake.

Item: Excellent (and unusual for the Trillium – ungated) article on the aging population of family physicians in Ontario and what it could mean for the future.

My thoughts: None of this is surprising. Four of the five doctors in my clinic are late 50s or older. We are heading for a real problem if we don’t immediately support family medicine now.

Item: I somehow missed this but it seems that Australia just had its worst flu season on record.

My thoughts: I wrote this in 2017 warning that our health care system couldn’t handle a bad flu season. The situation is worse now. I don’t know what the flu season will be like, but if it’s a bad one we will see a proliferation of horror stories about health care. At the risk of sounding like a broken record – get your flu shot people. Keep yourself safe.

Yours truly getting his flu shot this year.

That’s it for this week. I’m away next week. Might have a blog later on a specific issue that is making Ontario an undesirable location to practice medicine. Back in two weeks with more snippets.