@OntariosDoctors – justanoldcountrydoctor

The OMA’s AGM: Locked Out and Let Down

Old Country Doctor’s Note: In my last blog, I downplayed the technical glitches at the Ontario Medical Association’s Annual General Meeting (OMA AGM) because I only had a couple of issues. Turns out a lot of people had much more trouble. My thanks, to Dr. Paul Hacker for guest blogging for me today about those issues. Please sign his petition linked at the end of the blog.

Dr. Paul Hacker (pictured inset) is a former Vice-Chair of OMA Council, former co-chair of the GT20 Governance Transformation Committee and former OMA Board Member.

On May 7, a “record turnout” (according to the OMA) of members attended the Annual General Meeting of the OMA. This means that a record number of physicians cleared their weeknight schedule, put clinical obligations on hold, set aside family time and sat down at their screens at the appointed hour. I personally know of emergency physicians who felt attending this meeting was so important that they worked with colleagues, while on shift, to be able to participate in voting on important matters.

And nothing worked.

The purpose of the meeting was to conduct some routine business of the OMA corporation and to consider, debate, and vote on a number of proposals submitted by members.

The routine business went ahead, but the members’ motions were beset with technical snafus.

Even worse, this one annual event where members can hear directly from their leadership, obtain updates and ask questions was blocked for many who had difficulties registering and logging in. They were locked out of our organization’s most important annual event, on their own, with no way in and inadequate help from staff.

The Board’s Response: What It Says and What It Doesn’t

Let’s look at the response from the OMA’s Board Chairs (both outgoing and incoming):

“…we all left the meeting frustrated by the technical and procedural difficulties that occurred as the meeting progressed…”

“The AGM included a significant number of motions and proposals within a limited timeframe, and technical issues related to the hybrid format affected the flow of the meeting and prevented completion of the full agenda before members called for an adjournment.”

Firstly, there is no mention of the registration and login issues. The Chairs completely disregard this as an issue worth addressing to the many members who were shut out completely. (The silver lining for them is that they didn’t have to endure the “procedural difficulties” that have many saying they will never attempt to attend an AGM ever again.)

Second, the email subtly but firmly places the responsibility for the time pressures on members. Those motions were submitted by members, followed all OMA rules, and were duly accepted. The implication that their volume contributed to the problem is a subtle but pointed deflection. Where is the accountability for an organization that has held many members’ meetings in the past and should have a full understanding of how long it takes to properly hear and consider different viewpoints on the issues? Where is the accountability for the unusually cumbersome handling of motions and amendments, when these have been handled well in several past meetings?

A Legal Obligation, Not Aspirational Language

It is important to note that the OMA has a legal responsibility — under the Ontario Not-for-Profit Corporations Act (ONCA) — to ensure that all members can participate reasonably in electronic meetings. This is not aspirational language. It’s a statutory obligation. The OMA is not a tech startup that gets credit for trying. It is a mature corporation with legal duties to its members. The fact that this happened at all, let alone to the extent it did, reflects a failure of preparation, not just execution.

“We Take This Seriously” Is Not Accountability

The OMA, as usual, frames this total failure as a learning moment, with no commitment to report back to members:

“We are committed to working with our CEO, Kimberly Moran, and the leadership team to understand what occurred, identify where improvements are needed, and ensure physicians are well supported for the followup meeting.”

“We want to thank our colleagues for their patience, and continued involvement throughout the evening. Even in moments of disagreement and frustration, physicians continued to demonstrate how deeply we care about the OMA and its governance.”

Well, there is at least that last bit. Members do care about how the OMA goes about its business. Members do care about who represents them at all levels of the organization. And unfortunately, due to the ongoing shredding of the fabric of our health care system, something the OMA has failed to significantly impact, members are quite familiar with disagreement and frustration. We are a resilient bunch, but there are limits. When our organizations are not accountable, not transparent, not fair and truthful about their responsibilities, members lose faith. Many, including myself, have lost faith multiple times.

Members Have Power — And a Petition

But members have power. Members have their own voices. Members have shown, in the debate that was allowed to occur at the AGM, that they can push back on unfair, opaque governance. Similarly, we can push the OMA to own and be transparent about its own failures.

The OMA responds to organized member pressure. That’s one lesson of this AGM. We can apply that pressure to get answers — to ensure the OMA is accountable not just for the things it wants to be accountable for, like ‘technical difficulties,’ but for things like failing to meet its obligation to ensure members can participate in their organization, and then not even acknowledging these issues in its communications.

I have created a petition to demand that the OMA conduct a full survey of members to determine how many had issues, how many were excluded, and how this event has impacted member attitudes towards the OMA. It’s been over three years since the OMA last surveyed members to ask them “how are we performing on your behalf?” If one truly positive thing can come out of this AGM debacle, maybe it can be the resumption of the OMA doing some asking of members, not just telling them.

The petition can be accessed here: https://tally.so/r/44A225

You gave your time. The least the OMA can do is count you.

AGM Shows That Front Line Physicians HAVE Power Over the OMA

This year’s Ontario Medical Association Annual General Meeting (OMA AGM) was more exciting than usual. There’s much to talk about. But to my mind, it appears that members have once again exerted a degree of control over their association. That is a good thing.

The meeting got off to a very inauspicious start when both Board Chair Cathy Faulds, and CEO Kim Moran blatantly misled (at best), or at worst, lied to the members. Both of them repeated how the OMA secured agreements with the government to provide significant funding increases for physicians. This is, of course, patently false. An independent third-party arbitrator imposed an award that the OMA and government have to abide by.

It is true that after the money was awarded, some aspects of the byzantine physician services contract were negotiated. Many others, including the much-hyped FHO+ program for family physician, were arbitrated. To suggest this represents an agreement with the government that was acceptable to everyone is insulting to members and outright false.

The highlights of the meeting were two speeches. First, by outgoing president, Doctor Zainab Abdurrahman (whose last name Dr. Faulds still couldn’t pronounce properly). I think she’s done a very good job as being spokesperson for the profession, no more so in her advocacy around trying to fix the outdated and incompetent OHIP billing system. Doctor Rebecca Hicks, the incoming President also gave what I thought was a truly inspiring speech. This bodes well for how she’s going to represent the profession in the future. And, it’s the first time the OMA has had two female presidents in a row – which is well overdue.

OMA Past President Dr. Zainab Abdurrahman

Unfortunately, the meeting went downhill from there. I will not blame the technology. I’ve attended many virtual meetings for many different organizations. The technology for the software is expanding much faster than the server resources are allowing, and so there are always going to be significant glitches. I also need to point out that the parliamentarian who was hired to run the meeting did an excellent job given all the limitations that he was facing. And I want to give a shout out to the frontline OMA staff who diligently tried to keep the technology moving.

Sadly, my criticism is going to be directed at many of the physicians who did their best to obstruct motions that were duly presented, met all the timelines, and followed the bylaws. Unfortunately, we physicians are sometimes done in by a small number of our colleagues who seem to think they know better than the rest of us, and can’t have us expressing our contrarian views. This was never more evident than last night.

Immediately after Dr. Conte’s first motion (to change the bylaws to remove non-physician Board Directors) came up, there was a motion to defer for one year. This was to let the Board create committees to “study the implications” of the motions. This is, of course, nonsense. One of the things the OMA did do fairly well is they put out a package on the implications of what would happen if these motions passed and if they failed. It was very thorough. It was available to every member who attended the meeting. The fact that some people chose not to read it is a reflection on them.

More suspiciously, the people who spoke out for the motions to defer were the usual suspects (double entendre intended for a couple of select friends of mine). The type that sign up for every committee and collect their stipends from members dues. Thankfully, the majority of attendees were going to have none of this, and deferral failed.

Unfortunately, this did not stop more shenanigans. There were all sorts of attempts to block this motion, questions about process, points of order – too many to remember really. But eventually, fifty-three percent of members at the meeting supported his first motion. However, the motion needed 67% to pass as it was a bylaw change.

This brings back shades of the motion of nonconfidence in the then Ontario Board Executive in 2017. That motion also required sixty-seven percent, but got fifty-five percent at council. The Executive eventually did the right thing and resigned. One hopes that the non-physician Board Directors, who by all descriptions are decent people with integrity, will see the writing on the wall and resign.

The fact that this motion actually had majority support sent supporters of the current leadership structure into a state of panic. The next motion, which would have removed the non-physician Board Directors, but at the end of their terms, only required fifty percent plus one to pass. This meant that this glorious structure that had been put together where the OMA chose candidates for board and not the members themselves, and the OMA could manipulate the elections to satisfy a select few was in danger. More motions to delay, more procedural gimmicks. More “we haven’t had time to study this.”

Eventually, as the meeting was running over time, the decision was made to defer the rest of these motions to another meeting that will occur within six weeks. This puts the OMA in the same kind of limbo that it was in after the board executive of 2017 was rejected but refused to resign. Not a good place for an organization to be.

More importantly, however, despite what I’m sure is being said about people like Drs. Conte, Hacker and yes myself, these events actually show the true power of the governance transformation. As the guy who was tasked with giving the speech to the then OMA Council to convince them to go down this path, let me state clearly that the driving force behind the transformation was always to give front line physicians power to control the organization if they felt it was not serving their interests. It has not been easy, or quick, and will drag on due to the shenanigans at the AGM, but members are exerting a level of control, and pressure over the OMA that they have every right to do. It may very well be painful for those in charge (they didn’t get their way) and it may very well require members to invest more time (yet another meeting), but it is a very good thing.

Ontario physicians deserve a strong and responsive OMA. This year’s AGM, as messy and complicated as it was, is a step in the right direction.

If you have any questions about the meeting, and what happens next, I encourage you to sign up for the OMA Webinar on May 13th at this link.

Animal Farm and the OMA

I was thinking about what to write about the current state of the Ontario Medical Association (OMA). Being of a certain age, my mind went back to the classic George Orwell book, Animal Farm. It tells the story of how a group of animals were not well represented by Farmer Jones. They wound up rebelling against Jones and took over the farm.

In the aftermath of the revolution, attempts were made to reform the farm so it could advocate for and protect all animal citizens. The guiding principles were the seven “commandments” that every animal agreed to abide by. The most important being, “All animals are equal.”

However, some vested interests began to manipulate the situation. The pigs eventually took over the running of the farm and bent the rules to their own advantage. When the rest of the animals went to complain, they found the most important commandment had been re-written to “All animals are equal, but some animals are more equal than others.”

It would of course be ridiculous to suggest that the OMA is a drunken, abusive farmer. It would be even more ridiculous to suggest that the staff of the OMA have the malevolence of Mr. Jones. The staff there are well-intentioned, good people. However, as my friend Greg Dubord pointed out to me, there is something that’s inherent in all organizations known as the “iron law of oligarchy.” Essentially, organizations eventually think of themselves first, not their members.

So it is with the OMA.

Our “revolution” did not have Old Major, or Snowball, or Boxer. We did, however, have Dr. Shawn Whatley, who famously resigned from the Board when he recognized that the association was going off the rails. We had Dr. Nadia Alam who inspired a legion of physicians by her activism. We had 25 brave Council delegates who successfully called for the first ever vote of non-confidence in the leadership of the OMA. There were a lot more but you get the point.

In the aftermath of the revolt that booted out the Board Executive in 2017, there was a strong desire to modernize and improve the OMA. A significant change in the governance structure was enacted. To this day, I support a lot of the principles and rationale behind that change. And there was a strong desire to ensure that the membership had the power to oversee the association and correct it if things went wrong.

We never encountered an evil character like Napoleon the pig. Rather the “iron law” principle itself became our nemesis. Organizational desire to protect itself, not members, began manipulating processes that were put in place into something much different than intended by the rebel physicians.

Nowhere can this be seen more obviously than in the selection process of non-physician board directors. Initially (2021), there was a genuine open election. Non-physician candidates competed alongside physician candidates and were subject to the same member vote.

However, only two years later (!) the process began to diverge. Non-physicians directors seeking a further term were presented for “ratification” as a reappointed director, as opposed to running for a competitive re-election like physician Board Directors are required to. This year the process evolved further. The AGM materials confirm that rather than a standalone ratification vote, non-physician reappointments are woven into the AGM business as a simple “yes/no” matter.

The OMA’s own communications make it clear. What began as a fully competitive open election process for non-physician directors has gradually shifted to a board-managed reappointment track. But physician directors continue to face competitive, multi-candidate elections chosen by the membership. (The physician candidates were also screened by a supposedly independent third party before being “allowed” to run, but I‘ve already gone over that in a past blog.)

In essence, some Board Directors are more equal than others.

The OMA also realized that by changing this process, they could have a stronger hand in selecting non-physician board directors. They could select board directors that on paper had significant skills, but would perhaps be more in line with a corporate philosophy.

One senior OMA executive told me that in the corporate world, there is no running for elections on Boards. The organization recruits who they feel is best and “people of that calibre” don’t submit themselves to votes. “I certainly wouldn’t.” I’m happy for that executive, and wish them luck. However, all those other organizations are not member driven organizations, they are corporate organizations beholden to shareholders.

In a member driven organization like the OMA, there needs to be some degree of political and strategic oversight of the staff. This is not a bad thing. Again, the staff are well-intentioned and want to help physicians. But they need a strong, independent Board to guide them and set strategy. To let them know what will not work for members.

This cannot happen if a block of Board Directors are non-physicians, and worse, have been selected by the OMA (I don’t buy the independent third party bit and neither should you). The voting Board Directors need to be truly independent practicing physicians. This is why Dr. Paul Conte is making four motions at the Annual General Meeting on May 7, with the goal of eliminating the positions of non-physician Board Director, so that once again, all Board Directors will be equal. If successful, this would constitute a sort of “mini” revolution after the big one in 2017. (Full disclosure – I’m seconding all the motions).

Since there are no proxies allowed, I would once again encourage all Ontario physicians to register for the AGM by clicking on this link. You can attend virtually, and make your vote count.

At the end of the book version of Animal Farm, the animals realize that despite their best efforts, they are once again subjugated and really no better off and live in despair. The 1954 movie version changes the ending into something somewhat more hopeful. The animals are once again able to unite, and launch a second “mini” revolution, like Dr. Conte wants to.

Will the OMA follow the path of the book or the movie? We’ll find out on May 7.

Why Does The Old Country Doctor Hate Non-Physician OMA Board Members?

My last blog supported Dr. Paul Conte’s four motions that he is presenting at the upcoming Ontario Medical Association (OMA) Annual General Meeting (AGM). At the heart of the motions is a strong desire to course correct the governance changes at the OMA that have gone too far. The OMA is taking physicians authority to govern themselves away. Dr. Conte’s motions are excellent and I am very proud to be the seconder on all four of them.

However, the questions I keep getting asked about in that blog all pertain to the non-physician Board Directors. What exactly do I have against the non-physician Board Directors? Why do I not like them? Is there a grudge of some sort? Do I not recognize that they can contribute skills to the Board that most physicians just don’t have?

I guess that’s a symptom of some of the “spin” that is likely quietly being put out there about the motions and the blog. It’s easier to portray this as someone with an axe to grind rather than encouraging people to read the blog. My previous blog clearly stated that as the founding Chair of my local Family Health Team – I absolutely ensured and supported having non-physician members on our Board. They really provided some valuable guidance during the formative years of the FHT.

To be completely fair, a casual look at the resumes of the current three non-physician Board Directors, suggest some very impressive backgrounds. I’m obviously not on the Board, but on paper it sounds like they could contribute to many of the discussions there and bring different, but important perspectives.

Here’s the thing. The OMA Board ALWAYS has had experts in areas where physicians didn’t naturally have proficiency. The best example would be the negotiations counsel. They are experts in their field. They frequently present to the Board on how things are going with the negotiations process. At the Board level they inform the discussions and yes, they do try to persuade the Board to make certain decisions. All of which is fine as far as I’m concerned. That’s they way things should work and this applies not just to the negotiations counsel, but to a whole host of other experts who present at the Board.

But.

The one extremely important distinction is that at the end of the day, the negotiations counsel does not have a vote at the OMA Board (nor does any other external expert). They can persuade, cajole, entice and coax all they want. But the Board will ultimately have the final authority on whether to accept their recommendation (which is also as it should be). There were times when I was on the OMA Board where we did reject their advice (much to their chagrin).

This to me is the BIG difference. Currently, all three of the non-physician Board Members will not only provide advice based on their expertise, but will then vote, and thus, have a degree of authority and control over physicians.

The OMA Board is currently comprised of seven elected physician Board Directors, the OMA President, and the three non-physician Directors. The manner of how the three non-physician Directors have been chosen has evolved far away from what was intended. Initially there was an election for the position. Then last year we were told that one wasn’t needed for a non-physician Director if it was just a term renewal. Then this year a preferred candidate (preferred by whom??) was presented to the membership for “approval”.

These three NON-physicians, selected and recruited by the OMA as an organization, and NOT by the members, can effectively hold the balance of power in decisions that determine how the OMA advocates for physicians livelihoods. Having been on the Board and seeing diverse opinions amongst physicians, it is not at all hard for me to envision a scenario where 5 physicians oppose a staff recommendation, 3 are in favour, and then the 3 non-physicians would line up as a block to support a staff recommendation. In essence, despite a MAJORITY of physicians on the Board opposing something, it would still get passed.

This is just wrong, and was why I had advocated (and lost) from the start that non-physicians should not vote on the Board. Dr. Conte’s first two motions will correct this mistake.

What Dr. Conte’s Motions will NOT do

Just as important to realize is what Dr. Conte’s motions do NOT do. There is an argument to be made that having non-physicians on the Board on an ongoing level is a good thing. It will allow them to see the full dynamics of what goes on at the Board, and provide ongoing advice. Fair enough. The Georgian Bay FHT that I chaired certainly benefitted significantly from just that same concept. And there is nothing in Dr. Conte’s motions that will prevent the OMA from enacting a similar structure for their own Board.

At the Georgian Bay FHT, we called those Directors “ex-officio”. For some reason that I never understood that term was frowned upon by OMA Legal and the consultants that we hired during the governance transformation. Fine. Create a new position. Call it “Board Advisor”. Call it “Board Mentor”. Call it whatever you want. Have three of those positions available. Bind the candidates to Board confidentiality rules. Let them talk at the Board.

But do not let them vote.

Only physicians should have voting authority over matters at an organization whose main goal is to advance the interests of physicians. Only physicians inherently and intuitively understand the challenges faced by physicians. Yes, they should hear out external voices and weigh their opinions thoughtfully. But only they should be making decisions.

Since proxy voting is not allowed, I once again encourage all Ontario physicians to attend the OMA General Meeting and support Dr. Conte’s motions. You can attend virtually. Just click here to register, and let’s correct this mistake and bring voting authority at the OMA back where it belongs.

Why the OMA Annual General Meeting Matters This Year

I was thinking about what to say about this years OMA Annual General (AGM) meeting. As a die hard Star Trek fan, my thoughts went back to the excellent Next Generation episode, “The Drumhead“. After foiling the ambitions of a Federation official to twist things for her own benefit, Captain Jean Luc Picard reflects that “vigilance is the price we continually have to pay.”

It’s the same for the OMA. Things go off the rails IF members don’t pay attention. Given how big, complex and convoluted the OMA is, well, members do tend to ignore some of the goings on (I am just as guilty of this as other people).

The governance changes at the OMA are a great example. What started out as well intentioned (and badly needed) changes to modernize the organization, in the aftermath of the debacle of the mid-2010s, has been turned into something worse than what was intended. For a bunch of reasons, I personally continue to think that it is still better than the previous structure – but a course correction is needed. We’re now in a situation where the staff seemingly control everything, regardless of what members want. Because, let’s face it, as a whole, we physicians didn’t pay enough attention to the OMA. Thus, the organization was able to repeatedly put changes in place that benefited the organization, ahead of the rights of front line physicians.

It’s gotten so bad that two OMA Board members, Drs. Paul Conte and Paul Hacker, resigned their roles early. These are not just ordinary Board Members. Dr. Conte is a former Board Chair, and also Chaired the Governance and Nominations Committee of the Board. Dr Hacker Co-Chaired the Governance Transformation Committee when all of these changes were put in place . They are absolute experts in the field, and if they say something is wrong with what’s going on, well, you can bet it is.

This is why you should all virtually attend the OMA’s Annual General Meeting (AGM). Dr. Paul Conte has come up with four motions (which I am seconding) to present to try and get the organization back to where it should be. There is some wordy legal jargon in the full motions so I’m only going to list what each motion hopes to accomplish and why. The full motions should be in the meeting package you receive when you register.

Motion 1 and 2: Removal of references to non-physician members and increase physician directors to 10

Some background. I was the founding Chair of the Georgian Bay Family Health Team. When we put the team together we knew that there were some skill sets, information and knowledge that physicians just didn’t have. Finances, negotiations, business plans and so on. So we had non-physicians on the Board of the team to help provide those insights. But we also realized that you cannot have a situation where non-physicians governed physicians . As a result, those non-physicians were what we called ex-officio Board Members. They could contribute and offer suggestions at the Board level, but they were not able to directly make decisions.

When the OMA began the necessary governance transformation process, I begged the staff of the OMA and the consultants to do the same thing with non-physician directors. They refused. I was told “Board Members had to vote” under ONCA (Ontario Not for Profit Act). This is twisting things. If you really want a non-voting person on the Board you can create a separate category – say “Board Advisor”. But the staff and consultants just didn’t want to, regardless of what the duly elected representative of the profession said. Then Covid got in the way, and ……….

By passing these motions we will eliminate non-physicians from having voting authority at the Board Level. The OMA can still have them there as consultants if they want – but non-physicians will not have the ability to govern physicians anymore.

Motion 3: Removal of the Screening Process for Board Directors

This year’s election process was an absolute travesty. Not only did the OMA unilaterally screen and short list candidates for Board Director, and only allow members to vote for the candidates THEY felt appropriate, they impugned the reputation of one of the President Elect candidates, by putting up a subjective opinion of their social media posts. It’s up to each individual physician to judge a candidate, NOT the OMA.

By doing so, not only did they harm a reputation, they’ve bastardized the whole election process and by default have tainted the victory of Dr. Haroon Yousuf.

This motion will put a stop to this nonsense.

Motion 4: An end to the Nadia Alam Rule

When I was on the OMA Board, it was quite obvious to me that many of the Board Members were extremely jealous of the popularity of Dr. Nadia Alam, who pretty well skyrocketed to fame because she spoke up and inspired others (including a certain grumpy curmudgeon who was going to sit the dispute with the government out). As a result they forced the implementation of a rule that says that anyone who held the role of President can no longer run for Board, even if they have less than 6 years on the Board (the current term limit).

Dr. Nadia Alam

The stated rationale for this goes something like “we give our presidents all sorts of publicity and it’s an unfair advantage if they run.” This is, of course, a load of cow manure. There are a whole lot of Past-Presidents who got lauded by the OMA and would get exactly one vote if they ran for anything ever again. This rule assumes the membership is too stupid to recognize who can inspire them and who can’t – and really is telling the membership they aren’t smart enough to know who to vote for.

Furthermore, Ontario is THE ONLY Provincial Medical Association that has this rule. (For that matter, no other Provincial Association screens Board candidates like this or puts subjective comments on election packages.)

Time to end this rule as well.

What happens if members don’t show up and the Motions Fail?

As members, we have a choice. We can spend a couple of our hard earned hours investing in and attending the AGM, hearing arguments both pro and con, and voting in the best interests of physicians. Or we can sit passively by, in which case the motions will likely fail, and the OMA will be emboldened, and continue to make choices for us, rather than the other way around.

Since my friend Paul Conte prefers the other, far inferior space franchise, this will be akin to the end of Revenge of the Sith, where Padme Amidala realizes:

Let’s not let that happen

If you are an Ontario Physician, I urge you to register for the AGM here:

https://web.cvent.com/event/c17ccc6c-d186-4ab8-985f-2e48127b4ffb/summary?sfmc_id=7563168

Open Letter To Dr. Cathy Faulds and Ms. Kim Moran: Why Should Members Bother Voting?

To: Dr. Cathy Faulds, Board Chair, and Ms. Kimberly Moran, CEO, Ontario Medical Association

Dear Dr. Faulds and Ms. Moran,

I’m writing to express my extreme displeasure about how the OMA has handled the elections process. The past couple of years have seen more and more that the OMA, as an organization, has sought to limit the ability of front line members to choose their representatives. This has had the effect of further disenfranchising the hard working physicians whom you are supposed to serve.

In the past couple of years, the OMA as an organization has put in extremely restrictive rules on candidates, particularly for Board Director. Candidates were not allowed to “campaign”. Candidates for Board and President can only offer up a brief statement that answers certain questions, and not much else. Town Halls were controlled with Orwellian like micromanagement. All candidates could only submit a pre-approved list of skills. No one is allowed to let their personality show through.

Even asking candidates a question, like I did last year, is verboten. The penalty for daring to ask candidates to answer a difficult question was to have your career and livelihood threatened by a code of conduct complaint.

This year, the elections process is markedly worse. Instead of letting members choose who they wish, you shortlisted candidates. (NB – please spare me the nonsense about hiring an “independent” third party to review the candidates – we all know that “independent” consultants get guidance from the organization they are hired by. They just do the dirty work of the hiring organization).

I will NEVER criticize a candidate for running (I may criticize their position or views – but not for choosing to run). It takes a lot of guts to stand up and bear the slings and arrows that inevitably come your way. BUT, the blunt reality is that your “shortlisting” process is by default going to create an entirely bland, non-confrontational and non-outspoken Board. It will create a Board that will not provide appropriate oversight to the OMA.

For example, one of your approved Board candidates was asked on Social Media if elected they would commit to change the direction of the OMA so that it would stop speaking out against expanding the scope of practice for pharmacists and others. (The questioner has been very vocal that allied health care providers can do much more). Your approved candidate replied with a response (I’m paraphrasing):

“I will always be on TeamPatient. We need to follow the evidence where it leads.”

The questioner was quite happy and obviously didn’t realize that the exact same response could be given if someone had asked the candidate: “Will you get the OMA to be MORE forceful in preventing expansion of scope of practice to allied health care professionals.” It’s the type of bland, non-specific, non-controversial response that is often taught in various “Leadership” courses and “Director” courses. You know, the type that is designed first and foremost to not offend anyone, while making everyone on both sides think you agree with them in the hopes that this will somehow make you able to enact change.

(I’m not naming the candidate because truth be told, overall I actually like the person and if it wasn’t for the shenanigans that the OMA has been doing, would likely have voted for them – It was just too good an example to illustrate my point to pass up).

What’s worse is how you have treated the current list of candidates for President Elect. While I absolutely would agree with doing a social media search (along with other reasonable background searches for a position of such importance) – the decision should simply have been one of if a candidate is appropriate or not. And if not – they should not be allowed to run, and the OMA should deal with the consequences.

Instead, the OMA, under your leadership, has chosen to promote a document that characterizes one of the P/E candidates in a negative manner. (Yes this was the third party view – but you already know what I think of third party views). This negative characterization can, and should, open you up to legal action (whose defence will be paid for by my dues – which I find even more objectionable). Attaching subjective comments to the profiles of eligible candidates is outside of established governance norms.

ALL of these actions smack of the OMA as an organization self selecting candidates that the OMA finds suitable (not the members). It reeks of the organization wanting a complacent Board, a Board that simply rubber stamps what “experts” bring in front of it, rather than a Board that provides true oversight. True oversight demands that the Board ask hard, uncompromising and uncomfortable questions of the staff when appropriate. I can’t see a thing in your Board vetting process that would suggest you let candidates with these skills through.

You are undoubtedly aware that as a result of the actions of your current leadership, both Dr. Paul Hacker and Dr. Paul Conte have publicly resigned as Board Directors. Historically, the last Board Director that resigned under similar tumult was Dr. Shawn Whatley in 2016 . That was the same time as the disastrous tPSA fiasco. He was one of 25 (ish) physicians, or 4% of the physician Board Directors. You’ve lost two of 8 physicians – or 25%. That’s a critical blow. (Dr. Alam resigned a month early as well – but that was with much less fanfare).

What’s worse is the calibre of Directors that resigned. Dr. Hacker co-chaired the Governance Transformation committee of the OMA. Dr. Conte not only chaired the Governance and Nominating Committee, but was Board Chair. Having worked with them, I can tell you that both members have extremely high levels of integrity and both are extremely well versed in governance. They are absolute titans of good governance principles. They KNOW when governance is going off the rails, and for them to take this steps speaks volumes about your leadership.

In summary then, it appears the OMA, as an organization, has taken well meaning attempts to reform it, and make it more member responsive, and instead turned it into a way to only allow certain, pre approved members to be in charge. Outspoken, critical voices are not allowed. Strong opinions (however well stated) are unwelcome. Independent thought must give way to complacent behaviour.

All of which is my long way of asking, given that you have undemocratically preselected candidates, and impugned those you find wanting, why should any member bother to vote?

Yours truly,

A very very annoyed Old Country Doctor.

About Dr. Elaine Ma: We’ve Been Here Before, and Didn’t Fix It…

My thanks to Dr. Mike Goodwin (pictured inset) for guest blogging for me today. Dr. Goodwin is a retired family physician who held numerous roles in medical politics including (but not limited to) being a member of the Coalition of Family Physicians, a member of the Section of General and Family Practice Executive and an OMA Board Director. He brings a historical perspective regarding medical audits to this blog, and I am grateful for his contribution.

I admire our courageous young colleague Dr. Elaine Ma, she of the seemingly never-ending OHIP billing/auditing dispute with a media savvy beyond her years. Dr. Ma’s impeccable sense of public health propriety during COVID has earned her a growing band of supporters. It has hopefully gained her financial support from both the Ontario Medical Association (OMA) and the Canadian Medical Protective Association.

But what Dr. Ma and younger colleagues may not appreciate is that OHIP’s abuse of doctors, utilizing its antiquated billing payment and auditing processes, has been ongoing for a long time. Between the years 2000 through 2005, a hundred odd doctors every year in Ontario were being subjected to the same sort of unfair retroactive audit, which Dr. Ma is currently experiencing.

Back then, just like now, we had a Schedule of Benefits (SOB) badly in need of an update, a pettifogging bureaucracy unwilling to interpret said schedule with any modicum of common sense… vague auditing rules which conferred the burden of proof upon the accused rather than the province, and the same one-sided authority to claw back payments or garnish future accounts receivable. OHIP even had computers back then, almost certainly the same ancient models they still use today (which they claim can’t possibly be configured to pay doctors in a timely manner after the award of binding arbitrated pay increases).

Administrative abuse of the profession in the very early aughts was rampant. OHIP had enlisted the help of the CPSO, because the College had administrative and regulatory authority, beyond criminal law, over all physicians pertaining to the practice of medicine. Actual auditing and enforcement of decisions was done by an entity of the College called the Medical Review Committee (MRC). It apparently escaped everyone’s notice at the time, and still today, that medical billing to OHIP was and is based upon definitions contained within an official MOH document called the OHIP SOB. The OHIP SOB is, at least in theory, derived from agreements negotiated between the province and the OMA, not the College! One might argue, logically, that any dispute concerning rules and definitions documented within the SOB should always be addressed in the first instance between the Ministry and the OMA.

At any rate, anger and despair over the medical billing and auditing system in that far away time came to a head when a gentle Welland paediatrician, Dr. Tony Hsu, committed suicide. I suspect that Tony felt he had lost face by going public with his own particular auditing horror story. The concept of “face” is important in the Chinese diaspora, and Tony, who worked a one in three (sometimes one in two) on call rota at the Welland County General Hospital (without any on-call stipends in those days), in addition to maintaining a community practice, was forced to repay $96,000. He had to take that out of his retirement savings.

Public and political outrage at Tony’s death, particularly in the Niagara region, was immediate and intense. Then Health Minister George Smitherman was pressed to call for a “public inquiry” into medical billing and auditing. By happy accident, retired Supreme Court Justice Peter Cory was available and appointed to the task. Those of us acquainted with Mr. Cory’s reputation silently cheered.

Former Health Minister George Smitherman

And when Cory’s very comprehensive report was published, nine months later in April 2005, the indecent OHIP billing auditing system finally came to an end.

Or so we thought!

In his report “Study, Conclusions, and Recommendations Into Medical Audit Practice in Ontario,” Mr. Cory did not mince words. “The medical audit system in Ontario has had a debilitating, and in some cases, devastating effect on physicians and their families,” he said. “It has had a negative effect on the delivery of services, and has undermined Ontario’s attractiveness as a place to practice.”

Also, and very pointedly, the honourable Cory recommended the appointment of a new independent audit board, while declining to take up an offer from the College to continue auditing medical billings as they had been doing prior to his inquiry. In all, Justice Cory made 118 separate recommendations, and I reproduce only the first four, below, since they were (possibly) the most important:

Jurisdiction and structure: the responsibility for conducting the audits of physicians fee claims should be conferred on a new and independent board. See recommendations (1) to (4).
Purpose of the audit process: The audit process must be employed only for the purpose of determining the appropriateness of physician fee claims. The audit system itself must be accountable. A biennial stakeholders forum should be established to receive reports on the operation of the new audit process and to receive and consider proposals for its improvement. See recommendations (5) to (7).
A new emphasis on assisting physicians to comply with billing requirements: The primary goals of the new audit system should be (1) education to facilitate compliance with billing requirements, and (2) identification and elimination of false, fraudulent, and egregiously erroneous billing in a fair and effective manner. See recommendations (8) to (9).
Schedule of benefits: The schedule of benefits must be revised and adapted. It must also be interpreted flexibly so that a physician is not deprived of payment for a service that is medically appropriate and that complies substantially with the requirements of the fee code. See recommendations (10) to (14).

(NB – as the report cannot be found online, Dr. Goodwin used his own personal copy of the report as a reference – Old Country Doctor)

In the wake of the Cory report, Minister Smitherman ceased audits immediately and promised changes. But no one at the MOH or College lost a job. And ministries or bureaucracies (like the CPSO) are resistant to any change from age-old ways of doing things. That’s particularly true when change might reduce influence, or even more important, authority and funding.

So when I joined the OMA board in 2005 as a newbie director, the ministry was already flooding the zone, as they did, with multiple new issues demanding our attention. Promises made didn’t materialize, and almost none of Mr. Cory’s recommendations, especially the most important, to “confer responsibility for conducting billing audits on a new and independent board,” were implemented. Months became years, and “the Cory report” gradually disappeared from sight, consigned to death by inattention. You can’t find it anywhere today, even with a Google search. Not even on the OMA website: for shame!

I’m convinced that if a significant part of Mr. Cory’s report had been adopted in 2005, much of the shoddy bureaucratic shenanigans from OHIP would have been fixed (including, maybe even their ancient computers). Dr. Elaine Ma would not be undergoing her current marathon persecution. Nor would we be seeing those cases where OHIP seems to let grifters get away with corrupt billing over multiple years before it (OHIP) picks up on the scam. How does that work, by the way?

It’s not every day you get support from a retired Supreme Court justice at your back… particularly such clear, sensible, workable recommendations from arguably the most influential liberal justice of the post-constitutional era in Canada. Peter Cory was famous for his kindness, and for his defence of human dignity at every opportunity…though he definitely had an iron fist in a velvet glove when the need arose. For anyone (like me) who ever had the good fortune to meet him, he was just an unforgettably decent man.

Memo to the OMA:

If you really want to fix this auditing problem, something which I and my colleagues failed to do, Peter Cory’s report from 2005 would still be a great place to start. Dr. Elaine Ma has provided you a good crisis: let’s not waste it.

What’s Behind OHIPs Persecution of Dr. Elaine Ma?

In over 3 decades of medical practice, I’ve seen so much stupidity from government bureaucrats that I really shouldn’t be surprised by the dumb things they do anymore. And yet, every once in a while, they do something so colossally, mind numbingly and egregiously idiotic, that I’m still left stunned. Such is the situation with the ongoing persecution of Dr. Elaine Ma. Last week, the general manager of OHIP recommended, and the Minister of Health agreed, to appeal the decision of the Divisional Court that gave Dr. Ma a partial victory in her seemingly endless dispute with OHIP.

Picture of Dr. Elaine Ma, family physician from Kingston, Ontario — Dr. Elaine Ma

I’ve written about this before, but a brief summary follows. Links are provided for people who want more detail. My three loyal readers can just skip the next paragraph.

Dr. Ma organized, set up and paid for dozens of Covid Vaccination clinics in 2021. She billed the codes for organizing the clinics to OHIP (since she paid for all the overhead). A couple of years later OHIP told her that she should have billed an hourly rate and demanded over $600,000 in fees back. Their reasons for saying she inappropriately billed varied seemingly from week to week. The clinic was outside, not inside! She used Medical Students! Different people injected! etc.

The case eventually made its way to Divisional Court. I never thought I’d see a more laughably ludicrous comment from bureaucrats than when the Ministry of Health’s negotiations team announced there was no concern about a lack of comprehensive care family doctors. But, as Einstein once said, stupidity is infinite and these OHIP bureaucrats outdid the MoH crew by suggesting that there were “no extenuating circumstances” warranting the setting up of these Covid Vaccinations clinics. The whole country was in the midst of a pandemic, there was the largest public health crisis in my lifetime, the country was locked down, travel had ceased and so on. But these were not extenuating circumstances in these eyes of these rigid, automaton bureaucrats.

However, it was also at the Divisional Court hearings that I personally feel that we may finally have seen why OHIP is so intent on tormenting Dr. Ma. The court did scold the bureaucrats for the absurd suggestion that extenuating circumstances didn’t exist. But, as I mentioned in my last blog, the court also found:

“…that the wording of section 17.5 does not limit relief to unpaid claims; it only requires the presence of extenuating circumstances. Since OHIP typically pays claims first and reviews them later, a restriction on unpaid claims would effectively nullify the provision. The court called this interpretation unreasonable.”

Section 17.5 of the legislation that governs OHIP (which in it’s current form is found buried in Bill 138) states:

“The General Manager shall refuse to pay for an insured service if the claim for payment for the service is not prepared in the required form, does not meet the prescribed requirements or is not submitted to the General Manager within the prescribed time. However, the General Manager may pay for the service if, in the General Manager’s opinion, there are extenuating circumstances.“

I mentioned last time that OMA lawyers really need to take a deep look at this ruling as it likely had implications for other billing disputes. And, indeed, the court’s interpretation of Section 17.5 appears to be main basis for OHIPs appeal.

According to a report by Michelle Dorey Forestell (who has done an excellent job reporting on this issue over the years), the General Manager of OHIP is appealing because:

“section 17.5 contemplates discretionary payment decisions only before funds are issued, noting that other provisions of the act expressly address recovery and reimbursement of payments already made……the court’s broader reading will make physician payment disputes more complex and uncertain.”

AND

“the case raises issues of public importance, given the potential impact on how physician billing disputes are assessed and adjudicated and on the administration of OHIP.”

This, in my personal opinion, is the real reason that OHIP is fighting Dr. Ma tooth and nail now, despite having (deservedly) lost at Divisional Court. It may have started out as bureaucratic ineptitude. But it’s no longer about recouping the money. Heck bureaucrats have wasted far more on various schemes.

No, the clear sense I’m getting is that OHIP bureaucrats, having botched their attempt to bully and harass Dr. Ma, they now find themselves in a position where they may be forced to make changes to their review process. If the Divisional Court ruling holds, it means that OHIP would have to modernize how they review payments (gasp!). Who knows, they might even need to buy some new billing computers that can more efficiently review physicians claims (double gasp!). But worst of all, it means OHIP bureaucrats will actually have to do real work (triple gasp!) to develop new processes.

Dr. Ma deserves better. By acting so quickly during the pandemic she ensured Kingston was one of the most highly vaccinated areas in Ontario. She not only saved lives, she prevented many hospitalizations. She undoubtedly saved the health care system far more than $600,000 by her actions.

Unfortunately for her, rigid thinking bureaucrats were unable to use some basic common sense and recognize how urgent things were in 2021. She has been egregiously wronged as a result.

But the sliver of hope is that she may actually have the last laugh. If the appeal is denied, or she wins at a higher court again, the bureaucrats will be forced to confront their own incompetence. They will need to develop a fair, modern and rational review process. If they don’t many other physicians will use her case as precedent by saying OHIPs review of their billing comes from an unreasonable process.

By not yielding to common sense, the OHIP bureaucrats may have wound up giving themselves much more headaches. And as far as I’m concerned, it’s entirely well deserved.

More on the OMA Elections

I don’t often reply to critiques of previous blogs. My opinions are my own, and disagreements are part of life. However, there were a couple of consistent themes in critiques to my last blog, OMA Manipulates Board Elections and Weakens Members Voices. I think it is worthwhile to address those.

Is “Relational Advocacy” a Concern?

The first theme was that it was distracting to express concern that people who work at the OMA would be inclined towards what’s been called relational advocacy. This would be to suggest that they may not be as aggressive as needed on some issues, due to concerns about implications for potential future career prospects with government. More than one person told me off about this.

In order to know for sure whether this is something to be aware of, or whether it’s just the rantings of a miserable grumpy old bugger, one would have to do an exhaustive search of people who went to work for government after working at the OMA. It would require extensive resources to search things like LinkedIn profiles, available public employment data bases, and the like.

It being 2025, I therefore had ChatGPT do the search. My initial ask was to see how many employees left the OMA to work for the Ontario government from 2000-2025. This turned up 12 verified people (I won’t print their names). Even I would admit that doesn’t seem like much of a concern.

I then realized I had done the search wrong. I should have asked how many OMA employees went on to work for the government OR any government funded agencies. Agencies like hospitals, Ontario Health at Home, Family Health Teams, Public Health etc etc .

The results of this much more comprehensive search? Up to 80 people. The software had to do a fair approximation due to not everyone having searchable info. (The OMA has about 300 employees).

Should we hold it against those people for seeking other employment? No. People should be able to make decisions in the best interests of their careers (you would too in their shoes). Should we suspect they are not working diligently on behalf of physicians while at the OMA. No, no, no, a thousand times no. The vast majority of employees there really are passionate about advocating for physicians and I’ve seen that firsthand. Should we question their integrity? Again, no, no, no, a million times no.

BUT – should the OMA Board at least be aware of the fact that up to a quarter of the employees may one day work for government (in some way or another)? Should the Board keep it in the back of their minds when reviewing strategy presented to them? Especially if it comes at a time when relationship with government is adversarial? Human nature is human nature….

To be fair, ChatGPT also helpfully suggested (without prompting) that up 220 physician leaders had roles in some capacity with the OMA and then moved on to government/government agencies during the same time period. So it’s not like we don’t need to re-think how we as physicians choose our own leaders either. Which brings me to the next point.

How Independent is Promeus?

The other main critique was that my assertion that the OMA staff would vet candidates for Board was off base. After all, the OMA has hired an “independent third party firm” called Promeus to screen candidates. Promeus would decide who was most suitable for Board positions, not the OMA staff.

Let’s get real here. The consultants will be told what the criteria are. Those of you who work in a hospital can relate to this. Do you know how when the CEO of your hospital is facing, say, a budget deficit or a revolt around some program? The CEO knows that he/she has to lay off nurses or cut a program or change leadership. But not wanting to be “the bad guy”, they hire a consulting firm. The consulting firm then “reviews the information”, helpfully provided by the CEO. The firm then recommends that a bunch of nurses get fired, or programs get cut. The CEO then says “based on the recommendation of the expert consultants we are going to….” (The CEO doesn’t say they would have done that anyway, but are glad to have someone else scape goat the decision for them).

Similarly, the criteria for what is “needed” will be provided by the OMA to Promeus. I don’t doubt for a minute that Promeus will do a good job of reviewing candidates and has experience doing this. But they will choose candidates based on the OMA criteria.

This kind of tactic is common in all organizations, both public and private. Those interested can look up Robin Hanson’s theory of young consultants or if you want a denser read, go look at Killing Strategy.

As an aside, a few people have contacted me saying they’ve been approached to run for Board. They are all strong leaders, and I respect them. But they are also people who have roles in government funded organizations.

The counter argument will be that 39 candidates was “too many”. I think the fact that 39 candidates ran for Board shows that members have strong interest in making the OMA better. Are some candidates better than others? Sure – let the members decide. Let the candidates campaign (currently not allowed) to explain their positions. Is it messy? Sure, but heck democracy is messy. As Winston Churchill said:

In short, I would once again state that the changes the OMA Board has allowed to happen will not serve members well. We are going to get a weakened, Board that is very good in speaking politically and saying, well not much. The strong passionate member voices will be sidelined in favour of the milquetoast and bland. And physicians will not get the representation they deserve.

OMA Manipulates Board Elections and Weakens Members Voices

On November 20, Ontario Medical Association (OMA) Past President Dr. Dominik Nowak sent all members an email encouraging them to run for positions in the upcoming OMA Elections cycle. As Past President, his role is to oversee the elections for over 100 positions. He needs to ensure they are fairly run so the voice of all Ontario physicians can be heard.

Current Past President of the OMA, Dr. Dominik Nowak

Unfortunately, the current Board has sabotaged this process and rather than listen to the members, will only present pre-approved candidates for Board Director, the most important role. They have the responsibility of ensuring the OMA speaks for, you know, the members. Buried in his email were the following statements:

A streamlined shortlisting process for board candidates, with two to four candidates, whose skills and experience align with the board’s needs, being presented on the ballot for each open position
Stronger screening and evaluation for consistency and fairness of candidates
More transparency about how the board performs and what gaps are in the skills-based matrix

There is no explanation of what exactly this “streamlined” process is. But it’s clear that there will be now be increased vetting of candidates and some candidates will be found wanting and not allowed to run. Now, there always was some vetting of Board Candidates. Candidates had to be in good standing with College of Physicians and Surgeons, the OMA, pass background police checks etc. Some basic stuff.

But now, undoubtedly based on the fact that something like 38 people ran for Board last year, the OMA Board has determined to vet candidates even more and reject qualified people if they don’t meet these nebulous criteria. Importantly, the criteria will be to pick candidates who align with the BOARD‘s needs, not the MEMBERS. This is of course, all in the name of “fairness” and “transparency” and to make decisions “easier” for physicians.

But here’s the thing, the Board will NOT do the vetting. Board’s don’t actually do any operational work. Their job is to set policy, and then let the staff of the OMA implement it. So it will be up to the staff of the OMA to vet the Board candidates, and then approve whoever is acceptable……..to the staff.

Colleagues, we have a big problem.

The OMA staff are generally good people who work quite hard on behalf of physicians. They get a lot of unwarranted criticism for decisions that are actually made by physician leaders. Our elected leaders that should bare the blame.

But, at the end of the day, the OMA staff are only human, and prone to human tendencies and failures. My friend Dr. Greg Dubord, who I was honoured to pen a blog with, introduced me to Robert Michel‘s “Iron Law of Oligarchy“. It would seem to apply just not to the CFPC, but to what is going on at the OMA. From Wikipedia:

“… all organizations eventually come to be run by a leadership class who often function as paid administrators, executives, spokespersons, or political strategists for the organization. Far from being servants of the masses…. this leadership class, rather than the organization’s membership, will inevitably grow to dominate the organization’s power structures.^[3]“

Robert Michels, a sociologist who described the political behavior of intellectual elites in the early 1900s

And that is exactly what is going to happen with these new changes. The OMA staff (not physician leaders, but employees of the OMA) will review the candidates for Board. THEY will decide who meets certain criteria. THEY will determine how many candidates run for each Board position, hiding behind a policy the Board has set.

Will they do their best to pick some good people? Sure. But their definition of “good” may not be what the members want. For example, someone like Shawn Whatley was openly critical of the OMA prior to being elected as President. Would he have passed these criteria? How about Nadia Alam? Prior to getting involved in medical political activism she was a relative unknown with little leadership experience (even though she is arguably the most well respected President of the past 25 years).

pictures of Dr. Shawn Whatley and Dr. Nadia Alam, both of whom are past presidents of the Ontario Medical Association — Dr. Shawn Whatley

Nope. My guess is they would have been found wanting. A total guess on my part would have been Dr. Whatley would be deemed “too disruptive” (he famously resigned from the OMA Board prior to being elected President). Dr. Alam would like be viewed as “too inexperienced.”

Worse, the blunt reality is that the staff will likely decide who is “best qualified” based on how well they can work with them (that’s just human nature). Not necessarily those who can, you know, push them and challenge them to do better.

The staff, generally being very nice people, always had a tendency to try to work co-operatively with the various government bureaucrats on bilateral committees. This is despite the over 30 years of evidence that always trying to be nice and reasonable just isn’t working. Cynics have suggested that its in part because they realize if they want to advance their careers – one of the places they can go after working in the OMA is the government, and it doesn’t help to burn bridges there. So why would they approve a candidate who had a reputation for being less than reasonable?

Want proof? Just look at how badly the OMA as an organization handled last year’s elections. I asked potential Board Directors to commit to filing a Freedom of Information Act request, to determine just how many patients Nurse Practitioners saw in a day and how much they cost the health care system per patient (easy to do with billing numbers). The goal was to get proof that they were more expensive overall (by a lot) than family physicians and slow down scope creep.

Not only did the OMA put a stop to that, they threatened the careers of people who signed that with a Code of Conduct violation. Can’t have people on the OMA Board who will be too aggressive can we? (Psst – hey Kim Moran, CEO of the OMA – how is sending strongly worded letters to the government asking them to stop scope expansion working out? Oh, right.)

Do you really think with that history, the current staff will allow someone even remotely controversial to run?

The OMA Board has shamefully allowed this to happen. As a result there will not be a diverse Board with many viewpoints that focus on members. Rather a bland, non-controversial Board that will be limiting to speaking in political jargon speaking points in response to all issues.

Physicians will truly be hurt by this short sighted decision.