“Smokey” Thomas Fails His Members

Authour’s Note:  Once again, I would like to state that while I am President-Elect of the Ontario Medical Association (OMA), I have not spoken with any of the Family Doctors in Owen Sound about this situation.  I did email them to ask permission to write this.  All of my thoughts are strictly based on reports in the media, and news releases (all of which are hyperlinked).

Last week I had suggested that Ontario Public Services Employees Union (OPSEU) President Warren “Smokey” Thomas should change his approach on how he dealt with physicians in union disputes.  Sadly, Smokey has doubled down on his tactics.  In doing so, not only has he utterly and completely failed his members, but he risks endangering health care in Owen Sound.

In Owen Sound (population ~ 21,000) there are 22 family doctors who have organized themselves into a Family Health Organization (FHO).  The FHO is a fairly common payment model that consists essentially of a salary and performance bonuses.  Like all other payment models the FHO models experienced years of deep cuts to their budgets during the desultory tenure of Premier Kathleen Wynne.  Cuts to physician payments, mean cuts to patient services.  Hence, the FHO focused on controlling expenses as best it could.

The staff at the FHO chose to unionize (which is their right) but unfortunately chose to do so under OPSEU, and became Local 276.  OPSEU and Smokey have absolutely no experience in dealing with intimate small office settings, and the necessary collegiality that is essential to providing high quality front line care.  As a Family Doctor, you MUST trust everyone from the receptionist, to the nurse and even the cleaning staff.  While disagreements occur, and are often healthy, the trust cannot be compromised, or patient care will suffer.

Smokey and OPSEU’s lack of experience showed almost immediately. Their bargaining team agreed to a contract and recommended it for approval to the FHO staff in May.  That’s right folks, OPSEU actually reached an agreement.  But the agreement was rejected by the FHO staff, a clear repudiation of OSPEU’s leadership.

This appears to be when Smokey went off the rails.  He (and OPSEU) could have taken a hard look at themselves and asked a simple question – “How could we be so out of touch with the members we represent, to have endorsed a deal they rejected off hand?”. But they didn’t.  Instead, in what seems to be an effort to prove to their members that they really are relevant, they doubled down and started hurling insults and threats.   Doctors were “punch drunk with greed” they screamed.

The FHO staff then went on strike, and the results appear to be disastrous for them.  Firstly, OPSEU should have told them that doctors office are not factories that make sprockets and cogs.  They provide essential medical services and they cannot be shut down.  The physicians continued to work, with legally allowable replacement staff (albeit at reduced levels).  All a picket line would do is harass patients, and that won’t win you public support.

Reports of harassment and even a serious medical event involving a replacement worker appeared, although it’s unverified.  Again, instead of stopping to think “What exactly are we accomplishing here?” Smokey, doubled down, increased his insults to physicians, demanded that the Health Minister and Owen Sound Town Council get involved (he failed miserably).  He also made a ludicrous allegation that physicians were “private and for profit”. Has Smokey not read the Canada Health Act?  Physicians haven’t been private since 1984.

Apparently, ten of the 30 FHO staff got wise to what a lousy job Smokey and OPSEU were doing, and actually quit their jobs.  Yet another opportunity for OPSEU to reflect on their own failures as a bargaining agent.  But yet again, Smokey lashed out, this time by asking the College of Physicians and Surgeons of Ontario (CPSO) to get involved.

Let’s be clear, the letter written by OPSEU is a collection of hearsay without naming any one physician. As such, it cannot possibly be investigated by the CPSO.  If they were to do so, it would diminish the already poor standing the CPSO has in the eye of most physicians, and would send a pall over the entire profession. They would almost certainly faced increased calls from physicians to lose self-regulation if there was anything other than a cursory “thank you, but this is outside of our purview” type response.

But the reality also is that a letter to regulatory body like this takes you beyond any hope of restoring trust in your team.  It’s the one thing that has potential to destroy careers. It’s the one action that essentially screams “irreconcilable differences”.  By going down this road, in what seems to be a desperate attempt to prove his worth, Smokey has caused a toxic meltdown to the point where there is no hope of a resolution.

The members of OPSEU Local 276 would do well at this point to really ask themselves if this is the kind of leadership they signed up for.

Can Helen Angus Save Ontario Health Care?

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

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

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

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

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

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

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

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

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

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

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

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