Tag: #familypractice

Dear Minister Jones – Fire Your Negotiations Team.

Dear Minister Jones,

Just me again, a certain crotchety and increasingly cantankerous geezer offering you advice in an open letter that you are not likely to take. But you would be better off if you did. More importantly, so would the people of Ontario.

Ontario Health Minister Sylvia Jones

First, I would once again suggest that you have done some good work in the health ministry. Moving surgical procedures to outpatient clinics, increasing the number of diagnostic testing facilities, starting a new medical school focused on training family doctors and more are all good moves. While the effects of some of those decisions will not be felt for many years – the reality is that somebody had to do this to help health care down the road and you’ve done that.

Unfortunately however, the past couple of weeks have been catastrophic for your Ministry’s relationship with Ontario’s doctors. It’s funny how one dumb decision or comment can completely wreck a relationship, but that’s exactly what happened when your Negotiations Team stated that there was “no concern” about a diminished supply of doctors. Therefore, they refused to negotiate money for retention of physicians or admin work, like other provinces have (cough BC, cough Manitoba, cough EVEN Alberta!)

In essence, your Negotiations Team has been a disaster, first by militantly dragging out negotiations into a very adversarial arbitration process (when all the other provinces above figured out a way to, you know, respectfully negotiate with doctors) – and then by making a statement about the supply of doctors that is so comically stupid and out of touch that Ontario has become a laughing stock.

David Price
Bob Bass
Craig Rix

Three members of the Ministry’s Negotiations Team pictured above.

This will not bode well for health care in this province.

Look, I know there may be a temptation to say “Ok this was a mistake” and to try and walk back the comments.. While it’s abundantly true that the people of Ontario are a good and kind people who will forgive politicians if they own up to their mistakes (cough greenbelt, cough enhanced police powers and closing playgrounds during covid) – one thing that politicians can’t survive, is being made a laughing stock. Except Donald Trump of course. I still haven’t figured that one out and I don’t think I ever will. (N.B. Donald Trump is not someone you should try to emulate).

Anyway, the reality is that at this point you really only have one path left to turn this thing around. You have to fire your negotiations team. All of them. I’m not just talking about the seven who were appointed to lead that team, I’m talking about the multiple bureaucrats who give them supporting data and have influenced their position.

The only rational explanation I can think of for those bureaucrats promoting a position of “no concern” about physician supply, and saying doctors are not working hard enough, is that they hate doctors. Many of them were likely hired at a time when it was fashionable to bash doctors for billing “too much”. (BTW how did that attitude work out for the people of Ontario?) They’ve clearly carried on with that belief in the arbitration proposals.

I get that in arbitration, there will be some posturing. If your Negotiations Team had said “we’ll pay you $50 a month as a retention bonus” or “admin work doesn’t involve seeing patients, so we’ll pay you $20 an hour” – I honestly would have shrugged my shoulders, recognized it was part of the arbitration “game” and said nothing.

But to say retention and recruitment of physicians is not a major concern, when people line up for hours on end just for the faint chance of getting a family doctor?? That thought process can only be due to a pathologic hatred of physicians, or a delusional mindset totally divorced from reality. Either is a cause for termination. Can the whole team now.

A long line forms outside CDK Family Medicine and Walk-In Clinic in Kingston, Ont.. It was the first day of ‘rostering’ at the clinic, where four doctors will take as many as 4,000 new patients. (Jamie Corbett) – from CBC News

But what of negotiations with the OMA you may ask?

Actually, that’s not hard either. Your ministry has an appointee to the Arbitration Board, just like the OMA does. I believe your appointee is one Kevin Smith. The job of the appointee is to tell you and your team what the lead arbitrator, William Kaplan is thinking and how he is leaning. How they do that is beyond me. When I met Kaplan it was like talking to a Vulcan. There was absolutely no emotion or hint of what he was thinking – but apparently Kevin Smith is better than I am at figuring this out.

One of the above is William Kaplan, Arbitrator, and even after meeting him I’m not sure which is which.

What your appointee will tell you, and what the OMA appointee to the Board will tell the OMA is – Kaplan is wondering “this” or thinking “that” or leaning towards “X percent”. Find out what that X per cent is, offer it to the Doctors for the first year of the new Physicians Services Agreement (PSA). That solves things for one year, which gives you time to pick a brand new negotiations team for year 2-4 for the PSA.

Note to my three loyal readers, yes, this arbitration is ONLY for the percentage increase of the first year of the four year agreement. Worse, while the OMA and Ministry have generally agreed to a 70/30 split of whatever the amount is with 70% allotted to raises, and 30% to be given to targeted programs, they haven’t been able to agree on how the 30% is to be targeted. This means…..more arbitration for that piece. Then, it begins again next year for years 2-4 of the PSA. In essence, we appear to be locked in a perpetual, never ending antagonistic arbitration process (which is still better than unilateral government actions but really frustrating nonetheless).

As I told Premier Ford recently- if health care doesn’t get fixed – I don’t care what the polls say now, or how many by-elections you seem to have won, this is going to be a real problem in 2026. With health care in the crisis it is in now, you need all hands working together and co-operatively. Locking Ontario’s doctors into two more years of extremely adversarial arbitration shows that we are not co-operating and not working together. This is why graduates are leaving the province. And we can’t afford that.

It’s time for you to do the right thing for Ontario, and cut bait with your current negotiations team.

Yours sincerely,

An Old Country Doctor.

Perspectives on Ontario Health Care by a Recent Graduate

NB: My thanks to Dr. Tristan Brownrigg for guest blogging for me today. By his own admission, he never planned to be political, or seek out the limelight. But the situation in Ontario is such that he felt his perspective should be heard. I have a great deal of respect for people like Dr. Brownrigg, who are willing to step out of their comfort zone when necessary, and I commend him for doing so.

Dr. Tristan Brownrigg: I am a family physician, outdoorsman, and rural generalist currently working a mix of clinic, ER and inpatient care in the East Kootenays of British Columbia. I graduated from the University of Toronto Medical School, and did my Residency at Queen’s University (Kawartha site).

I completed family medicine residency in Ontario in 2022 and worked there for 6 months. Prior to this I completed medical school in Ontario, completed my undergraduate in Ontario, and had called Ontario home. Over the years I had watched my goal of working as a comprehensive rural family physician slowly become unsustainable amidst a collapsing system, decades of funding stagnation and poor planning, with a patchwork of good people on the ground trying to do their best in a system that doesn’t seem to value their input. Day after day the insidious march of the family medicine crisis grew closer to the forefront of peoples’ lives and garnered wider media attention, while the government either denied its existence or made no substantive changes that would realistically address it. This has not been the time for band-aids, let alone denial. 

Last year I moved to rural British Columbia to try something different for a year, cautiously optimistic about the significant changes to family practice on the back of the LFP model implementation in early 2023. The Longitudinal Family Physician (LFP) model significantly changed how family physicians billed and were compensated in BC, including the ability to bill for the many hours family physicians typically spend on previously unpaid administrative tasks.

My experience has been night and day. For the first time in my medical career I have felt hopeful about the future of family medicine and find my day to day life to be sustainable. These changes have been received positively amongst all other family physicians I have discussed it with. It is not perfect and there are still kinks to be ironed out, but I at least believe my provincial medical association and government are trying to improve things for family physicians. I am not left questioning if government actions are purely incompetent or malicious with the intent to drive privatization.  

I had retained my Ontario medical license until now, awaiting the May 2024 renewal deadline unsure if I would return home after a year of trying on a different life out west. Reading the recent government positions and negotiation briefs has been the final nail in the coffin for me. The disdain the Ontario government shows towards the hardworking family physicians who hold up the medical system is nothing short of repugnant. After more than a decade of training and education here, I will now be relinquishing my license to practice medicine in Ontario and stay in British Columbia.  

The minister of health thinks recruitment and retention is “not a major concern.” That’s the problem; it should be. If I am not a prime example of this, I don’t know what is. 

I wish all of my colleagues still in Ontario who do not have the luxury to vote with their feet the best of luck. If not this government, then I hope the next one learns to value your work and dedication.