@OntariosDoctors – justanoldcountrydoctor

What Does the Leadership Change at the OMA Mean for Doctors?

On Thursday, Physicians across Ontario received an alert from Dr. Sharon Bal, Board Chair of the Ontario Medical Association (OMA) about a leadership change at the organization. Kim Moran is no longer the CEO. I think it’s safe to say the announcement caught most physicians off guard.

An OMA past president, Dr. Andrew Park, was appointed as interim CEO. I certainly wish Dr. Park well, although I note that he has, to my knowledge, not really run a comparably sized organization. I would also point out that while the title he had was “President”, the role really was media spokesperson (as I found out the hard way when I had the job). I do give him credit for holding an executive MBA, which makes him smarter than me.

Having recently been President, he would have a good idea of what’s going on internally in the organization, and for the sake of all physicians across Ontario, I hope he does well in the role while the search for a permanent replacement is carried out.

This doesn’t change the fact that the timing is exceptionally unusual. The continuation of the OMA’s Annual General Meeting (AGM) is in just a couple of more days (June 23 at 6:30 pm). The agenda has a number of member-driven motions that, in my opinion, are designed to make the OMA more responsive to physicians and a stronger advocate for us. Such a significant leadership change before what is shaping up to be a very important meeting is going to raise eyebrows.

Medical politics is a funny business.

But more importantly, what does it mean for physicians right now? In my opinion, it is even more essential for all of us to show up at the continuation of the AGM. For those of us who have been frustrated with certain things that have gone on at the OMA, this does not mean that we can say, “Oh, good. The CEO is leaving. Things will be different,” and ignore the OMA again. I continue to maintain that the OMA is at its best and most effective when members keep a close eye on it and prevent it from going off the rails. If the member motions don’t pass, in my opinion, what’s going to happen is that the OMA will simply revert to its old ways and non-physicians will continue to have decision making authority over physicians.

This is not acceptable.

The first member motion is to end the idea of having non-physician Board Directors at the OMA. This has been discussed ad nauseum and I won’t restate the rationale here. You can just look at my blog on why the OMAs AGM really matters this year, or on why I hate non-physician Board Directors (I don’t).

But the second motion is also incredibly important. It prevents the OMA from screening or gatekeeping Board Director candidates. Dr. Paul Hacker has done a really excellent analysis of this motion. He points out, quite clearly:

“The OMA currently uses a third-party vetting process for Director nominees, overseen by the Governance and Nominating Committee. The GNC is the only body that sees the complete list of candidates and the full vetting results. The criteria weighting used, the rankings produced, and the reasons for including or excluding specific candidates are not shared with the full Board. The Board is asked to approve a slate based on information it does not have access to in its entirety.”

This is just plain wrong and needs to be fixed.

Dr. Hacker was going to do a guest blog for me. But with the news about the CEO, I felt compelled to write a different blog about the importance of the AGM. However, I strongly encourage you to read his blog on why the second members motion is so important.

There are also other members motions that I am not seconding that physicians really should have a say on.

However, I guarantee you that none of these changes will occur, regardless of who the CEO is, unless all of us show up at the AGM and vote in favour. As Dr. Greg Dubord if fond of pointing out, the “Iron law of oligarchy“means that without members acting, organizations insulate themselves from member accountability, prioritizing institutional preservation over their founding mandate. In essence, they wind up placing themselves above the members. So please, please, please, if you haven’t already registered, do so by clicking here and attend the meeting.

You must register by Monday June 22 at 6:00 pm.

The OMA will only be as strong as the amount of supervision and guidance that physicians give it. This leadership change does not mean we should take our foot off the gas pedal. We all need to attend the AGM and make our voices heard.

The OMA Investigated Itself and Found Itself Not Guilty

My thanks to former OMA Board Director Dr. Paul Hacker for guest blogging for me today. He’s done a thorough analysis of the OMA’s report on the May 7 Annual General Meeting (AGM) and provides us with an excellent summary of where the report is strong, and where it is lacking.

The OMA has released its formal response to the May 7 AGM failures: a summary of findings from an unnamed third-party reviewer and a legal opinion from Wayne Gray of Gray Whitley LLP. Both are substantive. Both reach conclusions favourable to the OMA. And both are built on a foundation the OMA itself controlled.

The Review: What It Found and What It Missed

The review identifies twelve problem areas. Several recommendations are sensible: earlier registration cutoffs, mandatory test votes, end-to-end technical rehearsals, experienced vendor teams. Credit where due. But four findings deserve scrutiny.

Finding 3 states the voting platform “worked as designed” and attributes login failures to “a combination of user error and possible technical issues.” The 77 petition signatories who could not register or enter the meeting did not fail to read the instructions. They never received them.

Finding 4 states that “voting logs confirmed that no duplicate votes were recorded.” Multiple written accounts from petition signatories describe the page resetting unprompted, presenting the vote again without any action on their part. One member wrote: “I was able to vote more than once on motion 7.” Either every one of these members is mistaken, or the voting logs do not capture what happened at the user level. The review does not engage with this discrepancy.

Finding 6 admits the OMA used a less experienced local vendor team and no dedicated production manager for what turned out to be its highest-turnout AGM. This was a decision, not a malfunction.

Finding 8 states that procedural motions from the floor “consumed significant time” and contributed to the meeting running out of time. Those motions were submitted by members, followed all OMA rules, and were duly accepted. If the OMA did not allocate enough time for members to exercise their procedural rights, that is an organizational failure, not a member one.

The reviewer is not named. Members have been given a summary, not the full report. Members are being asked to accept the conclusions of a review whose author, methodology, and completeness they cannot evaluate.

The Legal Opinion: Sound Analysis, Wrong Numbers

Wayne Gray is a respected ONCA practitioner. His math is correct. His case law is sound. The problem is the factual premise.

Gray builds his opinion on the number 79, drawn from my petition: the total of categories A (could not register: 34), C (no login instructions: 10), D (could not enter: 20), and E (could not vote: 15). Even assuming all 79 had voted in favour of Proposal #1, the motion to remove non-physician Directors, it reaches approximately 60%, short of the two-thirds required. The motion still fails. That math is correct. Here is why it does not settle the question.

79 is a floor, not a ceiling, and the OMA knew it. My petition submission almost certainly represents only a fraction of the total number of affected members. I asked the OMA to conduct a member-wide survey of all 50,000 members to establish the true number. They declined. They then provided the incomplete data to their lawyer. The opinion is only as good as the facts it was given, and the OMA chose not to collect better facts.

Gray excludes Category B (no acknowledgement email), writing it is “hard to see how” missing an email resulted in a lost vote. The written accounts, which Gray says he did not see, describe exactly how: members were told by OMA staff it was too late to re-register because their confirmation email was required and they never received one. They were locked out. Including B raises the floor to 92.

Gray’s footnote describes the petition as conducted by members “whose interest in the vote outcome is not disclosed” who asked “certain participants (selected by the surveyors).” Both characterizations are wrong. The petition was public, open to any OMA member, shared through physician Facebook groups and the Medical Post. No one was selected. 84% of signatories provided a CPSO number for verification.

The Circular Logic

The OMA needed to know how many members were affected. They had two options: survey their 50,000 members, or use the petition data. They chose the option that produced a smaller number. The resulting number sustained a validity finding. They declared the matter closed.

If the OMA had surveyed its members and found a larger number, the conclusion might have been different. They ensured that could not happen by choosing not to ask. That is not transparency. That is institutional self-preservation.

Did the OMA respond to members?

You be the judge. Here were my formal requests when I submitted the petition data:

❌ Conduct and publish a member-wide survey on AGM technical access failures, using the A through G framework from the attached petition, within 30 days;

❌ Report the vendor review findings to members with specificity, providing actual numbers rather than summary language;

✔️ Have legal counsel advise the Board and report to members on the implications of the access failures, including the voting integrity issues documented in member accounts, for the validity of votes taken at the May 7 AGM (but incomplete information provided);

❌ Resolve the outstanding bylaw deficiencies relating to proxy voting, election rules, and the appointment process for non-physician Directors, including a remedy for the 2025 reappointments; and

✔️ Commit to a general member satisfaction survey, the resumption of which has been promised to members since 2023, to be conducted within 90 days.

June 23

The review and the opinion are not bad-faith documents. But both were commissioned by the OMA, informed by data the OMA controlled, and reached conclusions the OMA can live with. Members should read them carefully and draw their own conclusions about whether this constitutes the transparency the OMA promised.

The continuation meeting is June 23, virtual only. Registration closes June 22 at 6:30 pm. The motions remaining before the membership are important. Attend. Vote. The OMA responds to organized member engagement, even if they do not seek it out directly. That is the one lesson of this entire experience that is beyond dispute.

Register for the AGM here.

Past OMA Leaders Find Legal Review of the AGM is Wanting…

This blog has been authored by the following physicians (in alphabetical order):

Dr. Paul Conte – former OMA Board member, former OMA Board Chair and former Chair of GNC during much of the transition to the new Governance Model

Dr. Sohail Gandhi – OMA Past-President who was tasked with giving the speech at Council leading to the governance transformation.

Drs. Paul Hacker and Lisa Salamon – Past Co-Chairs of the GT20 Governance Transformation Task Force that oversaw the governance changes

Dr. Jesse Wheeler – former member of the GT20

The five of us would like to encourage ALL Ontario physicians to attend the Ontario Medical Association’s (OMA) continuation of the Annual General Meeting on Tuesday, June 23rd at 6:30 PM. This meeting will be virtual. The OMA’s bylaws do not allow proxy votes, so you will need to be there virtually. A registration link is at the end of the blog.

We were heavily involved in the governance transformation that the OMA underwent starting in 2019. We attended many many meetings, reviewed many pieces of legislation and consulted widely before making our recommendations. All of us feel that much of the work we did is being undermined by the current OMA leadership.

It is true that many of the changes that have occurred have been very good for physicians. The move to a smaller Board that represents physicians as a whole was badly overdue. The previous Board was too unwieldy. Despite best efforts there was some element of trying to represent your constituency on the Board as opposed to the profession as a whole. The current smaller board size is ideal for a forward-thinking organization that will need to respond to unexpected threats that come out of the blue.

Additionally, we’re very pleased with the move away from Council and into the Priorities and Leadership Group (PLG). While OMA Council had many dedicated members who gave of their time to represent their colleagues and did a lot of unrecognized work, the very structure and nature of Council created a bit of a divisive environment. Instead of building consensus, Council often times was reduced to entrenched voting blocs. This was unhelpful.

Judging by feedback from the last two PLG meetings, this mentality seems to no longer exist, and there seems to be a genuine cooperative effort to come up with ideas and to prioritize them for the OMA to tackle. We’re very pleased that this has happened. This can only be a good thing for physicians going forward.

Unfortunately, however, we continue to have significant concerns about how the OMA has handled the issue of governance at the Board level, and in particular, how the OMA has, in our view, manipulated the process for physicians choosing Board Directors. Specifically, having non-physician Board Directors voting on matters that affect physicians has proven to be unhelpful.

Drs. Conte and Gandhi presented a motion at the AGM to remove non-physician directors. To be abundantly clear, we are not at all opposed to the idea of the board seeking out external expertise in areas as needed. It’s imperative that a member advocacy association does that. It’s a good thing, and in our best interest.

The issue is who makes decisions on behalf of physicians. We feel strongly that that should be physicians only. Only physicians have the lived in day to day experience in health care that will help determined whether external advice, however well intentioned, is actually good for other physicians. We are disappointed that the current OMA leadership is fighting us on this. We’re further disappointed at some of the tactics being used.

Last week, the OMA Board Chair released 12 findings of an independent review of issues around the first part of the AGM. We thank her for sharing that. Issues ranged from insufficient testing, to late registration challenges, to login difficulties, and so on. The majority of their recommendations are good supportable recommendations.

We are concerned at the recommendation for including templates for anticipated motions and procedural motions. One of the most frustrating aspects of the first part of the AGM was what we viewed as gamesmanship. The clear impression was the leaders of the OMA were trying to get a certain result, regardless of whether the members wanted it or not. We are concerned that by openly stating the need for procedural templates, attempts will once again be made by those few to bog down the meeting in procedural delays, instead of letting members debate the merits of the motions.

Furthermore, we have significant concerns about the legal opinion on the validity of the vote of the first motion at the annual general meeting. We are not questioning the background, or the knowledge, or the expertise of the external legal consultant Wayne Gray. Rather, it appears that his opinion is based on information provided by the OMA. That is worrisome.

Mr. Gray states that the number of votes on the first motion (to remove non-physician Board Directors) was 534. But there needed to be a revote and only 483 people voted the second time. Additionally he was told 79 people were unable to cast votes. Based on that, the first motion wouldn’t have passed. That is true, but that 79 number came from a survey done by Dr. Paul Hacker. The survey had limited reach. The OMA certainly didn’t survey all the members. That number also doesn’t include those who couldn’t register or those who couldn’t log in. In short, we really don’t know how many people would have voted had there been no technical issues.

We are left with the strong sense that had the first motion passed, the OMA would be trying much, much harder to hold a re-vote on the first motion to get the result they want.

Additionally, the OMA leadership is putting up videos opposing the member motions for attendees to view. We were notified on Friday that we could add a video supporting the motions. This gives us less than ten days, while the OMA has had weeks to put theirs together, and also has the resources to make their videos look more professional. (This reminds us of the days of the 2016 tPSA when the Board produced all sorts of promotional videos to promote a bad deal to the members). Additionally, there were NO videos supporting or opposing the motions for the first part of the AGM. This creates a fundamental inequity in how the two halves of the AGM are managed, and we don’t think that’s appropriate. We will NOT be doing videos.

Drs. Conte and Gandhi also have motions to prevent the OMA from providing commentary on candidates and removing arbitrary criteria for banning members from running for Board. Other physicians have motions about tax information being used by the OMA and strengthening Districts.

What can you do dear member? Well, the answer is simple. It will take some of your very valuable time (and we recognize that). We ask all of you to register for the continuation of the AGM. Important, you MUST register by 6:00 pm, Monday June 22. It is essential that you make your voices heard. YOU have control over the OMA and its direction, if and only if you choose to exercise your authority. We sincerely hope you will.

Click here to register for the AGM.

FHO+: The Good, The Bad, and the Reality on the Ground

My thanks to Dr. Wael Guirguis, (pictured inset) who had a superb post on LinkedIN that he’s kindly allowed me to reproduce as a guest blog. Dr. Guirguis got his MD in Egypt in 2003 and has been practicing in Canada since 2011. He’s the lead physician for the Fairway FHO and provides comprehensive care for patients at the Danton Medical Centres. A thought provoking read which I hope you’ll enjoy.

Over the past couple of months, Family physicians across Ontario have started experiencing the reality of the new FHO+ model in day-to-day practice.The goals behind the reform are understandable.

Improve access. Support continuity of care. Encourage after-hours coverage. Create more accountability in primary care.

These are important goals, and family physicians should absolutely be part of improving the system. Some aspects of FHO+ deserve recognition. Organized after-hours coverage matters. Continuity of care matters. Accountability matters. But as implementation unfolds, many front-line physicians are beginning to identify operational consequences that may not have been fully appreciated during policy design.

The Efficiency Problem

One of the biggest concerns is the relationship between productivity and compensation efficiency. Under FHO+, physicians are now heavily constrained by hourly and monthly thresholds tied to direct patient care time. In practical terms, physicians can work harder, see more patients, and still experience a significant reduction in compensation efficiency. The unintended consequence is that the model may discourage efficiency during regular clinic hours.

A physician who develops efficient workflows, uses technology effectively, and safely improves patient throughput may actually feel penalized for doing so. That creates a concerning signal within primary care. Healthcare systems should reward:

safe patient access
continuity
quality
responsible innovation
sustainability
burnout prevention

Not unintentionally encourage physicians to slow down to remain within operational thresholds.

The Hidden Mental Burden

One of the least discussed consequences of FHO+ is the cognitive burden it creates for physicians throughout the day. Doctors are now not only thinking about patient care, they are also continuously tracking:

direct care hours
monthly hour accumulation
reimbursement thresholds
after-hours eligibility
continuity metrics
outside-use implications
whether additional work will still be compensated fairly

That constant background calculation creates mental fatigue. Family physicians already operate in an environment of nonstop decision-making: clinical care, inbox management, staffing issues, documentation, urgent requests, abnormal results, hospital follow-ups, and administrative work. Adding another layer of continuous operational tracking changes the psychology of practice itself. Instead of focusing entirely on patient care and clinic efficiency, physicians may begin constantly asking themselves:

“Am I crossing another threshold?” That is not a healthy foundation for sustainable primary care.

The Bigger Problem: Complexity Itself

This discussion is larger than FHO+ alone, It reflects a broader pattern in healthcare reform. With each reform cycle, the Schedule of Benefits seems to become increasingly complex rather than simpler.

New rules. New modifiers. New exceptions. New thresholds. New formulas. New tracking requirements. Yet very rarely do reforms focus on reducing front-line operational complexity for physicians. And complexity itself has consequences, It increases cognitive load, administrative dependency, billing anxiety, operational inefficiency, and eventually burnout. Complex healthcare systems may be unavoidable. But complex systems still require simple front-line workflows. That principle is often overlooked.

Continuity of Care Should Be Managed by the System, Not Punitive Billing Rules

Continuity of care matters. Family physicians understand that better continuity leads to better long-term outcomes, fewer fragmented records, reduced duplication, and safer patient care. But enforcing continuity through increasingly complicated physician payment penalties is not the right approach. A simpler and more effective solution already exists. If the Ministry of Health wants to strengthen continuity of care within capitation models, the responsibility should sit primarily with the system itself, not through constant billing complexity imposed on physicians.

For example: If a rostered patient repeatedly seeks care outside their enrolled medical home beyond a defined threshold, the Ministry could automatically review or remove the patient from the roster. The patient would be notified directly by the Ministry of Health not by the physician. This creates clear accountability while avoiding unnecessary tension between doctors and patients. Most importantly, it removes one of the major hidden burdens currently placed on family physicians: constantly monitoring continuity metrics, outside use calculations, and roster penalties while simultaneously trying to run busy clinics.

Continuity of care should be encouraged through smart system design and patient accountability not by forcing physicians to navigate increasingly complicated billing formulas and penalties. Doctors should focus on delivering care. The healthcare system should focus on managing the system.

The Human Side Nobody Talks About

Most family physicians are not trying to maximize billing. They are trying to:

keep clinics financially sustainable
reduce patient wait times
manage inbox overload
supervise staff
complete documentation
respond to urgent patient needs
avoid burnout

When systems unintentionally penalize high-functioning clinics for being efficient, morale suffers quickly. And eventually, patients feel the impact.

A Better Path Forward

Primary care reform is necessary. But reforms work best when governments collaborate closely with front-line physicians who actually operate clinics every day. The goal should not simply be measuring physician hours. The goal should be:

maximizing safe patient access
improving continuity
reducing unnecessary administrative burden
supporting sustainable family medicine
encouraging innovation and operational efficiency
protecting physicians from burnout

Ontario has extraordinary family physicians who want the system to succeed. The question is whether the system is being designed in a way that allows them to succeed too.

Why You Should Attend the OMA’s (Continued) Annual General Meeting

Last week, the Ontario Medical Association announced that the continuation of the 2026 Annual General Meeting (AGM) will occur on Tuesday, June 23rd, at 6:30 PM. This meeting will be virtual only. Once again, proxies will not be allowed. I would suggest that it is essential for every member to make an effort to attend.

My three loyal readers will remember that there were six member proposals (4 by Dr. Conte seconded by myself). Only one got voted on at the May 7 meeting, and the remainder will be voted on, on June 23. Regardless of what you may think of the individual motions, I would suggest the fact that members take the time to make proposals, and attend to vote is a good thing. It is important, as I’ve learned over the years, to pay attention to what’s going on at the OMA because so much of our livelihood depends on them.

This year’s AGM is proof of what can happen when members show up and make their voices heard. Now, I was criticized for my blog on the last AGM for calling out the shenanigans that occurred at the meeting. This all surrounded what were in my opinion, the two most important motions.

Both motions pertained to removing non-physicians from having voting authority over physicians at the Board of the OMA. To be abundantly clear, neither of these motions would have prevented the organization from seeking external expert advice on an ongoing basis. Organizations, particularly advocacy organizations like the OMA, do that all the time, as they absolutely should. Physicians are not experts in everything, and seeking out the best possible advice in different areas from experts in their fields is always a good thing to do.

No. These motions would simply have said that after getting the advice, and carefully reviewing it, the voting authority for who makes decisions at the organization should fall only on physicians. Only physicians have innate knowledge and lived in experience of how the healthcare system affects them. Only physicians will inherently know when such advice, well intentioned though it may be, will actually help, or those times when it is unhelpful.

At the last meeting, for reasons that are unclear to me, as I’m not a lawyer, the first motion, which would have removed non-physicians from the Board immediately, required two thirds of a vote. This motion, after much debate, got fifty-three percent. Now, I fully expected some of our colleagues to throw up roadblocks to the first motion. That happened. I won’t do a line by line analysis of that as I don’t think it’s relevant, but if it had just stopped there, I probably wouldn’t have made any comments about “shenanigans” or “the usual suspects.”

What happened was that once it became apparent that the majority of physicians at the meeting did want not want non-physicians voting at the Board level, it became crystal clear that the second motion, which only required fifty percent plus one, would likely pass. A friend of mine, who also attended virtually, commented to me, “I wasn’t in the room, but I swear I could hear the jaws drop and the shock from many of the people in the room.”

Rather than accept that the debate had already been had, that all of the points had already been made, and accept the will of the membership, some of our colleagues continued to try and delay the process and play games. Eventually they succeeded. The meeting was paused and now we have to do it all again. And those are the shenanigans that had me, quite frankly, extremely annoyed.

At any rate, the membership has another chance. If we all show up, we can vote on the second motion and determine if we do, in fact, want a large part of our futures decided by non-physicians. (Non-physicians have just over twenty-five percent of the vote at the board currently).

Other motions that are important for us to decide upon include the director election ballots process. This year marked, as far as I’m concerned, a new low in how the board director elections were run. The OMA screened candidates for board director and limited who could run based on their own criteria, that was fed to a third party firm to try to avoid blame. In essence, the OMA chose who we physicians could vote for. Furthermore, they impugned the reputation of one of the president elect candidates by printing subjective opinions about his social media posts.

The second motion would stop the OMA screening candidates and allow the members to pick who they want leading them.

Other motions include eligibility for board if you had previously held the role of president in the association. Once again, it is really the decision of the members, not the OMA, to rule out who can and can’t run (and yes, there’s a conflict of interest in there for me). There’s also a motion recommending the OMA not access personal tax information. The OMA has never actually accessed personal tax information despite significant misinformation about this. However, I personally see no harm in restating that again. And finally, there’s actually a really good idea asking the OMA to support their districts by sharing email lists in compliance with privacy legislation. Our districts do need strengthening, and this would help with that.

None of these changes, however, can occur without physicians showing up. It will take time. It will take effort. It is a couple of hours out our very busy days. I feel bad asking for members to sacrifice this amount of time, but at the end of the day, if we don’t pay attention to what’s going at the OMA, we will not get the results we deserve.

I encourage all Ontario physicians to register early for the AGM by clicking the link below:

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