Anger Leads To Bad Decisions

There were some interesting reactions to my last blog on the College of Physicians and Surgeons of Ontario (CPSO).  The most common (private) comment I got of course, was from colleagues saying they really liked it, but were too scared to share it in anyway on social media.  They didn’t want to be targeted by the CPSO.

The one comment that really stood out from me was by Dr. Darren Larsen, currently the Chief Medical Information Officer at Ontario MD.  Dr. Larsen wrote, “As professionals, why don’t we just treat each other with the same kindness and respect we would hope to be treated with by our peers and thereby stay completely off the CPSO radar screen?”  Dr. Larsen is right of course.  Having met him, I can also say that Dr. Larsen is genuinely one of the nicest people I know, and he absolutely always seems to live his life by the credo of being kind and respectful.  I’m happy for him that he’s able to do that.

Unfortunately, we are not all able to balance our lives like he has.

Currently physicians are overworked from trying to keep the health care system afloat.  When you crunch the numbers, Ontario has about 2.2 physicians for every 1,000 people.  In comparison, Germany has 3.8 physicians for every 1,000 people.  Heck even Bulgaria (!) has more physicians per capita than Ontario.  Coupled with an aging population and increasingly limited resources and bureaucratic inefficiencies, this leads to a significant increase in workload.  Physicians in Canada currently work over 50 hours a week plus call of between 20-25 hours a week.

The results of this crushing workload is entirely predictable.  The Medical Post recently did a survey on the best Province to practice medicine in.  My thanks to Dr. Dennis Kendel for tweeting out the chart below:

Work:Life

The most telling line is the one on work life balance.  Not a single province scored higher than “C” on this one.  Four provinces (including Ontario) got “F”.  A most telling table that gets to the heart of the issue of physician burnout.

Being human, physicians of course are subject to the same flaws as everyone else.  They don’t like to admit it mind you, but when the work/life balance gets skewed, physicians get irritable, depressed, make mistakes, and yes, say dumb things on social media that they wouldn’t otherwise.

More recently, I have noticed this irritability turn into anger amongst physicians.  In Ontario, physicians are going on over five years without a contract.  While we are still getting paid, the uncertainty of the situation is weighing on us.  Middle aged to older physicians are feeling the effects of years of mistreatment by the previous government and getting increasingly bitter with each passing day.

Even younger physicians have been affected.  Many trainees that I’ve spoken to (I’m a preceptor with the Rural Ontario Medical Program) are uncertain if they’ll be able to practice.  Turns out that despite an aging population, Ontario has unemployed physicians.  The situation is particularly acute in family medicine, where the government unilaterally slashed the number of Family Health Organization spots in half, leading to a new crisis in Family Medicine.  So even newer docs are feeling bitter.

I worry a lot about my colleagues.  We all know that making decisions out of anger and bitterness will generally lead to bad outcomes.  This applies equally to whether we are making decisions on patient care, or on issues like contracts, negotiations and especially medical politics.  We must base our decisions and actions on facts, and not frustration, no matter how justified that frustration may be.

Dr. Larsen also wrote: “….it is a privilege to be part of a self regulated profession. With that privilege comes responsibility.”  Again, absolutely a true statement and one that is hard to argue with.  But I happen to feel that the responsibility should apply not only to ourselves as individuals, but to regulatory bodies like the CPSO and also to member organizations like the OMA.  The OMA is planning a Task Force on the burnout issue, and will hopefully make some meaningful recommendations that can help with this issue.

To my colleagues, I once again ask that you do your best to look after yourselves.  Eat right.  Exercise regularly.  Take regular breaks from work.  Don’t feel guilty for taking a day off now and then.  Ask yourself if the decisions you are making are from anger, or based on facts.  Above all, try to be kind to your fellow colleagues.  They are probably feeling just as frustrated as you are.

Can The CPSO Regain The Trust of Physicians?

Disclaimer:  As always, the views below are mine, and do not represent those of the OMA, even though I happen to be the President- Elect.

The College of Physicians and Surgeons of Ontario (CPSO) governs, licenses and oversees the conduct of Ontario’s physicians.  Through a combination of a tone deaf, paternalistic attitude, and fear that “bad press” will lead to a loss of something called self-regulation, the CPSO has sadly lost the respect of physicians across Ontario.

Instances of poor physician behaviour continue to be (thankfully) very rare.  Despite this, it is safe to say that the CPSO has been under siege in the media.  Some of it is their own doing.  The CPSO actually once went to court to try to get a decision that their own Discipline Committee made enhanced – in effect they sued themselves.  Some of the media siege is due to zealous reporting (stories of “rich” doctors doing bad things sell newspapers).  Regardless, the media has clearly not been kind to them.

The CPSO response to the media was shockingly defensive.  Rather than trying to ensure a fair complaints process,  they decided to double down and severely prosecute physicians for truly ridiculous reasons.  The perception amongst front line physicians is that the CPSO is trying to “look tough” to get the press off their backs.

The most egregious example of this by the CPSO occurred during the debacle that surrounded the failed tentative Physician’s Service Agreement (tPSA) of 2016.  Emotions ran high in the profession  and physicians, being human, said things that they would not normally say.

Some of these things were clearly inexcusable no matter what the situation.  The CPSO was right to discipline physicians who repeatedly sent abusive emails to former Ontario Medical Association (OMA) President Dr. Virginia Walley.  But they went overboard in many cases.

When someone comes to my office who is angry, and using foul language, the CPSO expects me to show some compassion, try to find out why they are feeling the way they are, and work with them to reform them.  Yet the CPSO refused to extend that humanity to physicians who committed minor infractions.  Would it really have hurt the CPSO to ask these physicians if they were feeling burnt out, considering the magnitude of the physician burn out crisis?

I will not embarrass these physicians more by linking to media reports, but I will state for that record that the following physicians were disciplined, paid at least $10,000 each to the CPSO, and publicly shamed:

  • one physician, who replied to an anonymous email address with “stop sending me these f$%@#$ emails”
  • A physician who called Health Minster Eric Hoskins a “reichmaster” on facebook
  • Another physician who called Hoskins a “F@$% P#$&*” on facebook
  • A physician, who told a clearly inappropriate joke on a private electronic forum

NO patients were harmed.  NO medical incompetence was exhibited.  NO threat to the public.  And NO humanity exhibited by the CPSO to see if these physician were feeling all right.  If using the “f” word is cause for discipline, then judging by her Twitter feed, Dr. Jennifer Gunter, a leading expert in the fight against pseudoscience, had best not re-apply to practice in Ontario.

Worse, the CPSO exhibited a clearly one sided approach to how they meted out discipline.  In the aftermath of the tPSA, the OMA Executive faced a non-confidence vote.  Dr. Philip Berger, who has a well deserved reputation for social activism, decried the leaders of the non-confidence motion as “right wing coup plotters”, “dictators”, “fanatics” and so on.  Full disclosure, he is referring to me, current OMA president Nadia Alam and others.

In response, one physician on a facebook forum suggested Berger should take Ativan (a mild tranquilizer) and another suggested a stronger tranquilizer.  Guess who the CPSO decided to investigate, even though a formal complaint was NOT laid? (The CPSO can investigate at the discretion of their Registrar).  Guess who DIDN’T get investigated for making unprofessional comments about another colleague at the discretion of the Registrar?  The message from the CPSO was clear.  You can disparage another physician only if you have the right political view point.

For the record I will not lodge a complaint against Dr. Berger for disparaging me.  It would be a stupid, idiotic waste of the College’s time, and it was pathetic for the CPSO to wade into this in the first place.

More recently, workers striking at a family practice clinic wrote an open letter to the CPSO complaining about physician behaviour in a clear negotiations tactic.  Instead of realizing it for what it was, the CPSO instead sent their communications director to follow up and “offer support in filing a formal complaint.”  The fact that they were completely blind to this being simply a negotiation tactic is befuddling.  This was proved when the doctors in Owen Sound stated that the union withdrew the complaints as part of the negotiated settlement.

In fairness, new CPSO Registrar/CEO Nancy Whitmore appears to be trying to change all that.  She has promised efficiencies in the painfully long complaints process.  This would allow her staff more time to deal with serious complaints about physicians’ competency and misconduct, while quickly dismissing frivolous ones.

Additionally, I confess that I’ve been pleasantly surprised at how co-operative the staff at the CPSO have been with the OMA to modify the Continuity of Care Policy.  The original policy would have placed unreasonable bureaucratic burdens on physicians, and might have killed off family medicine and walk in clinics.

These are welcome changes in approach and should be lauded by every one.

I do feel Dr. Whitmore genuinely cares for physicians, and wants a fair process to help them and protect patients.  However, this might be seen as too little too late by many members.  The CPSO has governed the profession by fear (instead of respect) for so long that physicians are extremely jaded about the organization.  Public dissatisfaction with the CPSO doesn’t help either.  Here’s hoping that Dr. Whitmore can maintain the reform minded approach she has initiated.  It will be best for patients, physicians, and the CPSO.

Open Letter From Owen Sound Family Doctors

Disclaimer:  The following letter was written by the twenty-two family physicians in Owen Sound, who were recently the subject of a major labour dispute.  The doctors feel that there were many aspects of the dispute that were incorrectly reported in the media, and have asked me to publish their letter on my site so they can present their view.  Opinions are theirs.

The doctors of the Owen Sound Family Health Organization (FHO) feel they have an obligation to provide an update to the community with regard to the recent ratification of an agreement with OPSEU local 276.

After our employees decide to strike in May, we discovered that many of the practices we had been using to support the provision of patient care were inefficient and frustrating for physicians and patients.  We advised OPSEU of this in July.

Among the many improvements we made are better management of patient records, phones, web bookings and communications with patients.  Patient Kiosks have been established that many people use on presentation for an appointment.  Some redundant and inefficient activities during patient interaction were identified.  All of this was done while the workers were on strike.

OPSEU was advised of our plan to reorganize and institute two positions that we felt would better meet our needs.  We developed a position called a Patient Flow Co-Ordinator to help patients navigate our clinic.  We plan to hire Medical Office Assistants who ARE College certified to meet our other needs.  OPSEU ultimately agreed with our plan to move forward with these hires.  We’ve also hired 2 Clinic Managers.

Out of respect for the work done in the past, we offered the employees that remained a severance package (through OPSEU) that would provide financial support as they seek employment better suited to their skill sets.

OPSEU has produced much information during the negotiations, strike and ratification process.  Their details do not fit our understanding of what has happened.

We categorically deny any allegation of harassment, bullying or threats by the employers or its representatives, as OPSEU alleged (without foundation).  We feel that these allegations were advanced by the union and its supporters against physicians, patients and replacement workers in failing attempts to generate support for the strike.  This was horrifying and exceeded anything we would have expected in a workplace dispute.

One person who attended the health centre alleged that because she did not roll down her window to speak to strikers, her car was subject to $4,150 in damages.  She provided the picture below (complete with accessible parking permit in her dashboard).

BrokenWindshieldCut

Another incident involved a veteran who was attending the health centre and stated he was subject to abuse at the picket line.  He has provided a letter, but is too traumatized to allow his name to be printed.  There were many other incidents.

OPSEU has attempted to promote misinformation during the labour dispute.  It even filed a complaint of unfair labour practice with the Ontario Labour Relations Board.  We defended the complaint and it was ultimately withdrawn by OPSEU.  It had no merit.  Our response is attached.

OPSEU’s President also filed official complaints about 3 physicians with the CPSO (our licensing body) even though he never had any direct contact with those physicians.  We feel these complaints were used in attempts to intimidate the physicians.  In the end, we stood up for health care and the complaints were withdrawn.  They were without merit.

OPSEU’s President misinforms when he states that “public money” was used to hire legal support and security.  Physicians are paid for the services they provide.  Physicians then hire staff to support the provision of patient care as well as cover usual business costs (rent, utilities, equipment, etc).  When faced with complex legal and human resource management issues like this, we had to get appropriate legal support.  Given OPSEU’s tactics, security was essential to try to protect our patients.

Additionally, OPSEU did target the 3 physicians who were on the negotiation team as being “owners” of the organization.  This is untrue.  We are a group of 22 physicians who operate in a FHO and have formed a business partnership to manage our expenses.  We rent our premises and essentially own nothing.

Some of our former employees did not support the actions of the union and did end their employment with us citing a lack of support for the union.  Almost 45% resigned during the strike.  We regret that many good employees have had their lives disrupted in this way, but unfortunately there was nothing we could do within this system to rectify that.  Once employees are unionized they have to support their union or are threatened with major financial fines.

We feel that we have been transparent, respectful and honest during this process.  We have received overwhelming support from our patients and public and are enormously grateful for that.  Letters to the editor like this one have resonated with the community.  We hope we can move forward as a group and support each other to provide better, more efficient care.

Yours truly,

The Doctors of the Owen Sound Family Health Organization

 

 

Health Care Will Suffer in Owen Sound, Thunder Bay For Years

“That’s the thing about trust. It’s like broken glass. You can put it back together, but the cracks are always visible–like scars that never fully heal.” 
Hope Collier

A fifteen year old comes to my office.  She’s pregnant.  She’s petrified because her mom and one of my staff are good friends, and her mother doesn’t know.

A thirty year old man, with a long history of mental illness finally admits he was sexually assaulted as a child.  He didn’t tell me sooner as the abuser worked with the husband of one of my employees.

A couple is having marital problems.  There are affairs and now sexually transmitted diseases involved.  They’re trying to work it out, but were scared to seek help as one of my staff goes to the same Church.

I’ve seen all of this, and much more, practicing medicine in a smaller centre.  I would not have been able to manage these tricky situations if it had not been for the trust that I have in my staff.  Like all family physician’s staff, mine have access to a great deal of personal information.  I cannot effectively do my job without implicitly trusting them to ensure that confidential information stays confidential.  I rely on them to skillfully do tasks I assign them for patient care.  But I also trust the judgement that they have about certain situations and certain patients (they have a wealth of social knowledge that is invaluable to me).

This implicit trust is the hallmark of a high functioning health care team.  Each member of the team is valuable, and each carries out their duties, knowing the other member will carry out theirs.  This does not mean that we always agree on everything.  Healthy discourse is important.  But it means that at the end of the day, we know we will act in a patient’s best interests.

Which brings me back to the miserable situations in Owen Sound and Thunder Bay.  In Owen Sound, to try to make up for his failure as a leader, OPSEU President Warren “Smokey” Thomas wrote to the College of Physicians and Surgeons (CPSO) to complain about the alleged tactics used by the physicians in the dispute.  Let’s be clear, when you complain to the CPSO, you are threatening a physician’s career.  A complaint should only be made in an egregious situation (for example sexual assault) and not over a pay dispute.  Smokey himself is a nurse.  He should have known this.

The situation in Thunder Bay is worse.  Last week, under the leadership of Unifor President Jerry Dias:

Ontario Medical Association President Dr. Nadia Alam, stated that over 1,000 appointments were cancelled.  Many had travelled 100s of kilometres.  Many had been waiting for months for their appointments due to the severe lack of specialists in the North.  Cutting the power caused loss of vaccines and, as the only fertility clinic from Sudbury to Winnipeg, also a loss of sperm and egg samples.

Eventually, these disputes will end one way or another.  But what will never, ever be the same, is the trust between physicians in these clinics and the staff.  How are the doctors in Owen Sound going to trust employees who threatened to end their careers?  We are not talking about large corporations that make widgets where workers on the line never meet their boss.  We are talking about smaller, intimate offices where everybody knows everybody.

In Thunder Bay how exactly are the doctors there supposed to trust employees whose actions, however indirectly, led to alleged assaults, physical threats and intimidation and vandalism?  Unifor is denying responsibility for the vandalism, and no doubt will disavow assault/harassment as a tactic, but the blunt reality is that without the fence, none of the other stuff would have happened.  No wonder a number of physicians are considering leaving Thunder Bay.

Worse, what does this mean for the type of health care that is going to be provided in these areas?  The patients of Ontario have a right to high quality health care.  As mentioned, when there is no trust within a team, health care will suffer.

The stories of Owen Sound and Thunder Bay have gone viral in the medical community.  Both areas are short of doctors.  How they will now recruit new physicians in the current environment is beyond me.  The reality is that physicians are fortunate to have multiple options when they choose an area to practice.  Why would any sane person go to these toxic environments?  How will Thunder Bay replace physicians who leave?  The stench from these messes will take years to fix.

The biggest losers are the employees of these clinics.  They made a legitimate request for raises and improved working conditions.  Unfortunately, they put their faith in two Union men, who clearly didn’t have a clue about how health care offices work.  They used tactics more suited for factories, not physicians offices.  The tactics have failed miserably (four months and no contract yet).  In Owen Sound, 40% of the employees have quit, recognizing Thomas’ inability to get the job done.  In Thunder Bay, if physicians leave, there will be job losses amongst employees there as well.  Worse, the employees will be blamed for worsening access to health care, if doctors do leave.

The employees of these clinics deserve strong, effective and appropriate representation.  Sadly for them, they are not getting it from OPSEU and Unifor.

Nightmare in Thunder Bay

Not a full blog this time.  But for those of you who don’t follow me on twitter (@drmsgandhi), I just wanted to bring your attention to two blogs.  Both deal with the deteriorating situation in Thunder Bay where a union (in this case Unifor) has, as a result of their actions, denied health care to over a 1000 patients.  Many of these patients were elderly, and many had waited months for a specialist appointment.

The first blog is by the President of the Ontario Medical Association, Dr. Nadia Alam, and can be read here.

The second is by the Past President of the Ontario Medical Association, Dr. Shawn Whatley, and it can be found here.

I encourage you to read both of them.

View story at Medium.com

Smokey Should Put Out Fires, Not Start Them

I’ve had the pleasure of being a doctor for 28 years now.  I’ve long since appreciated that in order to provide the best care to patients, members of a health care team (doctors, nurses, pharmacists, allied health care providers and yes, even clerical support staff) must trust each other, and must work collegially and co-operatively.  Without that collegiality, the team fractures and the patients suffer.

This is why many physician leaders over the past few years have  advocated for more funding for Nurses, PSWs and other front line health care workers.  I’ve seen first hand how nurses and PSWs go above and beyond for patients.  My patients need positive, happy, engaged allied health care providers to serve their needs.

Unfortunately the recent actions of OPSEU president Warren “Smokey” Thomas and Unifor President Jerry Dias (both old school union types) show a total disregard for health care teams and patients.  They have reacted to some sort of labour dispute amongst the staff of the Owen Sound Family Health Organization (or FHO) and the owners  (essentially about twenty family doctors), by using old school divisive union tactics that may have a place in private business – but will hurt the patients of Ontario.

First, a full disclosure.  While I happen to be President Elect of the Ontario Medical Association (OMA), I actually don’t know any of the doctors in the FHO in Owen Sound.  I’m also not familiar with the situation there, other than what I read in the media and press releases.

But I do know that doctors have been warning that cutting patient services, like the Liberal Government did unilaterally, would cut staff and even close clinics.  Cutting physician funding is a cut to physician clinics, patients services and the staff who work there.

This is why it is so irresponsible Smokey and Dias to publicly shame physicians who own the clinics on social media.  I will not include a copy of OPSEU’s Facebook ad, but it basically implores people to “Tell the doctors….to get back to the table with a decent offer.  They can afford it.”  Then a list of all the doctors in the FHO is provided.  Smokey and Dias are now calling on patients to make an appointment with their doctors, to advance a political agenda.  At a time of wait lists and family doctor shortages, that is an appointment that could have, and should have, gone to a sick patient

Targeting employers is an old union tactic.  There are always ads from Unions advocating for membership on radio, TV and the internet.  But doctors are not big for-profit business. They’re not big box stores. They’re not giant corporations. They do this work because medicine is a calling. That’s why so many are offended by these ads.

Smokey and Dias also think suggesting doctors don’t know what they’re doing is a good idea.  They’ve spearheaded the “Without us, your doctor is just guessing” campaign which suggests that physicians can’t diagnose a disease based on, you know, talking to and examining a patient.  Can you just imagine what would happen if the Ontario Medical Association were to launch a campaign that said “Without Doctor’s Orders, Nurses Would Have No Direction?”.  (NB – The OMA won’t do that, we have too much respect for the nurses).

Suggesting that physicians work in “for profit clinics” that are analogous to private care (when everything is publicly funded) is another ridiculous statement.  Again, this is basically an old union tactic.  Go after “the rich” and “greedy capitalists.”  Use the politics of division to frame your members as the “have-nots”, the “poor” and the “oppressed” to garner public sympathy.  Embarrass the corporations into giving you what you want.  It may work in the real private sector, but these kinds of derogatory comments are only going to harm health care, and their own members.

Firstly, all health care workers, including physicians, are paid by the government of Ontario via your tax dollars. Obviously some workers (even some physicians) are salaried, some get a portion of physicians billings and some are on a bit of a hybrid model, but the money all comes from the same spot.

Secondly, Not sure how what Smokey’s long term strategy is, but is seems to me that attacking allies that have advocated for more funding for front line health care workers (OPSEU MEMBERS!) isn’t a great idea. Maybe Smokey is taking a page out of the Donald Trump school of leadership.

Thirdly, I don’t think Smokey and Dias have considered the damage that will be done to patient care.  Care teams for patients (particularly in family physicians offices) are smaller, more intimate and absolutely must work well together for patients to receive optimum care.  By using such divisive tactics in a small office they are sowing dissent and mistrust.  It’s really hard to see how trust will be rebuilt in the future.

Health care in Ontario has been in a crisis for many years know.  For the sake of the patients, physicians and allied health care workers need to work cordially and co-operatively to promote optimum health care planning for Ontario.  Smokey and Dias have started a bit of dumpster fire with their actions.  It’s a pity they don’t realize that.

 

 

 

Why Universal Pharmacare Is Doomed

“Hell hath no fury like a bureaucrat scorned.” – Milton Friedman

First, let’s get something out of the way.  I support the concept of Universal Pharmacare. From a basic human standpoint, I’ve seen many patients who cannot afford prescription medications go without them. It’s awful to see their health deteriorate when treatment could have been available.  Providing a social safety net is part of the Canadian ethos.  It’s almost un-Canadian to not have Pharmacare when places like Australia and pretty well all of Western Europe have it.

From a purely fiscal point of view, Pharmacare makes even more sense.  People who develop complications from untreated illnesses cost the health care system much more. Additionally, there are significant cost savings because a Canadian Pharmacare program will allow for bulk purchasing of drugs, which lowers costs.  It will also reduce the cost of running a business in Canada, thus helping the economy.

Currently Health Care is considered to be a Provincial responsibility,  and every Province has its own Drug Benefit Program for seniors and those on social assistance. Which of course means that each Province has their own formulary (the list of drugs that are covered by the provincial drug plan) and there are some differences. Ontario, for example, doesn’t provide coverage for some of the newer Cancer drugs that many Western Provinces do. Having a Canada wide formulary will mean we can fix these regional discrepancies and provide equitable treatment for all Canadians.

But if it Pharmacare is such a great idea, why is it doomed to failure?

For the same reasons that so many good ideas die in Canada – politicians and bureaucracy.  You see, politicians can’t see beyond their next election cycle, and their need for votes.  Bureaucrats can’t see beyond the need to perpetuate their own organizations and protect their own jobs.  It’s a toxic combination that has vexed health care in Canada for decades.

To understand this, let’s look at what should happen to make Pharmacare a success.  The federal government should come up with a Canada wide formulary.  This part shouldn’t be too hard; there are likely many commonalities between the varying Provincial formularies, and coming up with a list of necessary drugs should be easy.

Then the Canadian government should form a central agency, to negotiate a price and pay pharmaceutical companies for these medications.  In essence, Ottawa should take over the role of the Provincial drug formularies and establish one Canada-wide plan.

In order to pay for this, the Canadian government should reduce transfer payments to the Provinces by the amount of money they spend on their own programs.  Ontario currently spends $4.2 billion dollars a year on its Drug Benefit program.  So clearly, what the Canadian government should do is say to Ontario – “Look, we’ll take over the drug benefit program, you close down yours, and we will cut your provincial transfer payments by $4.2 Billion per year, since you don’t need it anymore.” And there’s problem number one. How do you think that will go over with the cash strapped government in Ontario?

From a politician’s point of view, they are going to risk angering the bureaucracy because this means there will be less jobs – economies of scale mean you need fewer people to run one big organization, then ten smaller ones.  This means the various civil service unions will be up in arms about closing the Provincial Drug Benefit programs. Granted upsetting bureaucrats probably won’t bother Ontario Premier Doug Ford as he has already signalled that he is going to reduce bureaucracy, but Prime Minister Trudeau (especially given his recent falling popularity) is likely going to want all the votes he can get.  Civil servants still donate to political parties – and he will not want to anger them.

Now if you have a strong-willed leader of your Pharmacare strategy, you can probably still make this change.  But alas, Trudeau hired the widely disliked and ineffectual Eric Hoskins to lead this program.  Hoskins’ main claim to fame is his utter and complete failure as a Health Minister in Ontario.  As predicted, he didn’t survive the disaster he made of Health Care.  It’s clear he jumped at the chance to get a cushy taxpayer paid job, as he knew he was going to lose his own riding of Toronto St. Paul (which was supposed to be one of the safest Liberal ridings in the Province).  His hiring does NOTHING to engender confidence that an effective Pharmacare program is possible.

What will we likely be left with?  Probably some sort of hybrid system.  This will be promoted to be in “the interests of recognizing regional diversity”.  Ottawa will create an agency to provide “oversight” and purchasing of a certain list of medications.  Then the Provinces will keep their own agencies, and buy the drugs via Ottawa. If you happen to need a drug that isn’t on the approved list, you can apply for an exemption to the Province (this part exists now).  But then the Provinces will likely turn you down and then you have to apply to Ottawa.  Goodness knows how much paperwork will be involved, and how many delays.

The end result?  TWO layers of bureaucracy for National Pharmacare, more civil service jobs, more money (and time) wasted on Provincial/Federal interplay.  How will this help?

Pharmacare is long overdue.  I just wish our politicians had the guts and foresight to implement it in a reasonable, efficient, businesslike manner.