Politics – Page 2 – justanoldcountrydoctor

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

Dear Sylvia Jones, Here’s How to Make Health Care More Convenient…

Congratulations on winning the last election and being re-appointed health minister. The health ministry is the toughest job in government. I sincerely mean now, what I wrote before, that all of us should hope you are successful. Ontario deserves the healthiest possible population.

Of course, that still won’t stop me from giving you advice (whether you want it or not)……

I’ve noticed that you place a really high value on making sure that health care is “convenient.” Your government even calls the overall program “A Plan for Connected and Convenient Care.” Your talking points in the press always mention “convenient.” Even the second major outline for health care uses that word.

I would suggest that rather a lot of your health care platform is based on making people happy by giving them what they want and making things easier for them. For example, your boss, premier Doug Ford, when talking about the expanded scope of practice that allowed pharmacists to prescribe treatments for minor ailments focused almost exclusively on the fact that it was one of the most popular things your government has ever done. The public was satisfied, so it must be a good thing.

Now I appreciate that you don’t have a health care background. If you did, you would know, that convenient health care, and patient satisfaction in health care, actually have a negative correlation with health care outcomes. Essentially, when patient satisfaction with the health care system goes up, the health care outcomes get worse. A study published in Medscape showed that focusing on patient satisfaction lead to 12% higher hospital readmission rates, 9% higher health care costs and 26% higher mortality rates.

Basically, focusing on convenience and satisfaction in health care costs more, makes people sicker and kills more people.

However, at this point, I doubt that I can get you to shift away from this philosophy. So I have an idea that will make health care much more convenient for people. Something that will reduce the amount of travelling back and forth that people do, and will allow them to quickly and easily get their health care needs taken care of in one spot.

It’s time for you to amend or revoke regulation 114/94 under the 1991 Medicine Act. This prohibits physicians from selling medications to patients. My sincere thanks to OHIPs former lawyer, Perry Brodkin, for pointing this out to me on X.

How will this be convenient? Well, right now, when a patient goes to see a physician for, let’s say high blood pressure, the patient will get assessed by their family doctor, and based on their medical history, an appropriate medication will be chosen for them. They will then drive to the pharmacy with that prescription. The pharmacy will take however long it takes for them to fill out their prescription, and after a period of waiting, the patient will get their needed medication.

By allowing physicians to have their own dispensary, a patient will now go to the physician’s office, and if a prescription medication is deemed necessary, they can just purchase it from the physicians office right then and there. It saves them an extra drive, and perhaps even parking lot fees depending on where they go. This will, of course, be extremely convenient for the patient.

What’s that you say? Isn’t this a conflict of interest? I mean, if a physician is now able to sell the drugs after making a diagnosis, wouldn’t it encourage physicians to prescribe more medications?

Um, can I ask why that didn’t seem to bother you when the pharmacists were allowed to expand the scope of their practices by you? Pharmacists now make an assessment for certain minor illnesses, get paid to do that by the government, determine what in their opinion the right treatment is, and then sell the patient the drugs at a profit. (This is what naturopaths and some chiropractors do as well, but that’s a whole other story.)

What’s that you say again? Pharmacists have to abide by a certain code of conduct from their college. They are bound by their code of ethics to act in the best interests of their patients. Um, ok. You do know that physicians also have a college that we answer to, right? You do also know that physicians also have a code of ethics? That we all took an oath to do no harm to our patients?

Might I ask exactly what the difference is between these two scenarios?

Of course, while most patients would be happy for this convenience, I imagine not everyone will be happy. I suspect (Shoppers Drug Mart bigshot) Galen Weston would be quite annoyed if you did this. But hey, look at the bright side, at least you won’t have to deal with some miserable crotchety old country doctor spouting off in the media wondering who exactly the health minister was in this province.

Galen Weston, of Shoppers Drug Mart and Loblaw fame.

Look, at the end of the day, for me, it’s health care outcomes that matter the most. I want patients to have the best possible results for themselves and health care as a whole in Ontario. But if you are going to insist on “convenience” then at least do it in a way that’s fair to all of the health care professions.

Change or amend the 1991 Medicine Act to make life a little easier for the patients.

Yours truly

An Old Country Doctor

P.S. While you’re at it, don’t forget to direct your OHIP Bureaucrats to not seek repayment from Dr. Elaine Ma. Don’t think doctors in Ontario have forgotten about this situation.

Unrelenting Bureaucracy is Killing Health Care (and Canada)

Canadians are currently dealing with the dizzying spectacle of Donald Trump’s tariffs against our country. On again? Off again? Delayed? Doubling? I’ve personally gotten seasick trying to keep up with whatever tangerine Palpatine is thinking.

U.S. President Donald Trump – aka the Tangerine Palpatine

However Canada’s response to this (and the nonsense about us becoming the 51st state) has frankly been quite lacking. Yes, it’s great to see Canadians being able to fly the flag with pride, especially after the miserable co-opting of the Canadian flag by the freedom convoy types, who likely themselves were Donald Trump supporters. (How’s that working out for you guys now?) Yes #elbowsupCanada is a wonderful approach to take and a great mantra going forward, particularly with how intertwined hockey is with our nation. (Quick reminder: Not only do we win Olympics, we win Four Nations Cups as well).

BUT, for all the outcropping of (absolutely warranted) national pride – our governments – outside of launching retaliatory tariffs, haven’t done anything to fix the systemic problems in our economy. For example, getting rid of domestic trade barriers and having free trade between provinces would provide a boost of up to $200 billion dollars to our economy, but seemingly no action on this yet.

Even more importantly and what’s long overdue, is an absolutely necessary look at the bureaucracy and impediments that many businesses face in trying to contribute to our economy. Let me talk about a personal experience (and no disrespect intended to the good people on staff in my township).

About 10 years ago, our community had clearly outgrown the medical centre. Some poor sap was put in charge of expanding it. (Guess who.) I had to deal a myriad of problems of putting an addition on our medical centre. Here’s a couple of examples of what I dealt with.

As per policy, the township requested that we provide an engineered site plan. The reason for this was to assess water drainage requirements. While on the surface this makes sense, all the engineered site plan was going to tell us what size of culvert to put on our property for water drainage. The estimate for the site plan was about $15,000.

A sad, lonely culvert, passing its life away draining water…

However, it turns out there were only two sizes of commercial culverts for our project. A big one and a small one. The big one cost $500 more than the small one. Being well-versed in the obstinacy of Ontario Health’s bureaucrats, but somewhat naive in the inflexibility of municipal bureaucrats, I offered to simply put in the bigger culvert right from the start in exchange for waving the engineered site plan.

Those discussions went as well as my less naive readers will expect. The site plan wound up costing $17,000, and it told us that we had to put in the big culvert.

Want more? The township requested a $250,000 letter of credit or certified cheque prior to approving the expansion of the building. My initial reaction was somewhat negative to this request, but upon reflecting, I did realize that it made sense. The request was put in place in case a builder started a project, ran out of money before they finished the project, and left a hole in the ground. The money would then be used to pay to clean up the mess they made.

I still grumbled about the fact that the township was making long term doctors who were clearly invested in the community do this, but I have to concede that it was fair.

The bank informed me there’s some complex fee formula for a letter of credit – and it would have cost $5,000. I asked them for a certified cheque, and it turns out banks don’t do that anymore. However, they were willing to issue a bank draft and the fee for that was $50. Obviously, I got the bank draft instead.

When I went to the planning office however, I was told this was unsuitable. The contract we signed specifically asked for a Letter of Credit or Certified Cheque and I had presented neither. Therefore we had not met the terms of our contract and the project would come to a halt. The staff person did offer to take this to the planning committee, and six weeks later they decided this was ok.

Is this me just griping? Nope – in fact his is happening all through health care and businesses in Canada. I recently spoke to the owner of a Nursing Home. His home had been approved on a “fast track” for a new build based on the dire shortage of nursing home beds in Ontario. I asked when the facility would be built and he just laughed. Apparently “fast track” means that there will “only” be 30 months of paper work (!) before the shovels go in the ground and he hopes it will be completed in 5-6 years!! I’m guessing this “fast track” must be on Toronto’s Eglinton LRT line….

A sad, lonely train on Toronto’s much, much, much delayed Eglinton LRT line

Want more? Just look at the saga of my local hospital, the Collingwood General and Marine. We’ve known for almost two decades that it’s far too small for the community. Heck the community has been asking for a new hospital since the early 2010s and finally got approval on phase 1 (of 5) in 2016. And 9 years later (!) we are at phase 3. The “hope” is that the new building will open its doors in 2032 – 16 YEARS after it was absolutely clear a new hospital was needed immediately.

This problem is not restricted to the health care sector of course. The Financial Post had a piece in 2019 (!) about how these rules are affecting multiple industries. Not only are we not building critical infrastructure in a timely manner because of an inability to cut the bureaucratic bloat, but it’s stifling private businesses as well. The Canadian Chamber of Commerce pointed out that the “ease” of doing business has gone from fourth in the world in 2006 to 53rd now, and this impedes economic growth and investment.

New Prime Minister Mark Carney is off to Europe this week to build trade and strengthen relations. Nothing wrong with that, we need reliable trade partners in the future. BUT, we face an unhinged, hyper volatile situation with our neighbours to the south RIGHT NOW. It seems to me there is no better time than now to drop intra Provincial trade Barriers and right size the bureaucracy allowing for businesses to grow and thrive more easily in Canada. As for health care, the right time was 10 years ago.

Health Care in the Ontario Election: Lots of Sound Bites, No Strong Policy

Last week, I had the opportunity to talk to Greg Brady, on his 640 am radio show, Toronto Today. The episode is on Spotify and, if you are in need of a great cure for insomnia, you can catch me starting from about the 19:30 mark:

Six and half minutes is not enough time to discuss health care in Ontario. Neither is a 1,000 word blog, but that won’t stop me from trying to expand on some of my thoughts.

The first and most prevalent thought I have is disappointment in ALL of the political parties for how they have addressed health care so far. Everyone on the front lines of health care has known for a least a decade that we need bold transformative changes in how health care is run and delivered in Ontario. Probably all of Canada.

And yet, the four would be Premiers all fail to outline a plan for such transformation. Instead, they have all resorted to that age old political vote grabbing stunt of saying “Let’s just throw more money at the problem” without actually reminding you that the money is going to come from YOUR pockets and is going to be, frankly, poorly spent.

The Conservatives hired Dr. Jane Philpott to oversee a spend of $1.8 billion in a plan to connect everyone with a “primary care provider” in the next few years. As I’ve written before, that plan, through no fault of Dr. Philpott, who I have a great deal of respect for, is doomed to failure.

The Conservatives did not start the downfall of family practice in Ontario (that was the miserable Eric Hoskins/Bob Bell duo during the wretched Kathleen Wynne years). But they sure haven’t done enough to fix the mess they inherited. Economist Boris Kralj, PhD, recently showed in the Medical Post that Ontario lost 238 family physicians in 2022/23 – the biggest loss of any province.

The Liberals for their part want to spend 3.1 Billion dollars. At least they promise everyone a family doctor and not a “provider” (and yes, there IS a difference, a BIG one between the two). However, their plan amounts to spending $1.3 billion more than the Conservatives. Spending more without changing things seems naive at best.

The NDP promise to recruit 3,500 more doctors, promise family doctors for everyone, cut red tape, establish a “Northern Command Centre” for health care (that’s actually a good idea) – all for the low low price of only $4.1 Billion dollars, a billion more than the Liberals.

The Green Party promises are actually the most detailed I could see, including lots of goodies, like recruiting more doctors, building more nursing homes, increasing nursing student spots, hiring 6,800 personal support workers and more. There is only one thing missing from the proposal (at least on their website). How much this will all cost YOU, the taxpayer.

Ontario spends $81 billion in taxpayers dollars on health care. Rather than look to see if that money is being spent wisely, and looking to transform health care, all the political parties are simply giving us sound bites. They promise to spend $83-$85 billion on the same failing system, without looking at changing things. Because spending more inefficiently will surely fix things.

OK Smart Guy – What do YOU Think Should Be Done?

Glad you asked dear reader, glad you asked. At an absolute minimum I’m looking for a party that has the political courage and wisdom to do the following three things.

First, A complete hiring freeze on all bureaucrats in health care, including not replacing those who retire, or leave for other reasons.

Currently Ontario has 10 times as many health care bureaucrats per capita as Germany. That’s too many. This means that any meaningful suggestions for change have to go through so many bureaucrats that the whole system is plagued with paralysis by analysis. Time to trim the fat.

Second, ensuring one, and only one, patient app that every resident of Ontario has, which will have access to all their health care data, and allow them to share this with the health care specialist or facility of their choice

Ontario is a digital health nightmare. Your health information often times can’t be shared if you go from one hospital to another, or one doctor to another. There are multiple inefficiencies and unnecessary repeat tests because of this mess and it should never have been allowed to occur.

It would be too expensive and too time consuming to force every health care facility to use the same electronic medical records system. What can be done however, is to force all the systems to integrate with ONE patient app. This will ensure a common standard, and moreover will allow a hospital you happen to be in, to access your out patient information (with your permission) which just doesn’t happen now.

Third, ensuring strong family physician representation at the board level of the Ontario Health Teams.

There is a lot of talk about the benefits of team based care. As someone who views one of his proudest achievements to be the founding Chair of the Georgian Bay Family Health Team, I would agree with this. The current plan for Ontario Health Teams does have merit. BUT, in order for these teams to succeed, they need strong family physician leadership at the GOVERNANCE level. That’s right, you need to put doctors (and more than just a token one) on the Boards of these teams and ensure the teams are led by them – for best clinical outcomes. I don’t see that in the plans.

Final Thoughts

My usual followers will know that I generally vote on the conservative side of the political spectrum (de gustibus non est disputandum). However, I’ve been frankly disappointed that the current Conservative government has been anything but conservative. Sadly, the other parties are really not offering the kind of transformative solutions we need in health care either. I firmly believe that we should all vote in elections, and I certainly will, but for now, call me an undecided old country doctor.

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 Board Betrays Members By Latest Action and This Changes My Vote

OMA Elections period has opened. A chance for members to have a say in how the organization is run and what strategic direction it should take .

After my last couple of missives on OMA Elections, I was going to leave this alone and see what transpired. However, when I went to vote, I noticed a curious thing. None of the non-physician Board candidates were up for re-election. This sent up a red flag. There are three non-physician Board Directors – and every year, as members we have to vote for either one or two of them (the terms are staggered).

If one looks at the OMA website, this little nugget is hidden away in the depths of the Elections FAQ page, a page that I suspect extremely few members would access, much less be aware of:

“…In the case where the director holds a non-physician position and is interested in serving an additional term, the director would be presented to the membership as a re-appointed director…”

There are some conditions the sitting non-Physician Board Directors have to meet, but the blunt reality is that the OMA has taken away the right and ability of Members to vote for these 3 positions if those Directors want another term. This represents 27% of the Board (11 positions total) – which is frankly a large block of votes and can sway a close vote at the Board.

Worse is the vagueness of what is written for IF there was a vacancy. There are a number of requirements for running for the Board for these candidates – all of which are appropriate – however the very last sentence simply states:

“Shortlisted candidates will go through detailed vetting by Promeus Inc., including reference checks, police record checks and social media checks.”

Nowhere does it clearly state that in the event of a vacancy – there would be an election for the non-physician Board Directors. Perhaps this is still the case – however not mentioning it definitively in writing suggests the possibility that this may change.

I was on the OMA board when the governance changes took effect. I supported the overall thrust of them (still do). One of the issues when discussing non-Physician Board Directors was a concern expressed that the type of candidates that might help the OMA out would not want to run in an election. Apparently, these candidates would be “used” to being recruited and simply expected to be given a job.

I personally thought that was silly. If you’re a strong person, have a sense of self-worth, and are confident in yourself, you should be willing to run in an election. You might lose but that’s life (I’ve lost elections). But the personal integrity to run is essential. If the OMA is to represent members, then the members must have the right to vote for all Board Directors. Up until now, that’s what was happening.

Perhaps some non-Physician Directors are thinking “if I was on another board, they’d simply appoint me, and I wouldn’t have to take a chance on losing and ruining my precious resume.” But those are NOT Boards of representative organizations like the OMA

As far as I’m concerned, worrying about offending the egos of some candidates is not enough reason to take away the rights of members to choose ALL of their Board Directors. How much longer will it be before these 3 non-Physician Board candidates will simply be chosen by a process set up by the OMA without any input from the part of members? In case you think it unlikely, that is actually what was initially proposed by the governance consultants in 2019, until we shot it down.

Worse this change was made without an open discussion with the membership. The OMA should have presented arguments for this change to the members in an open, transparent manner. By hiding it in a FAQ without informing members is a betrayal of the principles of giving members power over the OMA. That was the main thrust of the governance changes in the first place.

What can members do? I mentioned in my previous blog that I personally won’t vote for incumbents. It seems that there’s only one incumbent up for re-election, current Board Chair Dr. Cathy Faulds. I have a lot of respect for Dr. Faulds (really). She’s accomplished much in her career (her resume is incredible) with work in health systems transformation/patient care advocacy and bilateral work with governments.

I was considering voting for her based on the fact that a good Board does need to hear all view points (even those that differ from mine) but I so fundamentally disagree with this move, and the current culture the Board has overseen that I personally can’t vote for her now. Whether other members see it that way is up to them.

A glance at the other candidates for Board show that there are 11 candidates who couldn’t be bothered to do a video statement to advertise themselves. Sorry – but as much as I disagree with the current elections process – if you are going to run for the top position at the OMA, and you can’t even find the time to put a video together to advertise yourself – well that is concerning.

My few loyal readers will know that I strongly supported Dr. Ramsey Hijazi last year – and continue to do so this year. He has consistently stood up for members – most recently by setting up a petition demanding that the government stop tormenting Dr. Elaine Ma for running a Covid Vaccination clinic. He’s also been strong in the press. He will get my first vote (which in the weird way the OMA weighs votes is the most important).

After that, there are a number of candidates that caught my eye – in alphabetical order – Dr. Khaled Azzam, Dr. Douglas Belton, Dr. Joy Hately, Dr. Pamela Liao, Dr. Afsheen Mazhar, Dr. Shawn Mondoux, Dr. Sameena Uddin, Dr. Darija Vusovejic. To be clear, members should review all the candidates themselves and vote, but I am going to vote for them after Dr. Hijazi.

As a family doctor, I also have a vote for my SGFP representative. Lots of great candidates running there. It will again, not surprise any of my followers that I will strongly endorse Dr. Nadia Alam for SGFP Vice-Chair. She’s an excellent leader and a dear friend. She took a well deserved break from medical politics for a bit. But it’s good to see her getting involved again and our profession will better for it. I leave the rest of the voting to your good judgement.

Dr. Nadia Alam, Candidate For SGFP Vice-Chair

Disclaimer: NONE of the candidates listed asked me to endorse them.

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.

Dr. Elaine Ma Case is Proof Ontario is Unfriendly to Physicians

Last week, the Ontario Health Sector Appeal and Review Board (HSARB) denied the appeal by Dr. Elaine Ma in her fight against the Ontario Health Insurance Plan (OHIP). At the risk of upsetting Dr. Ma and many (? all) of my colleagues, that decision actually was legally appropriate. HSARB can’t actually look at whether a case is reasonable or not, their job is to go by what’s written in bulletins/updates. The real affront to physicians is that it should never ever have gotten here in the first place.

The Background

For non-physicians reading this, here is a condensed summary of what happened. It’s 2020. The Covid pandemic is raging. Ontario Premier Doug Ford appoints General Rick Hillier to oversee the Covid Vaccination program. He’s tasked with, as Ford calls it, “the largest vaccine rollout in a generation, a massive logistical undertaking, the likes of which this province has never seen.” Hillier’s stated goal? To get shots in everyone’s arms by August 2021.

Dr. Elaine Ma from Kingston realizes the need to act quickly to help her community. She organizes outdoor mass vaccination clinics. Over 35,000 shots were given and Kingston became the most vaccinated area of the province. Dr. Ma was given an Award of Excellence by the Ontario College of Family Physicians for her efforts.

Picture of an outdoor vaccination clinic found elsewhere on the web

The Dispute with OHIP

So what happened? For the Covid vaccine clinics, there were two sets of billing codes assigned. The first was a standard hourly rate. This was meant for physicians who attend a vaccine clinic and perform immunizations there. There were numerous such clinics set up by hospitals/public health/pharmacies and so on. Those agencies paid for the setup costs of those clinics. The physician just showed up and vaccinated.

The second set of codes is used by physicians who give vaccinations in clinics they set up. These codes pay somewhat more, but they’re meant to compensate physicians for the fact that they have to cover all the overhead in those clinics.

Dr. Ma would have had to make sure that things like electricians were hired to ensure that there was power and Internet access outdoors. She may have needed to arrange for commercial grade outdoor tents. Propane heaters to heat the tents and the propane might have been needed. Some staff were paid (others volunteered). All of this organizational work, and figuring out payments, needed to be done in advance. She did it.

She therefore billed OHIP the second code. This is entirely reasonable given the circumstances and the work she did.

So what happened?

The sudden increase in billings did not go unnoticed by OHIP and was flagged. This is absolutely appropriate. As taxpayers, we need to be sure that there is a mechanism to catch outlying bills. The anomaly was sent for review by the various bureaucrats at OHIP. Also appropriate.

So what went wrong?

Basically everything after that. The OHIP bureaucrats reviewed the situation. As pointed out by Perry Brodkin (OHIPs former lawyer, who was quoted extensively in the Kingstonist) – the information was sent “up the hierarchy” and would have reached the deputy health minister and minister.

Former Deputy Minister of Health Dr. Catherine Zahn

The bureaucrats and health minister decided she didn’t qualify for the codes. The reasons given (see the Kingstonist articles for more details) change at a whim. First it was that the clinic was outdoors not inside (you mean at a time when we are all social distancing – we should have crammed unrelated people into a clinic to immunize them??). Then it was that medical students were used (despite the strong endorsement of using medical students by the then Dean of Queen’s University Medical School, Dr. Jane Philpott). Then it was that she paid people to work there.

Dr. Jane Philpott – former Dean of Queen’s University Medical School – and a strong supporter of the vaccination clinics set up by Dr. Ma

Then things got ugly

And finally, after repeated questioning by the Kingsonist, things got really ugly when Hannah Jensen, the communications director for the Minister of Health issues a statement alleging that Dr. Ma “pocketed” the funds. This basically amounted to an allegation of theft by Dr. Ma and was widely viewed as a disgusting, immoral and reprehensible comment in the medical community. Even the Kingstonist was alarmed by this and called the statement “rife with allegations.”

Hannah Jensen, Communications Director for Minister of Health Sylvia Jones (photo from LinkedIn Profile page)

Why this offends doctors so much.

Let’s be clear about this. There is zero tolerance in the broader medical community for misappropriation of funds/intentional fraudulent OHIP billing. Zilch. Nada. But there is a recognition that the imperfect OHIP billing schedule needs to be interpreted with reason, especially when times are unreasonable (and what could possibly be a more unreasonable time than a once in a lifetime pandemic?).

Dr. Ma did all the work to meet the billing criteria (even the OHIP bureaucrats were forced to admit that yes, over 35,000 shots were given and yes she had planned and organized the whole thing). The fact that she did it outside and had medical students help when some 20 year old pre pandemic memos said not to is an unwarranted use of a technicality.

For many physicians, this brings back memories of when another set of bureaucrats persecuted physicians. They even told one paediatric respirologist that in order to bill a code, he had to perform rectal and pelvic exams on children!

What does this mean for Ontario Health care?

First, as Dr. Ma herself pointed out, it is now illegal for physicians to bill any procedures that they delegated to medical students. This means that medical teaching will effectively grind to a halt. Why would any doctor teach a medical student to say, suture a wound, when that doctor would now be financially penalized?

Second, this story has made the national press. It has also been reported in Canadian Journals that cater to physicians and other health care workers. The message to them is clear. Do NOT think of relocating/starting up a practice in Ontario. You will be treated grossly unfairly by the bureaucrats and health minister and there will be no reasonable interpretation of the rules.

What can be done?

According to Brodkin, Health Minister Sylvia Jones and Premier Doug Ford can direct OHIP to disregard the HSARB ruling. They need to do so immediately. However, because politicians only think of re-election, and not what is right, Dr. Ramsey Hijazi, the founder of the Ontario Union of Family Physicians wants to up the pressure on them.

Dr. Ramsey Hijazi, founder of the Ontario Union of Family Physicians – pictured inset.

His group has set up a petition that clearly demands that justice be done in this case. It demands that the Minister and Premier disregard the HSARB ruling. We need to support our health care heroes not penalize them on technicalities in outdated bulletins.

I urge all of my followers to sign the petition. If this case is allowed to go on, trust me on this, there will be negative consequences for health care in Ontario, and we don’t need any more of those.

Click here to sign the petition.

Sunday Snippets: Nov 24, 2025

Another in a weekly series of brief snippets of health care stories that bemused, intrigued and otherwise beguiled me over the past week along with my random thoughts on the matter.

Item: Dr. Sarah Giles writes in the CBC about how she was forced to cut her hours because of the burnout.

My thoughts: Kudos to Dr. Giles for talking so openly about this. Alarmingly few of my colleagues are willing to talk about burnout and how the system is affecting them. Instead they suffer in private, and that’s not healthy for them OR the patients they serve. It’s an important story that needs to be told over and over again.

Item: “Involuntary medical treatment” for people with addiction issues seems to be all the rage. A great article in the “Conversation” shows that this won’t solve anything, and in fact will make things worse.

My thoughts: I really can’t believe we are even discussing this. It has been well known for…..well forever, that people will not get better unless they want to seek help. We have to focus on making seeking help easier, not forcing them.

Item: The always excellent Dr. Katelyn Jetelina, who most of my colleagues know as a superb voice of reason and information during the height of the Covid pandemic, writes about her feelings now that RFK junior has been nominated to lead Health and Human Services in the United States.

My thoughts: My heart goes out to her and all the hard work staff who have tried keep us all safe during the pandemic. They deserve better.

Robert F. Kennedy Jr., a leading American Anti-Vax conspiracy theorist, now tapped to head Health and Human Services in the United States

Item: TV Ontario had a segment suggesting that foreign trained physicians could help tackle Ontario’s physician shortage.

My thoughts: I’ll shout it out again, we already have enough family doctors in Ontario who are already licensed to practice medicine in this province and are familiar with the Ontario Health Care system. The number is approximately 6,000 or so (see the graphs in the linked blog for details). Can we just not make it easier to practice family medicine instead??? If we can get even 1/3 of those doctors already in Ontario to start a practice, we would end this crisis.

Item: Great article on the physician gender wage gap in Health Debate. Clearly shows that the gap is real and needs to be corrected.

My thoughts: One of the best accomplishments of the OMA Board when I was on it was to publish the gender pay gap report. It was arguably too late, but I believe we were the first PTMA to discuss this and to use that as a basis for future negotiations work. While I’ve had some issues with how negotiations have been handled since, I am quite comfortable in saying that positions of the OMA in negotiations would take this into account and that there is likely to be funds demanded to narrow this gap. The blame for the fact that there has been no progress on this lies mostly at the feet of the Ministry of Health. We don’t have an agreement yet on how to divide the arbitration award – and that means the Ministry is not responding to OMA proposals that would close this gap. Shame on them.

Item(s): Alberta announced that it hiring a large number of nurse practitioners to become “primary care providers” to patients who don’t have a family doctor.

My thoughts: The National Health System (NHS) in Britain is under fire for the fact that it too tried to replace the work done by fully trained physicians, with staff who were likely well intentioned, but had less qualifications. It turns out there is significant risk to this, and likely a markedly increase cost in providing health care. The article “My wife died because the NHS used cheap labour” should be, in my opinion, required reading for any politician/health care bureaucrat who thinks they can provide better care by using less trained people.

That’s all for this week. Back next week (probably) with more.

Bureaucratic Stupidity in Covid Vaccine Clinic Case Will Have Far Reaching Consequences

I’ve repeatedly been told that I am too unkind and too harsh to Ministry of Health (MOH) bureaucrats. A senior staff member at the OMA once suggested I was “out of line” to a very sharp (but necessary) scolding I gave an MOH bureaucrat at a bilateral meeting we had. About a month later, that same senior staff person, when on a voice conference call with the same bureaucrat, got up and wrote “This is a waste of time” on a chalkboard at OMA headquarters. But I digress.

Yet every time I try to pull back, these same bureaucrats go and do something that is so incomprehensibly stupid that I once again wonder about the talent level and frankly intelligence of the bureaucracy as a whole at the MOH.

On this occasion, I’m referring to the Ontario Health Insurance Plan’s (OHIP) relentless persecution of Dr. Elaine Ma. The whole mess has been extensively reported and you can read all the details in the links, but I will summarize key points below:

October 25, 2024

Dr. Ma’s clinic in Kingston suddenly cancelled its October 26 drive thru flu/covid vaccine clinic. Over 600 patients had registered with more pending. The reason is that OHIP had notified her that she would not be paid to vaccinate patients at the clinic. Why? Because she was going to have medical students (who would be supervised) vaccinate. According to a 2001 bulletin OHIP pulled out, students are not employees and so she can’t delegate to them. (OHIPs story keeps changing and you’ll see that further down the blog). It also emerged that OHIP was attempting to recoup funds paid to her for running similar vaccine clinics in 2021.

October 30, 2024

It was now reported that OHIP was demanding Dr. Ma repay $600,000 that she billed to run outdoor vaccination clinics. She ran a number of mass Covid vaccinations clinics that gave over 35,000 shots. These were set up by her in response to the provinces call to “get shots in peoples arms“at the height of the Covid pandemic. Dr. Ma was widely lauded for her efforts at the time – and won the Ontario College of Family Physicians award of Excellence. Her area became the most vaccinated area of the province, something that should be celebrated.

OHIP now claims that she didn’t follow the rules for billing. Their excuse this time? That clinic was outdoors and not in a doctor’s office. (I told you OHIPs story would keep changing). Yes, you did read that right. In the middle of a pandemic caused by an airborne virus, OHIP wanted the vaccination clinics to be held in crowded indoor spaces!

November 1, 2024

Dr. Ma had rapidly gained the public support of the local medical officer of health (there was likely background support previously). She also had the support (previously background now public) of her MPP, the OMA and many others. She did not get the public support of Dr. Jane Philpott. Dr. Philpott, in her role as Dean of Queens Medical school was full of praise for the clinics. I suspect Dr. Philpott has 550,000 reasons to stay quiet publicly now. Hopefully she can influence behind the scenes.

OHIP now stated that the concern was that Dr. Ma used some of the funds to pay the staff who worked there. You read that right. They were worried because a physician billed OHIP (gasp!) then took the funds to pay overhead (double gasp!!). The horror!

Hannah Jensen, the Minister of Health’s Communications Director initially simply parroted the line that OHIP bureaucrats fed her about being ineligible to bill because of using medical students and it being outdoors. But she was rapidly exposed as being completely out of her depth when the Kingstonist questioned her about dates, which doctor, which clinics, how she arrived at figures and so on.

Additionally, her tone took a seriously ugly and aggressive turn. There was an accusation that Dr. Ma “pocketed the funds” which essentially is an accusation of theft. (No law enforcement is involved….yet).

November 7, 2024

The story hit the national news and it was reported that not only was OHIP asking Dr. Ma to pay back $600,000, but they were demanding $35K in interest as well (!). Who knew OHIP bureaucrats moonlighted as loan sharks??

November 8, 2024

Dr. Hijazi, leader of the Ontario Union of Family Physicians was interviewed by the CBC . He obviously was supportive of Dr. Ma demanded that the Ministry apologize to her. The Ministry issued an utterly and completely delusional statement to CBC radio stating that claims Ontario can’t get family physicians are “fictitious”. (Listen to the last 30 seconds at the link). 2.5 million people can’t get a family doctor in this province because doctors don’t want to work comprehensive care is “fictitious”????

Nothing much to see here. Just a fictitious clinic in Kingston, where fictitious people without a family doctor lined up hoping to get a doctor because a fictitious family doctor announced a new practice..

What consequences are there to this?

To0 many to mention, and they are all awful. Perry Brodkin, OHIPs former lawyer was quoted extensively in the articles about process. He pointed out that before attempting to recoup these funds, the bureaucrats would have run it up the chain to the deputy minister if not the health minister. There is therefore no doubt that this egregious action is one of the bureaucracy as a whole as opposed to one rogue bureaucrat. This cements the feeling that many physicians increasingly have had that bureaucrats as a whole are malicious (especially after the nonsense they claimed during arbitration).

It also badly threatens medical teaching. If the appeal that Dr. Ma filed is unsuccessful, then it essentially means that physicians would not get paid for teaching medical students. Which would effectively end teaching in Ontario. How exactly do you plan to replace the current supply of physicians as they age out, if no one will teach new ones?

With the story hitting the national news on CBC, it also will significantly impair attempts to recruit physicians from out of province. We are already losing younger doctors to provinces like BC and Manitoba where they see a co-operative relationship between government and physicians. Why would any of them come to a Province where you are called a hero one day, and then publicly embarrassed, harassed and vilified over a clearly outdated memo that needed to put aside during a once in a lifetime pandemic?

What SHOULD happen next (but probably won’t)

Unfortunately, Brodkin also points out that at this point there is nothing that will influence the appeal board. The process could have been stopped earlier before the hearing, but Sylvia Jones and her staff chose not to. But, if Dr. Ma wins, the government should immediately announce they will not appeal the decision to the courts. Additionally, Hannah Jensen needs to publicly apologize for her…..out of line…..comment on “pocketing” funds. And Sylvia Jones should also offer up an apology to Dr. Ma for the failure of her bureaucrats to recognize that rigid adherence to minutiae in a time of crisis is completely unacceptable.

Finally, what badly needs to be done is that the entire Ministry of Health bureaucracy needs to be given a very large enema to clear out the…….